School Nurse Incident in Orlando. What Would You Have Done?

  1. I'm not a nurse yet, so I only know how I feel about this. What should this nurse have done? What would you have done?

    Nurse refuses student inhaler during asthma attack

    School says medical release form lacked parent's signature
    Last edit by NRSKarenRN on May 26, '12 : Reason: Added news article title
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    About Exhaustipated, ADN, RN

    Joined: Feb '11; Posts: 449; Likes: 278


  3. by   NurseOnAMotorcycle
    Called 911 and done my ABCs? Called the pt's emergency contacts (MD, parents, etc)?

    Apparently this nurse didn't. We don't have the whole story, either. Why did she lock herself in the room? Did the teen get violent in order to get to his inhaler? Was she protecting herself?
  4. by   Dixielee
    I think there is probably much more to this story than is printed. It lost credibility to me when they said she locked the door and let the kid lie on the floor. I won't pass judgement yet because this story smells a bit fishy to me.
  5. by   Exhaustipated
    I agree there are absolutely holes in the story. I was just curious about how this should have been handled.
  6. by   sharpeimom
    as the daughter of a mother who occasionally had life-threatening asthma attacks, my first totally emotional reaction as a daughter is
    "what the <bleep> happened?" that nurse should be strung up by her thumbs.

    on the other hand, my reaction as an rn is the bulk of the story is just more of yahoo's sensationalism and overgeneralizing. i have to wonder whether the student is a behavioral problem, or panics easily, or cries wolf??

    i would hope that any reasonably prudent nurse would use critical thinking and assessment skills and if he had been in the thros of a bad attack, give him the inhaler and straighten out the paperwork later. an inhaler can be a maintenance drug as well as an emergency rescuer for many asthmatics.
  7. by   danarooo
    My initial thought having asthma myself would be to give the dang inhaler, but as an RN I don't have all the facts so can't really say with any degree of certainty. It's too easy to demonize the nurse for the general public, but as a nurse I want to see the school policy under which she was working regarding medications AND hear her assessment of the situation and her rational in order to say what I think.
  8. by   Double-Helix
    I can understand the policy of needing to have a signed release before allowing a student to carry the medication with him in school. That's what the article states the medical release was for. However, it doesn't say whether a medical release is needed to GIVE the medication- just to allow the student to carry it. Many medications are kept in the nurse's office and given when needed.

    I'm also curious how much time elapsed between when the inhaler was confiscated and when the asthma attack occurred. The nurse could have called the mother at the time it was taken and explained that they need a signed release. The nurse could have also called the mother at the beginning of the asthma attack and obtained verbal consent (with a witness) to give the child in inhaler until a written consent could be signed. We obtain consent this way for surgical procedures- I'm sure it could have been done for a medication.

    School nurses have it rough. On the one hand, they are hung out to dry if they don't do something in a medical emergency- even without consent of the parents. On the other, they are hung out to dry if they do something but the parents don't agree with what is done. This nurse was probably afraid of the consequences that could have come from giving a child a medication without parental consent.

    Of course, it seems that 911 would have been appropriate as well. But hindsight is always 20/20, so it's hard to judge from just the information in the article.
  9. by   canesdukegirl
    What Ashely said
  10. by   glencovediva
    I would do my ABC's, call 911 and emergency contacts.
    Quote from Ladylynn6
    I'm not a nurse yet, so I only know how I feel about this. What should this nurse have done? What would you have done?
  11. by   caliotter3
    Called 911. Shared in the responsibility because the signature should have been obtained. Nurse's responsibility to inform the parent that a signature is needed. Doubt this was a new prescription.
  12. by   Jolie
    Perhaps a mod can merge this thread with the one in the School Nursing forum, where a number of experienced school nurses have already weighed in.

    As a school nurse myself, my B.S. detector is going off...We don't have anything close to the whole story. If the child was truly unconscious and in severe respiratory distress, how did he get fixed without ACLS intervention?
  13. by   Exhaustipated
    My apologies. I didn't know there was a school nurse forum, or that this was already being discussed.
  14. by   Jolie
    I'm not going to attempt to justify or berate the nurse's actions, since we don't really know what happened. But for those unfamiliar with school procedures, I'll explain the normal routine for meds at school:

    Requirements vary by state law and district policy, but for the most part, for a student to receive medication at school, the medication must be necessary for school attendance and must be required during normal school hours. (For example, if a routine medication can be given at home outside of school hours, it will not be accepted at school.)

    For school personnel to administer meds at school, there must be a written physician order AND signed parental consent. One or the other doesn't cut it. The medication must be provided to the school in it's original container, with the original label clearly displaying the student's name. Bringing in pills in a baggie, a prescription vial with someone else's name, or an unlabeled inhaler is unacceptable. Just as nurses don't administer unprescribed medication in a hospital or clinic, neither can nurses in a school setting.

    Most states have laws allowing for the self-carrying and self-administration of emergency medications (usually inhalers or epi-pens) by students who are documented to have the knowledge and awareness of safety to do so. This requires physician documentation, parental consent and the agreement of the nurse that the student meets the criteria. This is usually appropriate for older grade school students (4 or 5th grade and up) and teenagers. If a student violates the safety rules attached to self-carrying a medication, such as allowing other students to play with the medication, it is removed from the child's posession and goes under lock and key.

    Some kids carry inhalers without consent and without the school's knowledge because their parents don't want to be bothered with filling out the necessary paerwork. We all know this, and do our best to get these kids into compliance by implementing self-carry paperwork. I don't confiscate inhalers, period, but will raise holy he** when I find them being used without authorization. These are the parents that refuse to be bothered by providing us with the necessary information we need to assist their children safely in school, but they will also be the first to sue when their child suffers because s/he hid in the locker room and ineffectively self-administered an empty, expired inhaler.

    Lastly, some states and districts have emergency protocols, signed by physicians that allow school personnel to administer asthma and allergy drugs while awaiting 911 in the event of a severe, presumed asthma attack or anaphylactic reaction. This is the best of all worlds, because it allows school nurses and personnel to do what is right, even if the parents haven't bothered to.

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