Role in behavior monitoring

[LilyRN99]

I go to school with a teenager with a heart condition and behavior problems. I monitor her respiratory status, carry an O2 tank and bring a wheelchair everywhere we go in case of fatigue. I help her on and off the van, unpack/pack backpack, assist with toileting, supervise lunch, help her navigate between classes. As instructed by her teachers, I've been giving her visual and verbal cues to help her complete certain activities. I offer encouragement and positive reinforcement with a token board per teacher's instruction. My concern is when her behavior becomes difficult (yelling, hitting, refusing to do what is asked) that I am also supposed to be firm and offer physical cues. I've seen what staff does with some of the other behavior issues of other students and I am not comfortable with raising my voice or physically grabbing a patient/client to get them off the toilet/to wash their hands or whatever the task is. I was shown the student's IEP and told that all the instructions there are for me to follow as I am indirectly an employee of the school. My feeling is although staff and I have the same goals for the student my role as a nurse is slightly different. Nurse's don't yell or discipline. I asked my nursing agency and she doesn't have a 485 since the case is through the school. They didn't offer me any guidance. I want to be a professional nurse. What is my role in behavior management?

[JustBeachyNurse, LPN]

You aren't employed by the school but the nursing agency. You still need a 485 unless you are working as a school paraprofessional not a 1:1 nurse. The one agency that didn't do 485 for school cases was removed from the school. Your agency is your employer.

[Kitiger, RN]

You aren't employed by the school but the nursing agency. You still need a 485 unless you are working as a school paraprofessional not a 1:1 nurse. The one agency that didn't do 485 for school cases was removed from the school. Your agency is your employer.

JustBeachyNurse, you are spot on.

I have never worked for a client who didn't have a 485 (or Doctor's Orders, back in the day). Nowadays, the 485, when signed by the doctor, IS your Physician's Orders, the umbrella under which you work.

I assume you have written Physician Orders pertaining to all the specific nursing care that you provide. You don't accept care of any client without Physician Orders.

If a 485 is not available, work with your nursing agency to create one. There is a ton of information that you can supply to your supervisor, although it is your supervisor's responsibility to actually create the 485. Your supervisor should work with the school - or at least request a copy of the IEP since the IEP is central to the problems that you are having - and take that information, your information, and the Physician orders and combine it into a 485 that the doctor signs.