Medication Mishap

Specialties School

Published

Got a student who has ADHD badly and she tends not want to take her medication and I was told in the beginning that she's a liar and that we need to keep an eye on her to take her medication. I wanted to trust her and help her, but sadly it didn't work out.

Today she came to take her medication. I gave it to her like always, and she proceded to go to the water fountain to take her meds. The secretary called out to me and told me she threw away the medication. I then proceded to give her another one, which this time I saw her take it.

My AP called me and asked me if she took her medication or not, and I told her she threw away the first pill and I gave her another one. She got upset because she said we didn't see her take the medication and gave her one, and the child told her she took it, but opened the capsule and took the contents. She never has done that with me, she always took the pill whole. Then the child changed the story to that she didn't take it.

My AP was upset with me because she said that I'm not doing my end of the bargain which was watching her take her medication and that yesterday was the second time I didn't give it to her on time.

I explained to her that yes, it was my mistake I didn't check before I gave her another dose, but I can't do anything if she doesn't take her medication.

She is upset, and wants to talk to my principal, which I did before her, explaining that I'm not sure how we can do this with this child, she is difficult and I now know why we can't trust her.

I wanted to give her trust but obviously she can't be trusted. It was my mistake and I am trying to fix this situation by finding a solution, but I'm not sure how I can defend myself when I talk to my AP.

I know this will be another written warning and I will write a rebuttal but I'm not sure how I can defend myself on this.

Yes, it was my fault, and I made a mistake and I'm willing to fix the situation, but what I do I tell her.

What OldDude said x 1 million!!!

I was a MA before I went to nursing school. Looking back, I didn't know what I didn't know!!! Glad I only worked in a Dr. Office then. I could not imagine being a school nurse without having a clear picture of the boundaries and legalities involved.

Specializes in Cardiology, School Nursing, General.
If mom told you to do a tongue check on the student, then you do the tongue check EVERY TIME. You do not allow the student to leave the room to take her medication unsupervised when mom has specifically asked you to visually assess whether the student has taken her medication or not. Medication administration is NOT the time to try to establish trust with a student who has the history you are describing.

It sounds to me like you wanted to be "the one" who this student could come to, and that you are empathetic to her situation. I can appreciate that, but you were told by multiple people/her files that she is defiant and a compulsive liar, yet you trusted her to leave your office and your supervision, to take a controlled medication on her own. And even though you have some personal experience and have read some stuff, you are not trained or qualified to be the person who helps this student overcome her issues, unfortunately.

I have to agree with other posters here. Based on this and the multiple other issues you are having at this place of employment, it might be time to consider another career option. And maybe do some soul searching. A lot of the issues you seem to have are with your coworkers. In my opinion (for what it's worth anyways), I can see having an issue with 1 or maybe 2 coworkers. You seem to have issues with everyone, from your secretaries to your AP, to your direct supervisor. You talk about reporting people for real (or perceived) things they have done to you. Have you considered that the common denominator for all of these people you have issues with is.....well, you? Things to think about: do you come off as abrasive? Are you polite (even if you are super irritated inside)? Do you ask questions when you are unsure of something? Do you talk down to people? Do you smile? Do you engage in small talk... like "Your son was sick the other day, is he feeling better?" What do you think you can do to improve your relationship with your coworkers?

I am not saying you do or don't do any of these things. Just some food for thought for you.

I know you have been struggling a while in this position. And I truly believe you do have the best interest of your students at heart. But you have to be SAFE about it. And what you did with this student was not safe (I think you know that now).

In all honesty I have. But I never done anything to anyone. I'm always polite and talk nicely to others. But because of my mistakes the people in charge of me are upset with me. This is why. It's not my personality but my work ethics and I'm trying my hardest to fix how I work but it's hard. I'm getting in trouble a lot lately and I don't like it. I'm not a nurse but they expect a nurse job from me. And it's getting very pressured here.

I heard you all, I want to leave but if I do quit, I want to do it right so it will look good on me and my next employer. At least giving them time to look for someone.

Specializes in Cardiology, School Nursing, General.

Thank you to the regulars who actually understands where and what I'm coming from. To the others who do not belong in this part of our forum, actually read my posts! Don't just type and put things. You do not understand my struggle or ours.

Specializes in IMC, school nursing.
Never working in health care again, would be best for all.

Referring to kids as brat's .. indicates you should not be anywhere near them. If you knew the medication caused loss of appetite, stomach pains and vomiting, you should have held it and discussed those complications with her doctor and parents.

Being a health care giver is NOT about you.

Note the forum you are discussing. We don't make those calls in the educational settings. We report to parents if new, obviously this is ongoing and the physician has deemed this med most effective. Please realize your knowledge deficit in this arena. I knew this would become chum on the general boards. We are coworkers here with the same dynamics as any acute care nurses' station. Please realize you are a guest here and your viewpoint may not be appropriate, as I don't go to the maternity boards and share my experiences. Thanks.

Specializes in Travel.

This is precisely what I came here to say.

Specializes in Travel.

