Paramedic and teachers assistant being pushed to cover for a irresponsible school nurse?

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Hello! Please note, I'm not a nurse. I'm a EMT-Paramedic and a Teachers Assistant.

Recently, I've been pushed to do short term coverage for the school nurse (30-45 minutes, sometimes an hour) at one of my schools, and the nurse has been gone more because she feels I'm qualified to cover.

I don't feel I am qualified to cover, and I desperately didn't want the district to make it a habit.

Any advice? Any heads up in case they do make it a habit?

(FYI I work at multiple schools, it's just one that consistently asks me to do this)

When i'm away from my office, a secretary from the office covers me. She doesn't have anything but her knowledge as a mom and common sense. If there is something that is beyond what she think she can handle, she calls my cell or texts me. I'm usually just away for my lunch, emergencies (which seems to be more and more frequent these days), and standard our of office stuff - (making photo copies, getting a file from archives, ect.) It works out ok. I trust her judgement.

Are you being employed as an EMT? As in...are they paying for that set of skills? If not, you are not employed to use your training and certification/licensure, therefore it's incidental, and you're right to be concerned about something happening while the nurse is away. It's different than you stumbling on a happening at school and using your training as a good Samaritan.

Second question (and I apologize for my ignorance): what skills can you do without a doctor's orders, and do you have the necessary orders to keep you within your scope of practice? It sounds like the district is using you for a work-around, and it's very convenient that you're there.

I am told that I *can* leave campus for lunch but I'm still responsible for all the lives on campus (even if I am not there because I took lunch). So....I just shut down after all the lunches for 30 minutes. It's been a challenge training teachers but most of them got it after my second email. "Your student has had three 90 minute periods to come see me, and that included their lunch. If it's not an emergency, direct them to wait..."

This, and this, both.

Remember folks, we don't work in a MASH unit. We work in a school.

Yes, as nurses, we do best practice day to day for our kids, but surely, someone can call a parent or 911 if we are out.

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In my experience I have noticed that school nurses often aren't nurses at all. In fact depending on the state, a school nurse does not have to be a certified nursing assistant even. All that quite a few states we've lived in required was a CPR and First- Aid course. Budget cuts have changed the school nurse position dynamically with many school districts sharing one registered nurse. Emergencies are turned over to 911 and besides basic care, CPR/Heimlich and epi-pen administration, the school nurse essentially is a liaison between the district nurses. I'd do some research to uncover what is required for your state. Chances are, you are over qualified. I've heard a few stories that ended horribly for children due to this risky budget adjustment but don't feel like many people actually know their school nurse is not an LPN/RN/CMT/Paramedic... Best of luck to you my friend.

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In my experience I have noticed that school nurses often aren't nurses at all. In fact depending on the state, a school nurse does not have to be a certified nursing assistant even. All that quite a few states we've lived in required was a CPR and First- Aid course. Budget cuts have changed the school nurse position dynamically with many school districts sharing one registered nurse. Emergencies are turned over to 911 and besides basic care, CPR/Heimlich and epi-pen administration, the school nurse essentially is a liaison between the district nurses. I'd do some research to uncover what is required for your state. Chances are, you are over qualified. I've heard a few stories that ended horribly for children due to this risky budget adjustment but don't feel like many people actually know their school nurse is not an LPN/RN/CMT/Paramedic... Best of luck to you my friend.

So, you don't think an actual nurse is required in the day to day, or are you saying paramedic is overqualified for lunch coverage.

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In my experience I have noticed that school nurses often aren't nurses at all.

In this case, it would be illegal for the school to call this employee a nurse. If you know of this happening, it is your professional responsibility to make them aware that it is illegal and report to your state BON.

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I think this depends entirely on the role that you were hired for. If you are there as a teacher's assistant, you should only be working as such. If you are there to "cover as needed" this needs to be clarified. You should not be "the nurse" when the actual nurse is taking lunch, you shouldn't be giving meds or being pulled to deal with minor boo-boos. If the nurse is off campus and a kid falls on the playground, you'd be a great person to ask to out help in that situation, but the day to day stuff shouldn't be your responsibility. Also, if the nurse is extending his/her lunch beyond what is allowed, a direct conversation needs to happen. I agree with your thinking that this could run into an out-side of your scope liability situation-administrative types love the word liability, maybe bring that one up to the principal.

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Specializes in EMS, LTC, Sub-acute Rehab.

I'm not quite sure why you don't feel qualified, it's not like you're drafting care plans or educating a patient on diabetes. You're basically covering for lunch right?

I was an EMT+P before I became a nurse. Physical assessments, medication administration, laceration management and accu-checks are in the the paramedic scope and are not dependent on your employer. Knowing your patient's Hx is important and some school nurses have this advantage because they're assigned to one school only.

However, if you run into some seriously emergent problems e.g. airway management, anaphylaxis, etc... I'd call EMS just like a school nurse would.

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I'm not quite sure why you don't feel qualified, it's not like you're drafting care plans or educating a patient on diabetes. You're basically covering for lunch right?

I was an EMT+P before I became a nurse. Physical assessments, medication administration, laceration management and accu-checks are in the the paramedic scope and are not dependent on your employer. Knowing your patient's Hx is important and some school nurses have this advantage because they're assigned to one school only.

However, if you run into some seriously emergent problems e.g. airway management, anaphylaxis, etc... I'd call EMS just like a school nurse would.

Perfect answer.

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Specializes in School Nurse, past Med Surge.
In my experience I have noticed that school nurses often aren't nurses at all. In fact depending on the state, a school nurse does not have to be a certified nursing assistant even. All that quite a few states we've lived in required was a CPR and First- Aid course. Budget cuts have changed the school nurse position dynamically with many school districts sharing one registered nurse. Emergencies are turned over to 911 and besides basic care, CPR/Heimlich and epi-pen administration, the school nurse essentially is a liaison between the district nurses. I'd do some research to uncover what is required for your state. Chances are, you are over qualified. I've heard a few stories that ended horribly for children due to this risky budget adjustment but don't feel like many people actually know their school nurse is not an LPN/RN/CMT/Paramedic... Best of luck to you my friend.

Sounds like your experience is pretty limited...

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Specializes in Med-surg, school nursing..

If it were me, I would probably have the school add it to my official job description (including extra pay) to CYA. If you live in a state that is required to have a school nurse certified present in each school, I would put my foot down as it seems like it would open you and your school (which quite possibly could throw you under the bus should something go hinky) to liability.

Also, who is covering your TA position while you are covering the nurse? If you are having to do it on your lunch break, no. If they are leaving a teacher without an assistant, no. I believe both are illegal, but I could be wrong.

All that said, if your state and school allows anyone that has been trained to administer medications, and you are comfortable with it (see again the job description point) then you are perfectly qualified. In our district an RN can delegate anything except insulin administration.

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Specializes in Pediatrics Retired.

Do you still work as a Paramedic somewhere?

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So, when a teacher has a lunch period and 2 planning periods - it is called a requirement!!!! However, when the nurse takes a lunch - it is called irresponsible??

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So, when a teacher has a lunch period and 2 planning periods - it is called a requirement!!!! However, when the nurse takes a lunch - it is called irresponsible??

I hope that's not what OP was saying, but that is how it comes across.

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