LPNinGH

@SaltineQueen I know the reaction the parents of my student will have, particularly mom, and it won't be pretty. It's a conversation I will be having with mom later today. As far as I'm concerned, we will continue as we have. I'll submit timesheets for working lunches and see how it goes. If my supervisor brings it up again, I'll again ask that the district provide riders to their liability insurance that specifically names myself and the other 1:1 nurse. That seemed to be more than my supervisor was willing to do, as I've gotten no response to the first request for such coverage. I wish we had Safe Harbor in my state, but we don't. Thank you for responding!

Our contract (in place before I hired on as a district employee) is not worth the paper it's written on. This was an employee association, not a bona fide union, and it almost dissolved three years ago because members wouldn't step up to the plate and participate. A handful of members volunteered to assume officer positions but essentially had no training or knowledge of what's expected in those roles. It was quite a sad state of affairs. I finally made contact with someone actually in the association (no response to several emails to HR, my supervisor, and other classified nurses didn't know who the officers were). It was only when I attended the nurses' Xmas party in December that I finally came into contact with the association secretary. Right away I started getting notices for meetings and attended one in January 2019. I became treasurer in April 2019 when the former treasurer left the district. I've never encountered anything like this before. Members want to complain but don't want to step up to support these needs, which is all volunteer-based. Because our contract expires August 31st and with the severe need for an entire revamp of the current contract and better member support, I joined the organizing committee. We affiliated with a union already established in this school district. It was a huge undertaking in and of itself, which I won't go into here. We finally became unionized in June 2019. Sorry, off I go again... With the focus finally being on a new contract, I volunteered for the negotiations committee and the negotiations team (the members actually going to the table). We start bargaining for the new contract this Tuesday. The lunch coverage issue I originally posted about on this forum didn't come up until June after I submitted timesheets to be paid for working through lunches after finding out a 1:1 para in the adjacent functional core class was getting paid for working through lunches. The other student cared for by a 1:1 nurse can't have care delegated to a para, because the student started having problems and ended up missing the last few weeks of school last Spring. The student was ultimately cleared to return to school this Fall, as long as intermittent supplemental O2 is readily available on campus. Thankfully, I have a union rep who hopefully will be able to help me navigate what surprisingly seems to be uncharted waters. I appreciate all the feedback! If anyone finds or comes across a situation similar to this with a final resolution, I'd be thrilled to hear about. Thanks, everyone!

@ruby_jane, BSN, RN Thank you! You understand my predicament. I appreciate your feedback so much. Were I still an agency nurse, I would have immediately contacted my agency supervisor regarding caring for two medically fragile students of this nature. I was paid so well by the agency that I didn't mind working lunches. Plus, there was no second 1:1 nurse my first year with this kiddo and the school nurse at that time had reservations about covering lunches for the reasons voiced in my original post. However, the district hired me Summer 2018 to continue working with the same student last school year, which I did, and plan to do for this coming school year. At no time has it ever been a stipulation of the job to "double-up" with another medically fragile child to cover lunches. It was only after I had become a district employee and submitted timesheets to get paid for working lunches that things became sticky. The current union contract supports being paid for working through lunches where no coverage is available. My situation falls into that category, so I followed this process. I still haven't been paid, though have been "assured" by my supervisor a couple of times recently that payment should be received with my August paycheck. It's a long, convoluted story. I've been working on contract revisions for our union over the summer and begin negotiations next Tuesday. You can bet I'm addressing this issue, as well as a host of others. Last year, the district wasn't going to pay me for my time riding the bus to and from school with my student. My supervisor was able to get this straightened out and approved at the beginning of the school year. However, when she attempted to get lunch coverage approval at the same time, she never got a response. As mentioned, it was only after I submitted time sheets that she repeatedly said the other nurse and I would double-up to cover lunches. I've repeatedly stated my concerns, in writing and conversation, with my supervisor. When I told her it may be a possibility as long as the district named me personally on their liability insurance with specific language referring to this situation, she said she would take this to the higher-ups; of course, a response hasn't been forthcoming. I'm so disappointed that my nurse supervisor isn't advocating for the students, but is willing to forego safety to save district funds for 30 minutes of lunch-time pay. Paying us for working lunches wouldn't force either nurse into overtime, but brings us up to an 8-hour day. They've allowed this for the last two years for two different 1:1 paras, who have cared for the same student in our class. It's my opinion that the precedent has been set. The other nurse hasn't voiced anything and doesn't respond to contacting her even for other issues. That is another story that I won't go into here. At any rate, thank you so much for your understanding. My primary concern is the safety of these kids and my ability to properly intervene should they both require attention for suctioning. My kiddo alone can require repeated suctioning over a 10-minute period, depending on the day and mucus production. The other kiddo is so impaired she doesn't have the ability to attempt to clear her throat or turn her head to provide even seconds of relief so she can take a breath. As I've mentioned before, nothing may happen, but it only takes one event for everyone to be tossed into a state of regret, remorse, and most likely an expensive lawsuit. I'm also concerned about my license. I love my job. I have a connection with my student and her family. I've been unsuccessful in trying to find any kind of documented evidence-based practice for this kind of situation. NASN doesn't address it, at least that I can find, nor does my local school nurse association. I've looked at area bargaining agreements, without any luck. I've searched at length the department of health. My next step is contacting the state BON, which is on the docket today. If you have any ideas as to where I might find this or any kind of documentation, I'd be so grateful to hear them. I think it's an unconscionable, let alone unacceptable, budget-saving measure that crosses the line of what is safe and in the best interest of these kids. Again, thank you so much for your kind and thoughtful response.

