Teachers can "Pinch Hit" for Nurses?

dianabay · Nov 26, 2008

Absolutely! When an adverse event occurs (and it will), whose license is on the line? Not the teacher's.

Aneroo, LPN · Nov 26, 2008

Absolutely! When an adverse event occurs (and it will), whose license is on the line? Not the teacher's.

NOT A ONE! Your license is NOT on the line if you can properly document and train these people.

If you train someone to check a blood glucose on a child, it's 30 and the child is unconscious and they give the glucagon incorrectly (even though they've return demonstrated with a practice thing, passed a quiz, and took a training session with you), it's not your butt! Sure, you might go to court, but if they see you did everything you could to properly train that person and they goofed despite learning what they needed to, you should be fine.

Aneroo, LPN · Nov 26, 2008

I wanted to add- I'm not pulling that out of my hiney. This is what I learned recently at a school nurse conference, and that was according to our state school nurse consultants!

Xbox Live Addict · Dec 3, 2008

I wonder how this journalist would feel about the idea of "protecting their jobs" if the L.A. Times falls victim, as so many print publications have, to the ready, if somewhat questionable, supply of information that the Internet provides? Will he gracefully give up his job if the public decides it no longer needs a paper version of the L.A. Times?

Teachers are replaceable too: Calvert School in Baltimore, MD, will provide you with everything you need to educate a child in grades 1-8 to the standards of any state in the country, all in a box shipped via UPS. The right nut job in the right position of power could cause an ugly "revolution" by replacing teachers with minimally trained "teaching techs" under the license of one single masters'-prepared teacher.

That kind of system would make for crappy education, of course... but it would save the state billions, so who cares?! Just like our hospital system!

But teaching is about more than just reading lesson plans... just like nursing is supposed to be about more than reading a sheet of physician orders. You have to know something about WHY you're doing what you're doing. That way, if an unforeseen complication arises, you're not stuck helplessly wringing your hands wondering what to do, because the book didn't mention this!

dianabay · Dec 3, 2008

"Your license is NOT on the line if you can properly document and train these people...Sure, you might go to court, but if they see you did everything you could to properly train that person and they goofed despite learning what they needed to, you should be fine."

Thank you for posting, Aneroo. You are certainly in a position to know more than I on this subject, and I appreciate your perspective.

I didn't mean to suggest that losing one's license would be a foregone conclusion in the case of an adverse event; my fear is that one's license may be vulnerable. As you said, "you may go to court" and if you've done your job well, "you should be fine".

That prospect alone scares me. The justice system can sometimes make some bewildering decisions (i.e. the incarceration of an 8 year old child, and seeking to charge him as an adult).

I wonder if anyone is aware of any case law or precedent? I simply would not want to be the one setting that precedent, regardless of the outcome.

Aneroo, LPN · Dec 3, 2008

"Your license is NOT on the line if you can properly document and train these people...Sure, you might go to court, but if they see you did everything you could to properly train that person and they goofed despite learning what they needed to, you should be fine."

Thank you for posting, Aneroo. You are certainly in a position to know more than I on this subject, and I appreciate your perspective.
I didn't mean to suggest that losing one's license would be a foregone conclusion in the case of an adverse event; my fear is that one's license may be vulnerable. As you said, "you may go to court" and if you've done your job well, "you should be fine".
That prospect alone scares me. The justice system can sometimes make some bewildering decisions (i.e. the incarceration of an 8 year old child, and seeking to charge him as an adult).
I wonder if anyone is aware of any case law or precedent? I simply would not want to be the one setting that precedent, regardless of the outcome.

It all boils down to delegation again. The sad truth is a lot of times we're stretched too thin to ensure the entire cycle of education is continued. We might be able to give some great education, but if we're too swamped to follow up and make sure someone is doing it correctly and doing everything they are supposed to, we're still liable. Yeah, we might be fine if we go to court, BUT I DON'T WANT TO GET THAT FAR. LOL

lindarn · Dec 3, 2008

It all boils down to delegation again. The sad truth is a lot of times we're stretched too thin to ensure the entire cycle of education is continued. We might be able to give some great education, but if we're too swamped to follow up and make sure someone is doing it correctly and doing everything they are supposed to, we're still liable. Yeah, we might be fine if we go to court, BUT I DON'T WANT TO GET THAT FAR. LOL

Seeing that teachers in most locales these days, (that was pushed by the teachers unions), for teacher-student ratios, why aren't teachers pushing for more NURSES to student ratios in the schools!!.

What is good for the goose, is good for the gander. Nurses are just as important as teachers. No one is pushing for teachers to "delegate" their lesson plans to unlicensed "teaching assistants", or the janitor, are they? So why is everyone so gung ho to have nurses delegate our jobs to these unlicensed individuals?

Teachers have louder voices than nurses do. They have learned through generations of UNION membership how to play to the public to get what they want. When they are trying to push their agenda, they have rallies at very public places with the TV news cameras and the local news papers, and it is all on the 6:00 news.

