Replacing School Nurses with Health Techs

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First, I have to tell you I am a brand new school nurse and love my job. Been working all of 1 week today and have won 2 awards so far--one for having the first student with lice in my school district and the second one for having the first student with a fx wrist. I'll probably be the first too, to use an epi-pen as I have 10 of them and 4 bee/wasp stings already :uhoh3:.

But what I wanted to discuss is the feeling among some of the staff that they think the RN's at the school should be replaced with task trained "health techs" to provide care as it is cheaper. There was pressure from the admin when I was hired, as they want to replace the RN's with unlicensed health techs. They point out that many schools do this, and have one RN in the entire school district that trains and monitors these health techs. These task trained health technicians are responsible for managing children with DM, CHO counting/calculating insulin/admin insulin, giving Glucagon, Epi-pens, oral meds, tube feedings, seizure management, asthma care, trach care, handling medical emergencies, and peanut/food allergies.

I thought about it for a while, and have come up with this scenario: I'm going to tell the teachers that what would they think if the administration came in and announced that the teachers are no longer responsible for teaching math to their students. A trained technician, with minimal or no college education, has been hired and tasked trained to teach math modules to the students. All this person needs to know is how to teach and present the current weeks math lessons, and has a few hours of classroom management skills that they learned from a teacher. They are basically task trained to teach math. Soon, the admin sees the success in using these cheaper trained techs, and now task trains them to teach pre packaged modules for science. The students master these concepts too, from the trained tech, and now, the techs are tasked trained to teach Social Studies....and pretty soon, there is one teacher overseeing many techs, with the unlicensed, uncertified techs doing most of the teaching and teachers are no longer needed. And if they think this could never happen to them, well, this is what is happening to RNs that work in schools. What do you think? Am I treading in water? Do you think they will get it?

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Specializes in school nursing.

Good one! I always like to ask staff if they would like their child who has severe asthma or is a brittle diabetic managed by a a unlicesed person or a trained medical professional? It will only take one student to die while being taken care of by an unlicensed person (with something that could have been prevented if properly assessed) to make people see our importance. Unfortunately, that one child is way too many!

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Specializes in M/S, Ortho, L&D, Neuro, Peds, School Nur.

love it! excellent points made!

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Specializes in School Nursing, Public Health, Home Care.

Well, I may become the most unpopular person on the planet, but there is another way to view this--when I train non-licensed personnel to perform delegated tasks, especially those dealing with students with diabetes--the rationale I give when they say "I'm not a nurse!" is that the student's parents aren't nurses, the students aren't nurses, and yet they can learn how to deal with diabetes, so you can too!

In light of severe financial constraints of school districts, the luxury of a nurse in every building may not be realistic. There are other ways to manage nursing needs. In the state of Wisconsin, the nurse to student ratio averages 1:2000 or so. This does not equate to a nurse in every building. NASN recommends 1:750.

Opinions?

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I somewhat agree with you that you can task train someone to manage diabetes, but when you also train that person to administer meds, do tube feeding, treat asthma, assess/splint fractures and sprains, manage seizures, perform trach care, etc then you have just taught someone to do everything an RN can do, without having to go to school. This dumbing down of nursing is not only jeopardizing our profession, but is cheating students out of having a qualified healthcare professional care for them.

On the flip side, if it is so easy to train someone to do this care, then why not train people to be teachers, using the module system as mentioned above. It would save $$$$$$ not to hire so many teachers, and use on the job trained techs instead. At least if they do an error or exercise poor judgment, someone's life or health is not at stake.

I think in the future nurses are going to look back on this time period when lay people were trained to replace nurses, and shake their heads, knowing that this is when our profession allowed us to be phased out--we did it to ourselves. Instead of kicking and screaming to protect our profession, we willingly train lay people to do our job as evident by using health techs in schools. In my opinion, this is only going to get worse, with eventually pt care techs handling most of the duties that RN's do now. This getting their foot in the door is going to kick it wide open and I predict it will doom nursing.

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I think that now that we are doing so much more care than school nurses were intended to give, above and beyond supporting education, we are supporting the health care system and providing care the health care payers should be paying for. It is time that payments be made from the health care systems to the schools to support the level of care needed. And on top of that, the state public health departments should be paying schools for all of the surveillance and immunization work schools do.

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The school district just might take you up on your suggestion, fire the teachers and hire all 'teaching techs'!

Personally, I'm split on this, both regarding teachers and nurses! What is the minimum required training/certification for providing certain services? Are those truly relevant requirements to the skilled provision of service? Is a bachelor's degree necessary to be a first-grade teacher? A bachelor's degree is not required to be a nurse in most settings. More education and formal training is always a good thing, but what's enough? Don't allow anyone to babysit toddlers unless they have a masters in early childhood development? Either you won't be able to afford it or the babysitter with the masters won't be making much money. I don't see easy answers!