Hey Amethya,

You should have someone who is your direct supervisor to ask advice of before you give a second dose of medication. Don't get nervous and get pressured into giving a second dose until you have contacted your supervisor to ask for guidance. That's what he or she is there for. Another option is to call in a second person by prearrangement to witness you dosing the patient. Talk to the secretary or the principal and ask who could come in to witness the patient being dosed.

This is just a difficult patient, and you need additional skills to manage her. Until you can learn those skills, get a witness, get a pitcher from the dollar store and don't let the patient leave without swallowing, or get lunch cups of applesauce to open a capsule into.

Please don't hesitate to inbox me if you need additional help. Hang in there!

Specializes in Cardiology, School Nursing, General.
Hey Amethya,

You should have someone who is your direct supervisor to ask advice of before you give a second dose of medication. Don't get nervous and get pressured into giving a second dose until you have contacted your supervisor to ask for guidance. That's what he or she is there for. Another option is to call in a second person by prearrangement to witness you dosing the patient. Talk to the secretary or the principal and ask who could come in to witness the patient being dosed.

This is just a difficult patient, and you need additional skills to manage her. Until you can learn those skills, get a witness, get a pitcher from the dollar store and don't let the patient leave without swallowing, or get lunch cups of applesauce to open a capsule into.

Please don't hesitate to inbox me if you need additional help. Hang in there!

Thank you so much and I shall!

May I ask your age?

I think a lot of people need to remember that laws vary state by state. I looked up Texas Medical Asssistant Laws and found this link:

Page not found

Within the link I found this:

"The term "medical assistant" has no real legal significance. MAs are not licensed, certified, or registered by any agency of the State of Texas, nor are they recognized under federal Medicare or Medicaid laws as a species of "provider." There is no reference to MAs in the Medical Practice Act or any other Texas Statute. Thus, there is no specific legal regulation of MAs.

What can a Medical Assistant do? Since there is no specific legal regulation of MAs, one has to look to the general delegation clause in the Medical Practice Act, cited above. The scope of MA "practice" is governed by this general provision, meaning that the MA's education and experience are matters that the supervising physician must take into consideration when giving them direction. The supervising physician may delegate tasks to the MA when he or she is satisfied that they are "qualified and properly trained" and the task delegated can be "properly and safely performed."

I think therein lies the problem. OP is practicing as an MA in a state with little to no regulation, allowing for the RN and or MD in charge to delegate whatever they see fit. It is a very unfortunate and dangerous position for OP to be in and it seems likely there are many other MAs in similar positions in her state of Texas.

I also found this link:

School Health Services - Nursing Practice Resources

Clearly states schools cannot employ someone as "nurse" , without proper credentialing, but I am sure the school can just say since they don't call her a "school nurse" they aren't doing anything wrong.

§ 21.003. Certification Required.

(a) A person may not be employed as a teacher, teacher intern or teacher trainee, librarian, educational aide, administrator, educational diagnostician, or school counselor by a school district unless the person holds an appropriate certificate or permit issued as provided by Subchapter B.

(b) Except as otherwise provided by this subsection, a person may not be employed by a school district as an audiologist, occupational therapist, physical therapist, physician, nurse, school psychologist, associate school psychologist, licensed professional counselor, marriage and family therapist, social worker, or speech language pathologist unless the person is licensed by the state agency that licenses that profession and may perform specific services within those professions for a school district only if the person holds the appropriate credential from the appropriate state agency.

If a school district hires a licensed vocational nurse (LVN), the LVN must be supervised in accordance with Chapter 301 of the Occupations Code. Supervision must be provided by a registered nurse, a physician, a physician's assistant, a podiatrist, or a dentist.

According to the Texas Board of Nursing (BON), "The licensed supervisor is responsible for overseeing the LVN's nursing practice and actively engages in a supervisory process that directs, guides, and influences the LVN's performance of an activity.

The NPA and Board rules and regulations prevent an LVN from practicing in a completely independent manner (that is, without a licensed supervisor); however, the NPA and rules are silent as to the proximity of the licensed supervisor. There are many factors to be considered in determining how quickly the licensed supervisor needs to be available to the LVN. Factors to be considered should include: (1) the type of practice setting; (2) the stability of the patient's condition; (3) the tasks to be performed; (4) the LVN's experience and (5) any laws and regulations that apply to the specific practice setting. The proximity to the LVN's practice setting and the type of licensure of the licensed supervisor should be determined on a case-by-case basis with input from the LVN and his/her licensed supervisor. The appropriate licensed supervisor must be accessible to the LVN at least telephonically or by similar means. To illustrate, compare the LVN who performs routine nursing tasks or nursing tasks learned through ongoing continuing nursing education (such as intravenous therapy) with an LVN who performs a delegated medical act (such as Botox administration). These are different situations and will differ in who (RN or physician) is appropriate to supervise the LVN as well as the proximity of the licensed supervisor. Other regulations, such as those related to reimbursement, may also be a factor in the latter situation."

