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.
I don't care if I have a note from a parent, physician, psychologist, superintendent, president of the united states - when that kid is in my clinic and my nurse gut tells me to call 911, that is exactly what I am doing! Go ahead and fire me! I am going to have the documentation to back my decision up while they will NOT.
The Board of Nursing only cares about 1 question - what would a reasonable and prudent nurse do????? Easy, place patient safety above all else!
I second Old Dude and the others above....I've had kids like this before. I work in a public school program for high school kids with emotional disabilities, and I see a ton of kids with trauma histories, PTSD, severe anxiety, and dissociative symptoms.
Apart from dealing with the actual episodes - and yes,call 911 if needed, because the psychologist is not going to be held responsible if something bad happens - other things to consider, to solve the bigger problems:
1) Find out if there's been a complete, recent physical workup by a doc....hopefully there has, but you don't want to find out later that she's got some weird cardiac or respiratory condition or medication issue that's contributing. Neither we nor Mr. PhD Psychologist can diagnose or rule out medical conditions, and that's essential. Get parents to schedule a complete physical (maybe ask for a referral to a psychiatrist while they're at it), and get the results in writing.
2) If the psychologist wants to actually be helpful, and I'm sure s/he does, have him or her write up a plan for this student, addressing the work that is within a psychologist's scope of practice. Probably they are teaching skills in the office - "star breathing," visualization techniques, grounding techniques, whatever - have them write up an intervention plan for the student. "When Susie feels overwhelmed, she will let her teacher know by asking permission to see the counselor. Susie will practice her grounding techniques in the counselor's office for 10 minutes"....etc. Or perhaps the psychologist has input for your staff about known triggers, or other helpful information.
3) Assuming there is a mobile crisis team for (psych) emergencies, use them. Work with the psychologist and/or your admin to specify when they will be called.
I also second all the above about getting an IEP in place. I understand parents can be hesitant, but the IEP really is the key to getting support services - it only adds help, it doesn't take anything away, and it doesn't have to be forever. A kid who can't get through a single day without fleeing or freaking out does not have access to her education, and needs some supports and services.
I know how anxiety-provoking and draining it can be to deal with kids experiencing these symptoms. You're being very conscientious and can be a great advocate for this student. Hang in there!
pappa22v makes a very valid point. I am not one to step on other professional's toes, but this is endangering a life. I would at least call and ask if there is a psychiatrist who could write that order, because you are not allowed under the NPA to follow orders from a non-medical high level. That would keep it respectful (even though they are a midlevel) and get your point across.
Don't ask for an order. You might get it. Then, your hands will be tied.
Just use your good judgment and common sense. Because if you don't seek emergency help for the girl and she suffers damage, you will be in lots of trouble.
EnoughWithTheIce
345 Posts
I don't care if I have a note from a parent, physician, psychologist, superintendent, president of the united states - when that kid is in my clinic and my nurse gut tells me to call 911, that is exactly what I am doing! Go ahead and fire me! I am going to have the documentation to back my decision up while they will NOT.
The Board of Nursing only cares about 1 question - what would a reasonable and prudent nurse do????? Easy, place patient safety above all else!