New School Nurse looking for liability advice

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Hi everyone, I am a new school nurse (as of the beginning of the school year) and could use advice. I cover a district in the state of MN where I am responsible for about 1000 students from pre-k up to 12 grade. I am part time (3 days a week) and our administrator has made it very clear that is all the time they are willing to pay me for.

I have a particularly hard case with a 7th grade student who has been suffering from episodes of unconsciousness, dissociate episodes (not having any idea where she is or what is going on), and along with this has had several episodes where her anxiety is to the point of respiratory distress (she also has asthma). I recently called 911 during a particularly bad episode where her respiratory status was quickly worsening. Parents are adamant that this student stay in the regular ed population and have denied any special ed evaluation or services.

During a meeting with her parents and our building principal I was given instructions by the students psychologist stating that "as long as the student is still breathing and her eyes are open" I am not to call EMS, and it is up to the parent's discretion if they want to pick her up or have her stay at school.

This directly contradicts what our district health and emergency response policy is. My administrators have not had something like this come up before and are looking to me to advise them from a medical and legal standpoint what we should do. My other huge concern is what to advise our unlicensed office staff that cover for me on the days I am not at work or when I am at one of the other 3 buildings I cover. Thanks in advance for any guidance you can give.

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I would follow the district policy, and make it clear to the parents that is what I'm doing. If I would get a letter from her physician stating otherwise, I'd still have to think long and hard. The minute she would stop breathing and could not be resuscitated they would come right back to you questioning your nursing judgement.

I don't know about where you live, but in our county, there is no charge for EMS to come, only if they transport to the hospital. If they do transport it is billed to insurance.

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Specializes in DD, PD/Agency Peds, School Sites.

Sounds like there needs to be a very specific written plan filled out and signed by parents AND doctor. I'd most likely still call 911 though. Angry parents are better to deal with than a non-responsive child. I'd have a O2 sat/HR monitor handy for sure to go with the specific written plan because of the asthma. We all know how scary that can be. Tough situation. I've had to call 911 several times and only got side-eye for it once by an assistant administrator. That person got over it.

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Specializes in Pediatrics Retired.

The advise from the psychologist is as worthless as the paper it is written on. You are responsible for the child's health if you are there. The principal is responsible for the child's health if you are not there. You can do a physical assessment and AVPU score. Unlicensed personnel can't. You can put together an algorithm with triggers when to call 911 based on "signs" of distress or decreased level of consciousness to CYA your principal when you're not there but otherwise you can't delay calling 911 for the convenience of anyone. Don't budge. It's your license and the child's well being. As everyone knows, with respect to respiratory distress and kids, you never know when you'll step into the abyss and there's no going back.

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Specializes in DD, PD/Agency Peds, School Sites.
The advise from the psychologist is as worthless as the paper it is written on. You are responsible for the child's health if you are there. The principal is responsible for the child's health if you are not there. You can do a physical assessment and AVPU score. Unlicensed personnel can't. You can put together an algorithm with triggers when to call 911 based on "signs" of distress or decreased level of consciousness to CYA your principal when you're not there but otherwise you can't delay calling 911 for the convenience of anyone. Don't budge. It's your license and the child's well being. As everyone knows, with respect to respiratory distress and kids, you never know when you'll step into the abyss and there's no going back.

I wish I could hit the "like" button 100 times!

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Specializes in school nursing, ortho, trauma.

I can't put it better than OldDude did.

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Specializes in kids.

Well, there seems to be no reason for her not to be in regular ed (almost all of our kids are main streamed). BUT, I would question the legality and safety of a note by a psychologist without a medical evaluation backing it up. She may well be having complicated psych issues, but that does NOT preclude her from having a regular old asthma attack.

And we all know how quickly THAT can go down the tubes.

I would ask for BOTH and also ask to have it reviewed by school district counsel.

Because you know who is on the hook when the kid goes into status asthmaticus and doesn't come out of it.

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Personally, I would never work at any school where the decision to call 911 was not mine. It is my nightmare to imagine wanting 911 and a non-medical person telling me no.

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Thank you all for the replys!

You all validated what I was already thinking. As a long time Peds nurse I certainly know that things can go from ok to deadly in a matter of minutes and time is critical. I just wish the parents would understand that before we get to the point where something horrible happens. In the meantime I'll just keep calling 911 if it is needed.

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Our school psychologist has approached the parents with each of these incidents to get them on board with moving forward with special ed services to get her help from our EBD program. Most of our EBD kids spend a good amount of time in the regular Ed classes but use the EBD room, teacher, and sides as a resource when the regular classroom becomes to much to handle or the feel a behavior being triggered. Our school is really the only one in the county that has a substantial special ed program so we have a large EBD program.

This particular student has not been able to make it through a single school day since Sept 15th without either passing out from the panic attack, having a psychotic break where she has no idea she is even at school or who she is and has become combative towards other staff and students (my health aide got punched in the face this week), or has tried to flee the building. She has gone from a straight A student to barely passing. The hope with parents agreeing to an IEP would be that someone could be hired and trained specifically to her on how to help her through the day and she could use the EBD room that has two "calm rooms" to go to before these episodes become so intense.

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Specializes in Pediatrics Retired.

Geez, poor girl, it sounds like she needs to be an inpatient for a while to work on a successful medication regimen.

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I know this isn't what you're asking, but has anyone considered PANDAS here?? Straight A student to being unable to make it through the day...hmmmmm....

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