New to board and seeking guidance

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Specializes in Pediatrics.

This the end of my first year as a school nurse and I have a situation that I am hoping I could get someone else's perspective on.

I have a special ed student that is diabetic on one of my elementary campuses. He is pretty high functioning (he can tell when he is high or low). We have his teacher and aides as UDACs but they only obtain bg checks and give him snacks when he is low- nurses administer the insulin. He has recently started an afterschool daycare program that is not provided by the school, but is open to children from the district. I have found out that the daycare program contacted the teacher about obtaining some of his diabetic supplies since his mother said to "call the school and have them send the supplies when he comes after school". When the teacher was called, she went over to the facility and found that the mother didn't leave "adequate instructions on how to handle his diabetes" so she told them what we do at school. I think she may have provided a copy of his diabetes management plan to them, though she denied it when I asked her. I have found out that she goes to the facility after school to make sure he is "adequately cared for" or they bring him back to the school if they have a medical issue with him. I have told the teacher that she can not provide medical care after he leaves school for the day, they need to call his mother. She is still going daily. His mom is not aware the teacher is doing this.How would you handle this? Is this not a HIPAA or FERPA violation?

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Specializes in Peds, School Nurse, clinical instructor.

This may be a FERPA violation although the information needed to be shared to adequately care for the child. I think what you did was correct in telling the teacher to stop providing after school care. Can you talk to his Parent? This is a sticky situation so maybe notifying your principal is warranted.

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Specializes in School Nursing, Ambulatory Care, etc..

Have you mentioned to the teacher that providing medical care without a license is illegal? Also, if it's outside of her duty hours, she is opening herself up to a lawsuit if something goes wrong - and even if it doesn't go wrong, the parent could still decide to sue.

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Specializes in School Nurse.

What is your state's policy on the UDAC (assuming this is like our "PDA" - parent designated adult who is designated by the parent and trained by a local diabetic educator). In my state, it is the the parent's responsibility to find the PDA, although a school employee can volunteer. It is not practicing without a license, it is following the law that allows for a PDA. And I would think they could follow the child after school if the parent is ok with this.

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Specializes in Pediatrics.

Thanks for the responses!

Our UDACs are unlicensed diabetes care assistants. Individuals who are designated by the principal and trained (by me in this case) to assist in the care of diabetics on school campus when a nurse is not available. The parent does sign an agreement stating that they know a trained, yet unlicensed individual may take care of their child at school.

I guess my questions are: Since the individual is authorized by the parent and school to perform the function at school, doesn't that limit their authority to the school day, on school campus, and those off campus functions provided by the school? Doesn't going off campus, after the school day, and to non-school daycare violate this agreement?

The parent did provide information to the daycare. The daycare did not understand the information and they were not provided a copy of the doctor's plan of care so the teacher felt that they were not provided adequate information. I worry that this teacher has gone beyond the scope of her duties to provide them with information since it is off campus and not sponsored by the school. I understand that it is well-intentioned, but also think it is a lawsuit waiting to happen if not a violation of HIPPA or FERPA.

It is my thinking that the facility would be better off contacting the parent and not calling the teacher at the school for medical advice for the child.

This is a very sticky situation for me. With two weeks of school it won't be an issue much longer (this year). But I really like the other perspectives I am getting on this. I don't know if there is a cut-and-dry answer or not.

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Specializes in School Nurse.

That sounds pretty different than what our state does. A PDA in our state could be anyone the parent designates (neighbor, friend, school staff - as long as they are available during the school day), but since you appoint them and train them (we don't) it sounds more like it is just a "during school hours" kind of thing.

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"It is my thinking that the facility would be better off contacting the parent and not calling the teacher at the school for medical advice for the child. "

Ah, yes, absolutely - like what are they thinking??????

"don't know if there is a cut-and-dry answer or not. " Yes, there is, your school is not the primary care doc and is not a prescriber. They need to talk to mom and talk to prescriber themselves. You are NOT their intermediary. SOunds like they need to hire a nurse.

"I worry that this teacher has gone beyond " yes teacher violated FERPA, but get the written consents signed to cover. Mom did seem to intend that there be communication, so she will sign.

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Specializes in Maternal - Child Health.

In addition to the inappropriate natue of the teacher advising the child care staff on this student's diabetes, I have concerns about the child care center's understanding of, and adherence to, state regulations regarding the administration of medicine and management of health conditions of children in their care.

In our state, there are regulations regarding the provision of medicine and medical treatments in the child care setting. Licensed child care providers must follow these regulations and have physician's orders, parental permission, medications and supplies provided by the parents, and trained personnel.

Our school district sponsors in-school child care before/after school and during school holidays. Even though these services are provided in our elementary and middle school buildings, the school staff is not authorized to administer medications or medical care during child care hours. Those services must be provided by child care staff. And the parents must provided duplicate supplies to be kept in the child care office. Under no circumstances are the child care staff members allowed to access supplies kept in the health office for use during the school day, and vice versa.

I'm sure the teacher is concerned and well-meaning, but she may potentially be creating a legal landmine for the school district if something untoward happens to this child.

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Specializes in school nursing.

The daycare is a separate entity from you, your school district, and the teacher. I believe any health communication and planning for this student should be between the day care facility and the parent.

I had a similar situation here at my school. The city uses our facilities to run an after school program. The employees who run the program are paid bythe city NOT my school or school district. However, several of my teachers do run this program. I found out they were getting keys from my office manager after I left for the day and giving kids inhalers, etc. Were any of theme trained by me to give meds? - NO! Was any documentation done by them? - NO! Did any of them ask if this was appropriate? - NO! The only reason I found out was that my gloves, band-aids, etc were being depleted and I found out that everyone for the after school program was helping themselves! Despite the fact that the city had provided them with a really nice first aid kit.

After I put an end to them having access to my stuff, they would chase me into the parking lot because one of their kids would have a tummy ache or a lost tooth. I explained that I am not paid by the city to provide medical care after hours and they would need to take care of these things themselves. Now, if a kid needed emergency help and I was in the building I would not hesitate to jump in and help, but........outside of that- once those kids are checked into the after school program, they are the responsibility of the city NOT the school district!

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