Need advice

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The other day one of the administrators at my school asked me to give her weekly allergy shots. Well, I felt funny about it but I have epi so I figured I would not fuss, even though I have no experience in this area. Now today, another administrator asked me to give his daughter her birth control shot that she takes every three months. She is not a student, but an adult. I was even more uncomfortable but I could not very well say no. Then, she immediately showed up, injection in hand with no dose or anything on the label. I frantically searched Google to get the scoop on this drug- I never worked in a gyne office either. I told her I could not give a drug unless I knew something about it- I did not even know if it was IM or what site or anything. So I hurried as best I could and looked it up and gave it.

My concern is, these kind of things are way out of my realm. Allergy shots are dangerous, and giving an IM to a person who is not under my care is just plain risky. What are your thoughts? Am I just paranoid? Do you do favors like this at your job?

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Specializes in School Nursing.

I would not give either. You're risking your liscense and opening up all sorts of liability issues.

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How do you say no in a situation like this? It is bad enough that they don't understand school nursing or treat me like a professional, but now they put me in this kind of a position. I just don't know what to do. They could make my life really miserable if I say no. Then, the daughter tells me she can't afford the doctor office charge, but Daddy is probably making $100,000 a year. And the allergy shot one just doesn't want to go to the office during work time. I never dreamed people would ask me to do these things.

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There is no way on earth that I would continue to do this if I were you. Probably more and more ppl will keep asking you to do this. This puts you and the school in a serious liability possibility. I don't imagine the school board would want you to do this. You say that administrators asked you to do this--- so don't know if one was the supt... I bet if the supt called the school lawyer.... he/she would advise against it... maybe this would be a way to get out of continueing this... you are responsible for whatever happens. I wouldn't even do it with an order directly from the dr. Sorry about this difficult situation... I hope you can get it worked out really quickly. GOOD LUCK!! Remember you worked hard for your license and you are the one that has to protect it.

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Specializes in Med-Surg, College Health, School Nursing.

I totally agree with you and your concerns. The people asking you to do these things don't realize how inappropriate it is because they aren't nurses. I don't blame you at all for giving the two things already, but next time explain the dangers to them (and to your license if you want to!) and offer to help them find a convenient place to get their needs met. If they understand your concerns for their safety they should be fine with it, if not, you can't please everyone!!

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Specializes in School, Camp, Hospice, Critical Care.

My "test" for such "convenience" requests is "Is there a legitimate medical reason why this needs to be performed or given during the course of the school day?" If they claim yes, then I request a written MD order to that effect; I also require meds with the Rx label intact, indicating pt, med, dose, etc. We have these same requirements of the students prior to med administration, and I just tell them they have to follow the same standard.

Perhaps you can cite your state's DOE med administration requirements, state pharmacy regs, or the state Nurse Practice Act as the reasons why you can't continue to administer these meds. I always tell staff that where medications are concerned, I answer to a higher power than the school administration: the State Board of Nursing.

They've put you in an uncomfortable position, but I find there are always going to be a couple of staff members who don't like the policies and procedures in my office. I follow the state regs, standards for safe practice, and the policies set forth by the school board--if somebody doesn't like it, they just have to get over it. Luckily, I have a principal who is very supportive.

Good luck!

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Specializes in Maternal - Child Health.

You have no established nurse/patient relationship with these people, and no physician order for the care they are requesting.

I am quite sure that your district's legal team would agree that these requests are inappropriate and it would be legally risky for you to comply with them.

Not to mention that these people are probably covered under the district's insurance plan. Let them go to the doctor's offic and pay their copay just like everyone else.

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We talled about giving adults injections in school last April and I posted the following response:

Is staff health part of the school nurse job description?

Is there a doctors order?

Can it be administered privately? (could kid's walk in?)

Does the school's insurance cover administering injections to staff?

Is the med administration is recorded on a med administration sheet in a chart for only that individual?

Can the staff teachers records be protected with HIPAA level security? (They are not covered by FERPA like the students)

If the above are a yes, ....

.....unless you have a crash cart, emergency plan, and a policy that states injection, including allergy shots can be administered to staff in the school, and a way to bill for it ......

...don't.

If the person went to their providers office, which has the crash cart emergency plan and is paying out the wahzoo for the insurance to cover it, they would pay for the visit. Why would a nurse risk their license and put the school in a risk of liability for free?

Hormone shots are less risky and I would not administer them to a teacher in a work situation either unless all the above is in place, part of the school nurse role and job description is occ health, and I could bill their insurance.

__________________

Martha Bergren

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Specializes in Coronary Care, School Nurse.

On a related note, how do you handle these types of requests outside of the school? Does anyone give injections for friends going through infertility and/or other situations?

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Specializes in Cath Lab, OR, CPHN/SN, ER.

I've had coworkers who have given allergy injections for school staff. She was located in the office, so she was close, and had taken the shots before without any adverse reaction. She brought doctors permission, MAR, and all the paperwork to cover that end.

The depo? Heck no.

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Specializes in Maternal - Child Health.
On a related note, how do you handle these types of requests outside of the school? Does anyone give injections for friends going through infertility and/or other situations?

Nope. Their physician's office needs to provide the patient and family with teaching on care at home. It is not reasonable to take on this liability. If the family is unable to meet this need, then they can make daily office visits for the injections or arrange for home health.

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Specializes in Emergency & Trauma/Adult ICU.

No way, no how, absolutely not.

"How do you say no in situations like this?" You just say, "no, that is outside the scope of my duties here."

Period.

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