not getting the help I need!

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I am the only nurse for a 2 school district (approx 800 students). We have a high mobility rate and are in a low income community. Prior to my hire last year, the district had never employeed a professional nurse. I have spent the last 2 years getting the district compliant as well as advocating for a second nurse. Our BOE does not see the necessity of hiring a second nurse, while the sup states that she does, but she tells me that her hands are tied.

Currently, I am in charge of mantaining all district wide state mandated paperwork (physicals, immunizations, dentals, eye exams), health plans district wide, IEP/504s district wide, recovering our failed hearing and vision screening program district wide, coordinating mobile health clinics district wide, maintaining emergency medications district wide, as well as maintaining the health office/stuent visits of 1 school. There is a health aid/secretary who is in the health office of the other school, whose respnosibility consists of student visits (which includes giving medications, care of a diabetic, and health assessments, which is not a part of her job description) and secretarial duties. I have to run much of what I do past administration before I do so (including self advocating to get a lunch break).

Although I am professionally responsible for both schools, I am aloted an hour a week to be at the other school unless I have a substitute nurse available to sit in my office at my main school. I have been named on documents and received calls from parents stating they have talked to me, when it was truly the health aid at the other school.

When I met with my administration regarding my concerns a few months back, we brainstromed some ideas to take some some of the load off of my plate. For example, the clearical stuff, like having someone else enter in the physical/immunization data into the computer for me and tag teaming with a secretary who is certified in hearing and vision (we would work together to complete the screenings, but I would take over the lead and follow up of the program). Both of those things were agreed upon during that meeting. They have recently been put back on my plate "to keep things accurate and consistent." More recently, I've started to get the "this needs to be done in a more timely manner next year" comments.

I feel like I am drowning and I also feel that the district is putting the student's health at risk as well as myself and the health aid at legal risk (although I'm constantly reassured that admin is assuming that liability). I can't decide if they just don't get it or if they are setting me up for failure. Do I stand a chance on convincing them somehow that I can't do it alone? I do enjoy the school where I am located at, but I am reaching my breaking point. I don't know where to go from here. Does anyone have any advice or thoughts for me?

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Specializes in ICU/community health/school nursing.

You are drowning and it's not your fault.

A 1:800 ratio on one campus is fine (mine is me plus my very qualified health aide to 2400). But you have leave to go to other campuses - I know many nurses do that and do it well but that would make me uncomfortable.

Thoughts: Enforce now that the secretary/aide states to parent s/he is the secretary/aide. You can't be responsible for what they tell parents.

Are you concerned about the delegation of the insulin to the unlicensed provider? You may not be but that's a start. Just because you CAN delegate doesn't mean you SHOULD. The data entry of the vaccine record CAN be delegated...but the assessment of the accuracy of the record cannot.

If they want things done quicker they're going to have to hire another nurse.

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Specializes in School Nurse, past Med Surge.

For me, unless there is an immediate change, there wouldn't be a next year. I'm fairly comfortable in assuming that if something did happen, that liability that they're claiming to be taking on would benefit the school alone.

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Specializes in school nursing, ortho, trauma.

i feel strongly that schools are quick to overlook the fact that the lack on a nurse being readily available is a major lawsuit point. They are quick to make the it department fat and happy and the guidance and cst department nice and full, but when it comes to the medical well being of the kids, it's bare bones all the way. I have never been able to figure out the rationale. Perhaps there have not been any really standout landmark court rulings that would change this - yet. In the meantime, i follow my nurse practice act, chart everything and keep my malpractice current

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Nothing to add, except CYA. I would be looking for another job.

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Specializes in Pediatrics Retired.

Two questions...what did this district do for state mandated compliance before you came to work for them and how far apart are the two campuses?

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Compliance was left up to the building secretaries who did the best they could.

The two campuses are 5 miles or a 10-12 minute drive apart.

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yes, flare, that is exactly how our district functions.

Thanks everybody. It is helpful to have my feelings validated.

I already keep records of interactions, most are via email, so it is at least documented, but I am going to be keeping stronger records for CYA purposes!

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Specializes in School Nurse, past Med Surge.

If you don't have your own insurance, I'd pick that up lickety split.

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Specializes in Telemetry, Gastroenterology, School Nrs.

Following this thread and sending you my deepest understanding. I am the ONLY nurse for all 4 of our schools (~1600 students) and I do not have subs or health aides. I am the lone provider, responsible for everything. I am to stay at my K-2 school unless there is an emergency. I am allowed to leave for an hour a day, at the end of the day to complete any of the millions of things that need to be done at the other buildings. I have been to board meetings and met with administrators, unsuccessfully. It's unsafe and unpractical and I dread the day that the roof comes caving in. Hopefully our colleagues will have some good advice!

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Specializes in Pediatrics Retired.

I'm in Texas but I would imagine your nurse practice act isn't much different. It appears you have been placed in a position with all the responsibility but no authority. You can be responsible for all the mandated reporting and district required procedures without having a RN license so that's a separate issue. What I would be mostly concerned about is you being held responsible for the actions of another associated with health interventions whom you're being held responsible for but someone you have no authority to delegate the tasks to. The campus principal is responsible for this person.

For instance, if I am not on campus, medication is administered by campus staff but I'm not responsible for that...the responsibility reverts back to the campus principal, i.e., if I don't perform the task or if the task is not performed by another licensed person to which the task can be delegated according to the nurse practice act.

I think this could be the ace up your sleeve. Gather all the information to convince your district the campus principal is responsible for health interventions on his/her campus since there isn't a licensed person for you to delegate tasks to in accordance with the nurse practice act.

Whadda ya say?

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I'm in Texas but I would imagine your nurse practice act isn't much different. It appears you have been placed in a position with all the responsibility but no authority. You can be responsible for all the mandated reporting and district required procedures without having a RN license so that's a separate issue. What I would be mostly concerned about is you being held responsible for the actions of another associated with health interventions whom you're being held responsible for but someone you have no authority to delegate the tasks to. The campus principal is responsible for this person.

For instance, if I am not on campus, medication is administered by campus staff but I'm not responsible for that...the responsibility reverts back to the campus principal, i.e., if I don't perform the task or if the task is not performed by another licensed person to which the task can be delegated according to the nurse practice act.

I think this could be the ace up your sleeve. Gather all the information to convince your district the campus principal is responsible for health interventions on his/her campus since there isn't a licensed person for you to delegate tasks to in accordance with the nurse practice act.

Whadda ya say?

Last year, I had brought this very topic up (medication adminsitration and health interventions should be conducted by an administrator) to the principal, vice principal, superintendant, and our board president. This year, I also have brought the same concerns up with our new superintendant. I've even gone as far as printing up my entire nurse practice act (I'm in IL) and highlighting the exact print within the document backs me up. They still claim that they as administrators will take the chance of the liabilty to have the health aid/secretary continue to administer the medication and health interventions.

I'm not too confident I can succeed, but I can try to do more research and figure out a different means to approach things.

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