Providing Care to Staff

[SchoolNurseK, BSN, RN]

This is my first year as a School Nurse. I am at a high school, so it can be pretty slow in the clinic. I have on several occasions, had a teacher or staff member stop by for a temp check, BP check, etc... I have never thought twice about this, as it never interferes with my care of the students. Recently, a teacher asked me to be a standby support as they learned to inject a new medication. I made it clear that I will not inject, however if available, I would be in the clinic with her. Well, that has come back to bite me in the bum big time now. I was out with THE FLU last week and unable to provide this support, so apparently the teacher demanded that my unlicensed back-up do it for her. This person of course refused and the situation escalated all the way to the principal. What a disaster!!! My attempts to do a simple Teach and Train out the kindness of my heart, created a terribly dependency. Not only that, I fear it looks like I wasn't doing my job. So my question is, do you all see teachers when they come in? If no, how do I change my methods mid-year like this? Help!!! I just want to set up camp under my desk at this point.

[Csn2016, BSN]

Wait...the teacher has to self inject medication? And it escalated to the principal because she could not do it herself and you werent there? Thats not your problem thats the teachers problem (and the districts for not have a qualified substitute) you are allowed to take sick days/personal days etc.

Do not beat yourself up over this, if I am understanding this correctly you did nothing wrong!

[Eleven011]

I do many things for staff - mostly b/p checks, some lice checks on the uber paranoid, "what do you think of this rash/spot" type thing. But nothing treatment wise like a shot. I would have offered the same as you, come into the clinic and I'd be glad to walk them through the learning curve. Sorry, she took advantage of the situation.

[SchoolNurseK, BSN, RN]

Thank you, I really don't feel like I did anything wrong. The resolution of the situation is that if I want to "voluntarily" stand-by while she self-injects, then the liability is on me. I have since told the involved parties that I will no longer be doing this, because clearly this is too much of a mine field. Also, there is no liability to me because I don't even do the injection. Ugh...

12 minutes ago, SchoolNurseK said:

the teacher demanded that my unlicensed back-up do it for her. This person of course refused and the situation escalated all the way to the principal.

This makes zero sense to me! How can they expect an unlicensed person to inject a medication, especially when you are licensed and refused??? You did the right thing by not agreeing to inject. I am not understanding why the teacher thinks it is OK to make someone else do it in your absence.

[SchoolNurseK, BSN, RN]

Just now, MHDNURSE said:

I am not understanding why the teacher thinks it is OK to make someone else do it in your absence.

#truth

No good deed goes unpunished, apparently.

[CanIcallmymom, BSN, RN]

Sounds like she needs to contact her doctor who prescribed the injectable medicine to her without adequate training/return demonstration in their office. You did not do anything wrong. I probably would have also said I'll observe a time or two, but beyond that I don't see a need for continued supervision. Your doctor trusted you enough with the med...

BUT, I do have teachers come in from time to time. I have had a few chest pains, but the majority is usually temp checks/BP checks. I don't want to set the bar that I am not here for them, but I let them know that "What I give you is just a number. It does not rule anything IN OR OUT, and you MUST contact your doctor, as I am not that." I write a short nurse note to keep on hand (in case anything comes back) that documents that I specifically referred them to the doctor or suggested ER, etc.

[Flare, ASN, BSN]

like the others, i will take a temp or a bp on staff. I will check a head or listen to a medical concern. I make it clear that I won't diagnose or direct treatment for them. In the case where a staff member wanted my "support" when they self inject, I would have probably told them it was fine to inject in my office, but that I would not provide any actual assistance. And I agree with the sentiment that it would be faded ASAP. Beyond that, if the staff is simply looking for a place to perform an injection and a sharps container, that'd be fine.

Treating staff is a slippery slope. At my previous school, the principal always sent staff to me so I could "clear them to stay at work or make them go home". I hated it. You are a grown adult and can decide if you are too sick to stay at work. I had one staff member c/o chest pain and refusing to go to ER. I was pissed. And he kept coming back to see me. Another teacher with pelvic pain and irregular bleeding...Always happy to take a quick temp or listen to them moan about a cold, but this other nonsense gets to be too much.

[ruby_jane, BSN, RN]

Sweet Baby Moses.

[BrisketRN, BSN, RN]

Yikes. This teacher tried to take advantage of your kindness. I agree with others, I'm happy to take a set of vitals for staff members or listen to their concern and say "you should call your doctor." I've had my fair share of weird requests. A female teacher tried to show me a bruise on her upper thigh/buttock area. NOPE. A teacher injured her leg on a ski trip (out of state) and sent me a photo to ask if it looked broken ?.

Before I came here we had a teacher get her finger caught in a closing fire door (severed, nurse got it in a bag on ice, reattached at hospital) and the old nurse helped with dressing changes because the teacher's husband was too queasy to help. Even in that situation the teacher was so grateful for the nurse's help. I probably would have helped in that situation too.

[Ice keeper]

My first supervisor insisted her nurses informed all staff "I will only check your BP etc if you guarantee that you will do what I advise" before they did anything for a staff member. She told us if they didn't agree, to send those grown adults on their way. If we didn't know how high their BP was we were not liable and didn't need to stress about them not following up. I still apply that rule now. I have had a few obviously sick teachers change their minds after the fact, but on occasion (chest pain etc) I have involved the Principal and had them call 911