More specific to the question of school health personnel, if a trained health care tech isn't competent to provide school health services, just how much more competent is an RN without any other training or background to provide those same school health services? School nurse jobs in my state require a BSN but not necessarily any previous professional health care experience. I had all of two days with a school nurse as a nursing student and without any other experience would have had little to no experience handling emergent situations, honing clinical judgement, practicing hands-on skills, heading up immunization campaigns, dealing with head lice, etc. My experience with g-tubes, IDDM management, anaphylactic shock, food poisoning, child abuse, etc were little to none. It would've been sink or swim, learn-on-the-job same as a well-trained health care tech. If there were a real emergency, basic first aid & call 9-1-1 (same as a new health care tech) - is all I would've had to offer as a licensed, inexperienced nurse.

Anyway, just food for thought!

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Lets all remember nursing judgment and nursing assessment can not be delegated to unlicensed staff. These people do practice nursing "tasks" under our license, but they are NOT critically thinking professional nurses! I have refused certain people to perform some tasks if I did not feel they could do it safely and to my standards.

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The school district just might take you up on your suggestion, fire the teachers and hire all 'teaching techs'!

Personally, I'm split on this, both regarding teachers and nurses! What is the minimum required training/certification for providing certain services? Are those truly relevant requirements to the skilled provision of service? Is a bachelor's degree necessary to be a first-grade teacher? A bachelor's degree is not required to be a nurse in most settings. More education and formal training is always a good thing, but what's enough? Don't allow anyone to babysit toddlers unless they have a masters in early childhood development? Either you won't be able to afford it or the babysitter with the masters won't be making much money. I don't see easy answers!

More specific to the question of school health personnel, if a trained health care tech isn't competent to provide school health services, just how much more competent is an RN without any other training or background to provide those same school health services? School nurse jobs in my state require a BSN but not necessarily any previous professional health care experience. I had all of two days with a school nurse as a nursing student and without any other experience would have had little to no experience handling emergent situations, honing clinical judgement, practicing hands-on skills, heading up immunization campaigns, dealing with head lice, etc. My experience with g-tubes, IDDM management, anaphylactic shock, food poisoning, child abuse, etc were little to none. It would've been sink or swim, learn-on-the-job same as a well-trained health care tech. If there were a real emergency, basic first aid & call 9-1-1 (same as a new health care tech) - is all I would've had to offer as a licensed, inexperienced nurse.

Anyway, just food for thought!

But at least as an RN student, you had 2 years of classes/education to teach you these skills. And you do pull knowledge from your clinical training too. A trained health care tech gets their training on the job, with no little or no classroom. And their training is usually a week long, and they are taught the same thing you learned and end up doing the same skills that you do. As well as being task trained, they also assess children. How else can you treat an asthma attack or a bee sting without assessing them?

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Specializes in school nursing.
Lets all remember nursing judgment and nursing assessment can not be delegated to unlicensed staff. These people do practice nursing "tasks" under our license, but they are NOT critically thinking professional nurses! I have refused certain people to perform some tasks if I did not feel they could do it safely and to my standards.

We must not forget what our Nurse Practice Act dictates! And remember, having a license means that we have proven that we have the education and have passed a test that proves we are capable of performing nursing only tasks.

Health aides make a great contribution and fill the gaps in the school system. However, it is unsafe when they are not properly supervised by an RN!

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What a school nurse is responsible for varies as well. I'd argue that an RN isn't required to cover all school health care needs. (I'm not stronly committed to this argument, just some thoughts as I think of them.)

If we're talking primarily bee stings, falls from play equipment, diabetic crises, seizures, tummy aches, menstrual cramps and the like, that doesn't require an RN necessarily, does it? Lifeguards, EMTs, camp counselors, hiking leaders, babysitters all need to be prepared to handle such cases even if it just means keeping the victim calm and calling 911 or having a parent come pick the child up.

Dealing with g-tubes or daily routine medication administration I think also can be easily handled by unlicensed staff so long as they have a professional resource to provide training and back-up.

Health education in the classroom? I'd love to see more of it! Again, does that require an RN? RN education has incredible bredth but not depth. So it wouldn't take much for any motivated layperson to quickly get up to speed on basics like hand-washing (how and why) and the importance of a balanced diet and be able to make presentations to classes. Yes, an RN is well-positioned to take on such a role but so are many non-RNs such as those with degrees in health education or public health.

Keeping track of immunizations and school-wide health promotion (eg providing anti-bacterial gels in classrooms, working with food services on nutrition issues) don't require licensed nurses either. I think BSN programs do require more public health training but there are also many non-RNs out there who could also carry out these type of roles.

So where do I think a licensed nurse would be necessary in school health? I'd think it would be in initial assessments, care planning, and regular check-backs on any child with known health care needs that an aide and/or teacher is going to be dealing with. In other words, a licensed nurse might only be required as a clinical case manager for special health care needs students. Other school health functions could be managed by RNs or non-RNs. That doesn't mean that certain roles could be performed by just anybody for minimum wage, however! Just that an RN may not be required for many of the roles of that school nurses play.

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I think your example is right to the point. I can not see how anyone could disagree.

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