My whole point is that is seems OP is employed within a school that doesn't prioritize student safety over saving money, and OP will continue to be asked to perform duties that are outside either her scope of practice, her comfort zone, or both. I do not know what type of supervision you are getting OP (district RN, MD, etc.) but whoever is technically supervising you, is also putting their own license at risk.

For your own sake, I would begin he process of finding a position where you have better supervision, collaboration with colleagues who can advocate for you and assist you, and in general, put yourself somewhere where you will be valued and not be put at risk on a daily basis. Just my .02

Specializes in Cardiology, School Nursing, General.
I think a lot of people need to remember that laws vary state by state. I looked up Texas Medical Asssistant Laws and found this link:

Page not found

Within the link I found this:

"The term "medical assistant" has no real legal significance. MAs are not licensed, certified, or registered by any agency of the State of Texas, nor are they recognized under federal Medicare or Medicaid laws as a species of "provider." There is no reference to MAs in the Medical Practice Act or any other Texas Statute. Thus, there is no specific legal regulation of MAs.

What can a Medical Assistant do? Since there is no specific legal regulation of MAs, one has to look to the general delegation clause in the Medical Practice Act, cited above. The scope of MA "practice" is governed by this general provision, meaning that the MA's education and experience are matters that the supervising physician must take into consideration when giving them direction. The supervising physician may delegate tasks to the MA when he or she is satisfied that they are "qualified and properly trained" and the task delegated can be "properly and safely performed."

I think therein lies the problem. OP is practicing as an MA in a state with little to no regulation, allowing for the RN and or MD in charge to delegate whatever they see fit. It is a very unfortunate and dangerous position for OP to be in and it seems likely there are many other MAs in similar positions in her state of Texas.

I also found this link:

School Health Services - Nursing Practice Resources

Clearly states schools cannot employ someone as "nurse" , without proper credentialing, but I am sure the school can just say since they don't call her a "school nurse" they aren't doing anything wrong.

§ 21.003. Certification Required.

(a) A person may not be employed as a teacher, teacher intern or teacher trainee, librarian, educational aide, administrator, educational diagnostician, or school counselor by a school district unless the person holds an appropriate certificate or permit issued as provided by Subchapter B.

(b) Except as otherwise provided by this subsection, a person may not be employed by a school district as an audiologist, occupational therapist, physical therapist, physician, nurse, school psychologist, associate school psychologist, licensed professional counselor, marriage and family therapist, social worker, or speech language pathologist unless the person is licensed by the state agency that licenses that profession and may perform specific services within those professions for a school district only if the person holds the appropriate credential from the appropriate state agency.

If a school district hires a licensed vocational nurse (LVN), the LVN must be supervised in accordance with Chapter 301 of the Occupations Code. Supervision must be provided by a registered nurse, a physician, a physician's assistant, a podiatrist, or a dentist.

According to the Texas Board of Nursing (BON), "The licensed supervisor is responsible for overseeing the LVN's nursing practice and actively engages in a supervisory process that directs, guides, and influences the LVN's performance of an activity.

The NPA and Board rules and regulations prevent an LVN from practicing in a completely independent manner (that is, without a licensed supervisor); however, the NPA and rules are silent as to the proximity of the licensed supervisor. There are many factors to be considered in determining how quickly the licensed supervisor needs to be available to the LVN. Factors to be considered should include: (1) the type of practice setting; (2) the stability of the patient's condition; (3) the tasks to be performed; (4) the LVN's experience and (5) any laws and regulations that apply to the specific practice setting. The proximity to the LVN's practice setting and the type of licensure of the licensed supervisor should be determined on a case-by-case basis with input from the LVN and his/her licensed supervisor. The appropriate licensed supervisor must be accessible to the LVN at least telephonically or by similar means. To illustrate, compare the LVN who performs routine nursing tasks or nursing tasks learned through ongoing continuing nursing education (such as intravenous therapy) with an LVN who performs a delegated medical act (such as Botox administration). These are different situations and will differ in who (RN or physician) is appropriate to supervise the LVN as well as the proximity of the licensed supervisor. Other regulations, such as those related to reimbursement, may also be a factor in the latter situation."

My whole point is that is seems OP is employed within a school that doesn't prioritize student safety over saving money, and OP will continue to be asked to perform duties that are outside either her scope of practice, her comfort zone, or both. I do not know what type of supervision you are getting OP (district RN, MD, etc.) but whoever is technically supervising you, is also putting their own license at risk.

For your own sake, I would begin he process of finding a position where you have better supervision, collaboration with colleagues who can advocate for you and assist you, and in general, put yourself somewhere where you will be valued and not be put at risk on a daily basis. Just my .02

Basically hit it right in the nail, it's in Texas where I live in.

I am doing this at time, hopefully find something soon.

Specializes in IMC, school nursing.
Basically hit it right in the nail, it's in Texas where I live in.

I am doing this at time, hopefully find something soon.

Print out the above and keep it handy. Your employer is operating against the law and the sate's Nurse Practice Act. They are liable for everything.

Specializes in RETIRED Cath Lab/Cardiology/Radiology.

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