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 .
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?
Where do we draw the line? Can a non-licensed person really handle a diabetic crisis? Can a non-licensed person listen to lung sounds in an asthma student? A non-licensed person can be taught the 5 med rights, but do they understand the pharmacology of that med? We are seeing higher health needs in today's students. As an RN, I dont always know the answer BUT I have the critical thinking skills and knowledge to know where / when to ask for help. Is that something that can be taught to a non- licensed person?
I know everyone has their own opinion. I would like to speak my few cents in this matter. Speaking about the teacher techs or aids. This may not be a bad idea because how many parents home school their children. I know they all are not certified teachers. How about the daycare providers. They can go to social services can recieve some kind of paper that only allow them to care for maybe five children at a time. These home day care providers do not have an Early Childhood Development degree. To top it off I know people who are teaching that do not have a degree in teaching and didnt take a certification of any kind to teach our students. So tell me, what is this world coming to? Everyone is trying to take the cheaper route. To save money for what their pockets. Just a thought.
I know everyone has their own opinion. I would like to speak my few cents in this matter. Speaking about the teacher techs or aids. This may not be a bad idea because how many parents home school their children. I know they all are not certified teachers. How about the daycare providers. They can go to social services can recieve some kind of paper that only allow them to care for maybe five children at a time. These home day care providers do not have an Early Childhood Development degree. To top it off I know people who are teaching that do not have a degree in teaching and didnt take a certification of any kind to teach our students. So tell me, what is this world coming to? Everyone is trying to take the cheaper route. To save money for what their pockets. Just a thought.
I have to agree with this. I think teacher techs would work great for teaching students--as someone pointed out do you really need someone with a masters degree to teach first graders? Especially if there is a pre packaged module that has been prepared by a certified teacher, that could supervise several "teacher technicians." It doesn't take a masters degree to teach-- I homeschooled both my kids from 4-6th and their state test scores soared!
But are we dumbing down America by task training people to do careers that, in the past, have required a college degree, all in the name of saving money? Is this the direction that the country really wants to go? During lunch, I have been asked questions about the cognitive effects of DM on school children and how do BS levels affect learning. Today I assessed a child in a wheel chair and talked to her mom about issues related to being multiple handicapped. Too many issues have come up that it would take an RN to recognize. Yesterday, during hearing screens, I noticed an underweight child that I checked on that it turns out was already being followed by an MD. Would a health aide recognize these things? I spoke to a child today that has been a real behavior challenge that I thought was showing early signs of mental illness--yet no on had thought to do a psych eval on the student.
I think we are short changing students by allowing health techs to become RN replacements. By using techs, we are losing a sense of professionalism that is vital to society.
remember nurse techs, health aids, teachers, etc. cannot, and i will repeat it, cannot do assessments, etc. someone has pointed this out in a previous post. please review your nurse practice act. i would never delegate those tasks to anyone under my license.
that said i would like to respond to the following:
"bee stings, falls from play equipment, diabetic crises, seizures, tummy aches, menstrual cramps and the like".
bee stings can turn into anaphylaxis. if you don't know the "pending" s/sx when full anaphylaxis is realized it could be too late. falls from play equipment need to be assessed extensively. a child who falls could have internal injuries including a closed head injury that if you do not assess appropriately and periodically you could miss something very serious. how many times have you heard "well there isn't a bump"? if there isn't a bump you better be worried. a diabetic crisis is one of the most common medical conditions that 911 are called for by parents and care givers because they do not know what to do. i can't think of the number of times i looked at my diabetic student's lunch trays and questioned the portion size and have had to march back to the kitchen to find out who was serving that day and had to ask how many ounces the spoon they are using was. would someone who wasn't paying such close attention to the details bothered to do that? just a half of unit extra in insulin can drop a child into a diabetic seizure do to blood sugar being too low. sometimes a diabetic crisis is unavoidable but it is the management of the disease that is so important and cannot be taken lightly. seizures are another issue. a minor form of seizures can occur but would you know what to do if a child began to seize and the seizure lasted more than 5 minutes or was followed by cardiac arrest? tummy aches and menstrual cramps also need to be assessed. either of these could actually be an obstructed bowel or even appendicitis both requiring emergency surgery. tube feedings are done by an rn...not assisting personnel. trachs fall out and must be replaced. vent students are very complicated and need an rn. asthma is probably one of the most common however many people fail to recognize the early s/sx of a child who is beginning to have problems. it is through good assessment skills that these problems are caught and the appropriate treatment given that keeps our children healthy and in class.
