School nurse praised for quick thinking

Jolie, BSN · Sep 17, 2005

I'm so glad to read that the little boy is doing well thanks to the school nurse's actions.

But the article raises more questions in my mind than it answers. In our school district, the nurse is not allowed to administer any medications at all without a doctor's prior written authorization. Not even Tylenol. Not even with parental consent. So in our district, the nurse would not have been allowed to intervene in this manner. Also, since the little boy did not have a known allergy to bee stings, I assume that the epi-pen did not belong to him. Did the school have one in stock? (Which I think ALL schools should have?) Or was the nurse lucky enough to have access to another student's epi-pen? Does anyone know?

Also, do school nurses typically have some kind of standing order from a district physician regarding emergency treatment of life-threatening allergies? Sadly, in our district, the only option would have been to call 911.

peaceful2100, BSN, RN · Sep 18, 2005

I don't know about that district

I am only a Sub for now in one district now but I plan to sign up with some other districts here soon. I went in for observation/orientation day yesterday and noticed that they do have a Epi-Pen on stock in the health rooms.

Also the district has a M.D. that is in the community as the consultant and he has given the district standing orders for all schools.

However, for medications like Tylenol that MUST have a parent's permission.

suebird3 · Sep 18, 2005

I'm so glad to read that the little boy is doing well thanks to the school nurse's actions.
But the article raises more questions in my mind than it answers. In our school district, the nurse is not allowed to administer any medications at all without a doctor's prior written authorization. Not even Tylenol. Not even with parental consent. So in our district, the nurse would not have been allowed to intervene in this manner. Also, since the little boy did not have a known allergy to bee stings, I assume that the epi-pen did not belong to him. Did the school have one in stock? (Which I think ALL schools should have?) Or was the nurse lucky enough to have access to another student's epi-pen? Does anyone know?
Also, do school nurses typically have some kind of standing order from a district physician regarding emergency treatment of life-threatening allergies? Sadly, in our district, the only option would have been to call 911.

I wonder, too. I would worry about the districts that have to call 911. anything can happen, and so quick.....and our licenses are on the line, too.

DG5 · Sep 18, 2005

At the highschool where my daughter is, a nurse only comes once or twice a week. My worry is that by the time the school staff try to figure things out, calling 911 may be too late. Its a really scary thought.

bergren · Sep 18, 2005

The next time I attend a legal seminar, I'd like to ask the question about administering Epi Pen without an order. Many districts do have standing orders.

The number one location of anaphylactic reactions is in schools. I actually wonder of a nurse would encounter litigation for NOT administering it without an order since we know the consequences would be death. A nurse would probably not be found at fault, but the problem is living with the fact that you let the child die.

What would you do?

suebird3 · Sep 18, 2005

The next time I attend a legal seminar, I'd like to ask the question about administering Epi Pen without an order. Many districts do have standing orders.
The number one location of anaphylactic reactions is in schools. I actually wonder of a nurse would encounter litigation for NOT administering it without an order since we know the consequences would be death. A nurse would probably not be found at fault, but the problem is living with the fact that you let the child die.
What would you do?

Bergren.....when you do find out, drop me a line. I live a bit South of you.

Personally, I would use the Epi. I do Living History, and 2 people in our Brigade are severely allergic. True, we "didn't have" Epi back then, but if I have to, I would use it...on them OR the child.

Jolie, BSN · Sep 18, 2005

The next time I attend a legal seminar, I'd like to ask the question about administering Epi Pen without an order. Many districts do have standing orders.
The number one location of anaphylactic reactions is in schools. I actually wonder of a nurse would encounter litigation for NOT administering it without an order since we know the consequences would be death. A nurse would probably not be found at fault, but the problem is living with the fact that you let the child die.
What would you do?

I would administer the Epi-pen as well, and deal with the legal fallout later, as I believe most nurses would. But I could certainly envision a scenario where a school nurse might not do so out of fear of her license and her job. I am fortunate to be in a situation where working is not a financial necessity for me, and I think that would influence my decision. Losing my job (and perhaps my license), would be heartbreaking, but would not ruin my family financially.

If you are able to get a legal opinion, please post it here. It would make for very interesting reading! Thanks.

nitengale75 · Sep 18, 2005

The next time I attend a legal seminar, I'd like to ask the question about administering Epi Pen without an order. Many districts do have standing orders.
The number one location of anaphylactic reactions is in schools. I actually wonder of a nurse would encounter litigation for NOT administering it without an order since we know the consequences would be death. A nurse would probably not be found at fault, but the problem is living with the fact that you let the child die.
What would you do?

I am in central Illinois just south of you. We do not have standing orders for an epi-pen as we do not have a school physician. I do not even have any epi-pens for other students I could use. When I went to Boston 2 summers ago for my M.Ed., a school nurse from the Boston area had just lost a son, age 19 (I think). He had a peanut allergy and ate a nut he thought was safe. However, he started anaphylactic shock symptoms, administered his own epi-pen but died before 911 appeared while he was searching for a second pen. Please let us know if you find out any legalities regarding epi-pens.