My student receives focused care at home 24/7 from the family who has undergone training. They refused the offer of full-time nursing in the home setting. The hospital unit is a whole different scenario. I'm talking about medically fragile kids in a classroom and zero guarantees that licensed personnel will be available for backup. I'm one nurse with two hands.

Good Afternoon~ I'd like to connect with anyone who knows of a school district policy allowing 1:1 school nurses to care for two medically fragile students to cover coworker lunches. I've been with the same student going on three years now, first as an agency nurse and then since last year as a district-employed nurse. I was paid well enough by the agency that I didn't mind working through the 30-minute lunch break, especially since I fed my student and myself at the same time, making it a social activity. The prior school nurse was more than relieved because she didn't know how she'd manage the health room and the needs of this student. Last year, I was able to timesheet (submit time for pay) to remunerate me for working through lunch. I've recently been informed by my supervisor that another 1:1 nurse in the SPED class and I will cover each other so we get a lunch break this year. I disagree with this wholeheartedly. Both require frequent suctioning, one via trach, one for copious oral secretions who is quadriplegic and can't so much as slightly move her head. I can't suction both at once! The latter student was to cease having a 1:1 nurse because her suctioning requirement can be delegated to a trained para. However, she started having issues at the end of last school year, suffering profound desaturation and ended up missing the remainder of the school year. She now requires oxygen to be on hand in the event of an emergency. My concerns: 1. Liability. I am fearful something untoward is going to happen if they both need focused attention at once. I've informed my supervisor the district will have to specifically name me on their liability insurance if they're going to force the issue. Even then, I don't feel comfortable at all with this scenario. These are human beings! Someone's children! Plus, I worked hard for my license. I don't think the district should be asking me to do something that puts my license in jeopardy. It only takes seconds for a situation to go downhill. 3. When I voiced my refusal, the supervisor then said the main school nurse could cover lunches. How is that any better? She has two schools she manages. She's not always available for backup. Even then, our campus alone has a student body of approximately 1650 students. The health room is very busy especially at lunchtime. She is in no better position to back me up even if she was on campus. She is frequently called out of the health room to attend an urgent situation in the class or the gym, out on the field. We have circulating itinerant nurses, but most either haven't performed trach suctioning in quite some time or are relatively new nurses and never have done it. More so, they have voiced resistance at being responsible for this student in light of how busy the health room is on any given day. Trach suctioning is not a nursing task that can be delegated to unlicensed personnel. 3. I'm quite sure my student's parents would be upset to find out this was going to happen. I am their child's 1:1 nurse. This has really put a damper on my excitement for the school year to begin. Is it likely something will happen during those 30 minutes? No one can say. Is it worth the risk? I vehemently respond that it is not. The one student was getting ready to stop 1:1 care, then she started having problems out of the blue. Things can change with these students in a heartbeat! Up until I became my student's dedicated care provider, despite O2 being physician ordered to be available in the event of an emergency, the prior school nurse didn't feel the need to get one in place. I was mortified so did something about it. Any input would be greatly appreciated. Thank you for reading.

In my area, district employees working only the school year get paid year-round, but it's calculated on 180-186 days of work per year divided by 12. All national holidays are paid, as well as Christmas and Spring vacations. We receive our "vacation" pay in 12 increments, included in our monthly paycheck. It's nice that we still earn vacation time and are paid for them even though we have a lot of time off. If you're an agency nurse working in a school district, you get paid September through June, but usually at a higher hourly rate.

