Legal things...

[RNlove17]

I have just started as a school nurse at a large public high school in NY (my alma matar actually!) Anyway, sometimes I get confused over the legality of PRN med administration off of standing orders (ie. for tylenol or advil) to the students. We have standing orders for a 1 time dose and then have to give them a medication administration form that they take to their dr for an order and they have to then bring in their own supply.

Anway, if a student asks for it or if I think they need it, I call home/cell/alternate contact... but half the time no one answers their phones! Can I still give the med? I did a few times, I gave Advil for injuries because I wanted to help with inflammation -i'd call and if no answer i'd document and give. But then decided not to because I don't want to risk it. Plus we are already low on the meds and I can't keep giving them out like candy! I have a health aide too who has been here for years and helps me out, but ultimately it's my license.

What about students who are 18 or older? I personally think I should be able to give it and shouldn't even have to contact a parent because they are legally adults, and at the hospital we would not need parental permission anymore to treat them. But the schools tend to "baby" students soooo I still call parents for these students too. I'm really not sure who to ask here about the legality of it, so I just err on the side of caution and treat them like they are under 18. But then I think potentially if they came to me with a personal issue, I *should* have to keep it private from their parents if they're over 18... and it's just a messy situation they I need to know the legality of!

[hsnurse1]

I am in Arkansas and in our state we can give OTC meds with written parental consent. A doctor's order is not required. We include the consent form on the health history we send out at the beginning of the year for parents to sign. It is of course given at the discretion of the nurse.

I would not give meds without written parental consent or at least consent via phone. You need to check your state nurse practice acts and see if you need a physician's order to administer. Some states require this. Others do not.

[JenTheSchoolRN, BSN, RN]

In my school (in Mass), you do not need individual doctor's orders for OTC meds. There are standing school physician orders for those. However, you do need parental consent, no matter if the student is 18 or not. I send out a health form every year and one part of it has parental consent for OTC meds (acetaminophen, ibuprofen, benadryl, TUMS, etc.) and also consent for topical OTCs (hyrdocortisone, etc.). The parent can check off which meds are okay vs. which are not and it is valid for the school year. If I do not have this form, then I must call the parent for permission to give any OTC medication.

Now, privacy issues...well, that can be a different story. If a student, for example, came to you and told you she was pregnant, you do not have to tell her parents. You should consult with your state nurse practice acts like the poster above mentioned. In MA, we have a wonderful 2 day seminar that goes into the nitty-gritty of these things and is mandatory to become certified as a school nurse. Perhaps your state has something similar (my school paid for my training).

[morte, LPN, LVN]

I would think talking to the 18 year olds parents would be a HIPAA violation.

[JenTheSchoolRN, BSN, RN]

Comparison of FERPA and HIPAA Privacy Rule | State Public Health | ASTHOHIPAA vs. FERPA - soooo confusing sometimes. This site helps.