today's student population is not the same as the student population say 30 years ago. today, it is the right of all children to have an education and attend public school so we are seeing more and more children with what we would consider high acuity health issues that would have stayed at home way back when.
education has also changed. teachers are so focused on "no child left behind" that they tend to tell children to be quite and sit down and can easily miss the s/sx of a pending health crisis as it is occurring. teachers are also struggling with large class sizes. i tell my medical fragile children that if they are having trouble they are to grab the student next to them and head to the health office not asking permission to leave the classroom. i tell them in front of the teacher and in front of their parents too. i can assure you that if a medically fragile child gets up and starts for the health office a call will go to the office and we go into "all hands on deck" mode and we have procedures and protocols in place to provide quick help.
so please, do not assume that lay people can replace and rn or school nurse.
bee stings can turn into anaphylaxis. if you don't know the "pending" s/sx when full anaphylaxis is realized it could be too late. falls from play equipment need to be assessed extensively. a child who falls could have internal injuries including a closed head injury that if you do not assess appropriately and periodically you could miss something very serious. how many times have you heard "well there isn't a bump"? if there isn't a bump you better be worried. a diabetic crisis is one of the most common medical conditions that 911 are called for by parents and care givers because they do not know what to do. i can't think of the number of times i looked at my diabetic student’s lunch trays and questioned the portion size and have had to march back to the kitchen to find out who was serving that day and had to ask how many ounces the spoon they are using was. would someone who wasn't paying such close attention to the details bothered to do that? just a half of unit extra in insulin can drop a child into a diabetic seizure do to blood sugar being too low. sometimes a diabetic crisis is unavoidable but it is the management of the disease that is so important and cannot be taken lightly. seizures are another issue. a minor form of seizures can occur but would you know what to do if a child began to seize and the seizure lasted more than 5 minutes or was followed by cardiac arrest? tummy aches and menstrual cramps also need to be assessed. either of these could actually be an obstructed bowel or even appendicitis both requiring emergency surgery. tube feedings are done by an rn...not assisting personnel. trachs fall out and must be replaced. vent students are very complicated and need an rn. asthma is probably one of the most common however many people fail to recognize the early s/sx of a child who is beginning to have problems. it is through good assessment skills that these problems are caught and the appropriate treatment given that keeps our children healthy and in class.
i agree with all of that. my points are
1) there are many environments with kids with the same day-to-day risks (injuries,allergies) and kids with controlled chronic conditions (diabetes, asthma) that don't have rns on hand (swimming pools, day camps, day care, pre-school, etc).
2) having an rn license in no way means that one is necessarily well- equipped to handle the above scenarios; i know upon graduation i had very limited exposure to and familiarity with emergency/first aid care, managing/recognizing diabetic crises/seizures/cardiac arrest/obstructed bowel/appedicitis/replacing a trach/managing a vent; i would've been learning and developing those all important assessment skills on-the-job and through self-study, same as if my training were emt, lvn, multiple levels of red cross first aid courses. i can see that rn training is a great foundation, but i'm not convinced (convince me!) that it's a necessary requirement to be able to skillfully provide many aspects of school health services. again, i am by no means saying that "just anyone off the streets" could do a good job; i'm just not sure that requiring an rn license is necessary for the provision of many school health services.
I was a school health aide for about three years. I worked under a RN who had a cluster of two schools.
I would report any abnormalities to her and she would come to the school and do further assessment and treatments as needed. I was also required to have cna training and med tech training. I do see where the op is coming from. It is much cheaper and less safe to have health aides in healthrooms then rns.
However, I was a darn good health aide. I never worked out of my scope and my students and stafff respected me and relied on me to react in emergencies situations. Luckily I was in nursing school at the time and had more in depth knowledge about certain situations.
Well, what can we do about it... nothing. Now days its all about money. I believe all schools should have a LPN or RN, but that is not realistic in many schools. So until then staff, students, and parents have health assistants.
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SchoolNurseBSN
381 Posts
Where do we draw the line? Can a non-licensed person really handle a diabetic crisis? Can a non-licensed person listen to lung sounds in an asthma student? A non-licensed person can be taught the 5 med rights, but do they understand the pharmacology of that med? We are seeing higher health needs in today's students. As an RN, I dont always know the answer BUT I have the critical thinking skills and knowledge to know where / when to ask for help. Is that something that can be taught to a non- licensed person?