Way to go, Jennifer and Heather! And extra kudos for pursuing changing the law. I am a nurse in a school district. There is no reason for schools not to stock Epi-pens, glucagon, Narcan, and rescue inhalers, and lack of funding is included as an insufficient reason. On the same note, however, parents need to be held equally accountable when events like this occur unless a child was undiagnosed until a scary event occurred. Parents need to step up to the plate and provide these medications BEFORE the first day of school, along with hard copy orders for these medications signed by their child's provider. This is the biggest bugaboo at the beginning of the school year. Parents repeatedly get upset that their kids can't go to school without these emergency medications properly supplied in the school's health room. The same with any students who are allowed to self-carry. There has to be a parent's note that Polly Pupil can carry Advil. In my school district, older students are allowed to carry only enough of the medication for one day and it has to be in the original packaging. We have our students put the container and a copy of the parent's note in a ziplock bag in the event a teacher or other administrator unfamiliar with the student asks for proof it is allowed. Our district nurses send out letters at the end of the school year notifying/reminding parents to take care of immunizations and doctor's appointments over the summer in order to obtain current med supplies and orders in anticipation of the next school year. Another letter goes out midsummer and another letter a few weeks before school starts. These same notices are posted on the parent portal at the district website and on all registration materials, both online and on paper. How this remains such a problem is beyond comprehension. Whoops...off on a bit of a tangent... These nurses should be winning awards for heroism. I'm so proud of them for having the cojones to do the right thing!

Hello, I'm a 1:1 school nurse for a medically fragile student, with whom I've cared for over the past two years. My first year was with an outside agency, but the district hired me at the end of 2018, so last year I functioned as a district employee. My kiddo is cognitively and functionally impaired, wheelchair-bound and has a trach and g-tube. I accompany the student on the bus and then provide all her care during the day. When I discovered she'd had inconsistent attention by paraeducators in the past (through no fault of their own), I took on that role as well. I've been blessed to work with an outstanding SPED teacher and staff. My student gets PT, OT, and ST on a weekly basis. I've gained an incredible education on these specialties since starting this assignment. I've watched each and, with their help, adapted these strategies as part of my student's daily activities. There are many adaptive strategies for your son! He can dictate directly into a device and then print out his dictation and attach it to the worksheet. If my kiddo was able to speak, I'd gladly take dictation, though. There are communication devices where words or phrases can be selected instead of typing out each individual letter. The technology available is so amazing! There's one student who is able to communicate using a device that responds to eye gazes. There is adaptive PE that your son will be able to participate in if it's offered in your school district. Last year we took a bus to a different school, which all the kids enjoy. If you can, ask to meet with the PT, OT, SLP, and APE teacher to find out what's available in your district. My student gets g-tube feedings at home but also has a diet ordered for school that is chopped to 0.25 to 0.5 inch pieces or pureed. In my SD, no food from home is allowed unless Nutrition Services receives a waiver signed by parents and physician. Unfortunately, the APE outings for swimming aren't open to my student because of the liability associated with the trach. Another thing, make sure you have current provider orders for meds, tube feeding, and suctioning turned in to the health room before school starts or your son won't be allowed to attend school until these are submitted. Also, if tube feeds are done at school, usually three days' worth of feeding is required to be stored on campus, either in class or in the health room, in the event of an emergency. My student has O2 ordered in the event of an emergency as well. I contacted the local medical supply vendor that is associated with my student's provider. They contact the provider for the O2 tank and administration orders, and they deliver it to the school a week before the school year starts. The main school nurse at your son's school may be able to do all this. However, I work in a huge school district and help her out by making the calls and keeping her closely apprised via email. With regard to continued care after school, if the 1:1 nurse is a district employee, they won't allow this. However, if the nurse is hired by an agency contracted by the school district to provide care at school, you can contact the agency and see about extending daily care after school hours. If you already have a nurse who is already established with him and has a good rapport with you and your husband, you an approach the Health Services Director or Student Support Students at the district office to make arrangements for this person to go through customary school district employee onboarding, i.e. criminal background, fingerprinting, receiving an ID card. They're still a private agency employee, but have to "vetted" to be allowed on school district property. Oh geez, I didn't intend to write a book. I hope this information helps. With August more than halfway over, you may have already had your questions answered, but I felt compelled to respond just the same. Best wishes to you and your son!