Nurses, on the other hand, have "candlelight vigils", in a remote section of the city, and no one is there except the nurses and a few husbands and kids. The public has no knowledge of this, and the nurses do not have any organized agenda completed to share with anyone. In fact, it almost seems that the nurses themselves do not know what the entire meeting is about, or what they hope to accomplish. This is of course what the hospitals want, Nurses unorganized, and powerless.

If unions are so unprofessional, why are teachers ALL unionized (since teachers are all far more educated than most nurses) most with Masters Degres, and most nurses with ADNs, some still with nothing more than a Diploma, and some who have earned BSNs). There goes the argument that it is not "professional" to belong to a union. Higher educated individuals do not seem to be put off by belonging to a union. Doctors in some areas are unionizing.

That is why nurses are held in such low esteem, (This is what I meant when I said that the public may say that they hold nurses in high esteem and give us high marks for "ethics", reality is they only love us as long as they don't have to pay us, or sacrifice anything to have us provide our professional services).

Teachers do not want to "pinch hit " for nurses. They could care less if we had the janitor provide our professional services. As long as THEY do not break THEIR staffing ratios, they don't care if nurses put our license on the line. And teachers make more money that nurses do, have far better benefits, and pensions. JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Thornbird · Dec 5, 2008

Here in CT, only licensed nurses can administer meds to school children. As long as there is a school nurse (RN) in the building, the child may be attended by an LPN but never an unlicensed person. I really don't believe there are 30 states that allow unlicensed persons to treat diabetic children. I also don't understand why on earth the Diabetes Association would be in favor of having non-licensed people do this. Children with diabetes are very challenging to manage, especially the young ones who don't have a full understanding yet. These kids can't legally be excluded from school because they need nurses, I honestly don't understand what the issue is except the school districts are too cheap to pay an adequate number of nurses to provide for the kids with special needs to safely receive their education.

Thanks to a lot of parent advocacy, CT law allows any school staff member or day care provider to administer an Epi-pen after training. That includes bus drivers. The regs are very strict that everyone must be educated by the school nurse on the signs of a reaction and how to administer the Epi-pen. They are taught to give it if they have any doubt and to call 911. This seems very logical to me. Before the law passed, I went on a field trip with my son's class. One of the students had a bee sting allergy. The child informed me, not the teacher or nurse. The Epi-pen wasn't made available to me and the place was buzzing with bees. The school nurse was told to stay in the first aid area so that everyone could find her. Boy, was I nervous!!!

I made my point several times on the other thread. Just because anyone can do Do it Yourself work on their own home doesn't mean that licensed electricians and plumbers aren't required for public buildings. The requirement for nursing licensure to perform nursing care for the public is for public protection is just as much for public safety as the ones governing those professions. Why do people not get it????

dianabay · Dec 5, 2008

Thornbird, you hit on an excellent point there: The whole point of IDEA (Individuals with Disabilities Education Act) is that no child be deprived of education due to any medical or physical limitation; the school district is obligated to provide appropriate supports to accommodate them.

Purple_Scrubs, BSN, RN · Dec 18, 2008

Playing devil's advocate here - what is going to happen when there is no nurse in the building (I almost never have a sub when I am sick) and the child gets hypoglycemic. In this case, there is no one in the building who is trained to deal with the situation. To me, that is far scarier than a well-trained staff member giving insulin. They can call 911 but will they even recognize the early signs before it is too late?

Even barring an emergency situation, what about routine insulin injections when there is no nurse in the building? Should the parent really have to leave work several times a day to come to school and do it? My population is low income, the parents literally cannot afford the time off. It might come down to missing a day or two of work and not paying the electricity bill that month.

I am in Texas and we are allowed unlicesened "diabetic care assistants", but the training is very specific, thorough and well documented. While I do not have a diabetic student at this time, there are people in my building who I feel could be trained to handle it in my absence. If I did not have this option, I feel I would come to school with 104 fever for fear that there would be a problem in my absence!

dianabay · Dec 18, 2008

Hi Purple scrubs:

Absolutely; I think it is important to see this from all angles.

Having some staff members (well -trained) is a good idea for all the reasons you mentioned--for exceptional circumstances, but I don't think it should be the norm.

One of the scariest comments in that article was that it takes about 4 hours to train someone. My goodness, if nurses had only to learn the technical aspects of blood checks, giving insulin, etc., without understanding the theory behind it, nursing could be a 9 month certificate program!

And learning in nursing is an ongoing process; it is the day to day experience (along with that foundation in theory) that we learn from and makes us safe and effective caregivers.

I see and appreciate your point, and you are absolutely right, parents should never have to leave work to attend to their child's medical needs. The legislative intent of IDEA is that all children, regardless of their medical or physical needs are provided a free and appropriate education. The school districts receive funding to carry out that mandate; training educational staff is merely a way to carry out that mandate cheaply. I don't know, PS; it scares me........

Purple_Scrubs, BSN, RN · Dec 18, 2008

I agree with you dianabay. There has to be some better way or middle ground if they want this mandate to work. Maybe the districts can hire FT RNs whose sole duty is to go around to the different schools who have an absent nurse and diabetic child. On the rare occasion where they are no absent RNs, I know we could find a way to put her to use!!! It truly is a scary proposition with or without the mandate!