School Nurse Undermined

[Nurse Beth, MSN]

Dear Nurse Beth,

I am a school nurse with a total of 34 years of nursing experience. I am managed by a non-medical person which is very difficult at times. When I receive an order that is incorrect, incomplete, or does not match the prescription bottle (policy), and I am unable to accept the order, or the medication and the parent complains to the administrator, who will come barrelling into my office and insist that I accept both the order and the medication. I try to explain that I am unable to accept orders that are incorrect, or incomplete, not signed , and don't match the prescription bottle because of patient safety, and my practice.

She becomes extremely angry, and insistent, and berates me in front of whoever is present, and constantly tells me how difficult I am being, and that I simply must not understand that I am upsetting the parents, and causing them to be frustrated when they are trying not to "piss off the parents". She has e-mailed parents that she does not understand why I won't accept orders before I even have an opportunity to explain to her why I was unable to do so. I simply don't know what to do. I stand my ground, and won't cave in, but it sure makes for a difficult working environment. Any suggestions?

Dear Stand My Ground,

Your administrator is more interested in placating parents than safety.

As a school nurse, you are an advocate for student safety.

Practice varies from state to state. Some states require a doctor's order for all medications, while some states allow school nurses to administer prescription meds according to the label.

Your best bet here is to print out the school's policy and state law. Schedule a meeting with the administrator and go over the policies. Explain that you cannot practice outside of the law, and keep bringing the discussion back to the law and school policies.

If she persists, ask her if she is really asking you to against policy?

She is undermining you to the parents as well. Tell her it's important for the two of you to work together and provide a united front.

If you are not a member, join the National Association for School Nurses.

The school nurse forum here on allnurses is also very informative and supportive.

Best wishes,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

[JKL33]

On 4/9/2019 at 6:09 PM, Nurse Beth said:

I try to explain that I am unable to accept orders that are incorrect, or incomplete, not signed , and don't match the prescription bottle because of patient safety, and my practice

Agree with the above advice.

One way or another it seems like maybe you have used terms that allow this individual to believe that there is some degree of personal preference in the choices you are making and/or that you are acting upon perceived dangers that don't exist.

Unless you are 100% certain of all applicable laws and policies already, review them carefully before proceeding. Then:

Use stronger language.

"I cannot break the law." (Not, "I'm concerned about safety")

"That is illegal." (Not, "Nursing rules say that we shouldn't...")

"I empathize with the parents' reactions, but that doesn't mean I can break the law."

Would an analogy help? Generally it isn't a good approach if an exaggerated or inaccurate analogy is used. But maybe she could better understand if she was asked to ponder skirting some of the rules that she considers "hard and fast."