School secretary administring meds???

FLArn · Jan 18, 2011

I am sure the laws are different state to state but I do know the school systems usually DON'T have a nurse in every building every day. She/he travels from school to school doing lice checks, vision and other screenings and those types of things. So, yes, the secretary gives the meds to the students. Legal? not sure the norm? probably! Maybe a school nurse will post as they would have a more informed response.

BluegrassRN · Jan 18, 2011

I don't know why it wouldn't be legal. I agree it's not ideal. Non-medical professionals give prescription medications all the time in the community and private settings. It's not rocket science. I suppose your friend has two choices: teach the secretary how to administer the treatments, or go to the school and administer them herself when her son needs them.

School districts simply don't have the funding to provide for complete nursing coverage. Many schools have one nurse who travels between schools, with health aides, secretaries and teachers picking up the slack.

The secretary may have lied, or she may not have. If she said that she would pass all the info on the the school nurse; it could be that there is a school nurse who oversees several schools (or the entire district) and performs more administrative tasks...making sure the prescription is up to day, placing it in the student's chart, making sure the secretary knows how to administer the med via nebulizer. If that's the case, she didn't lie at all. If she actually stated that a nurse would be administering the medications, that's totally inaccurate and she needs to know it is not okay to tell parents a nurse will be performing these duties.

Beyond that, what exactly does your friend want to accomplish? Does the secretary deserve to be fired? Is the school district going to hire a full time nurse for the school? Neither of those things are going to happen. I'm not sure why your friend is going out guns blazing. It's a nebulizer treatment.

mentalhealthRN · Jan 18, 2011

I know that some schools are cutting back and not having a nurse or sharing between schools...I don't get it either and don't think it is--but if it's a charter school and they are not state funded many times they are not under the same regs. Your friend could call the state board of health. Its frustrating I know. I think sometimes that it's really nurses who are the ones who realize how important it is to have a licensed and trained nurse to administer meds and its the nurses who know what can go wrong. Someone who is not a nurse doens't know when to hold a med or how to assess to assure there are no red flags that need attention or to know what to do if a med doesn't work. If that asthmatic child comes to the office to be administered the inhaler and is in respiratory distress and the inhaler doesn't work would the secretary notice this or know what to do? Or the diabetic child.......its scarry, really scarry. And the fact that the secretary LIED is big!! I would definately be looking for another school with a nurse if I had a child with health problems. If my child was asthmatic or diabetic or had seizure d/o or something that could come up while in school-- no way would I have him at a school with no nurse there full time. Not worth it to me. I know the value of a licensed nurse who is experienced taking care of kids being there in the school. That nurse could be the difference between life and death for some of these kids with health problems. I say your friend should change her child to a school with a nurse--asthma can be serious.

Simply Complicated · Jan 18, 2011

I just found the statutes about it. They are required to have her sign a consent giving permission to a non-medical personel to do the meds, which they did not do. They flat out told her a nurse does the meds. They are also not legally allowed to do any invasive treatments, including finger sticks and insulin injections. Which she does do.

I understand it's just a nebulizer treatment. It was more that they flat out lied to her, and she knows for a fact they are doing blood sugars and insulin.

merlee · Jan 18, 2011

I was a school nurse for a while, and I can assure you that there were times when the admin personnel gave meds.

I believe that there should be a mandate for an RN in every school. You can't just 'switch' schools when a child has health issues discovered in the middle of the year.

I had a diabetic who crashed into the 20's and 30's - luckily I bought some icing gel to squirt under her tongue and knew enough to call 911. I had an undiagnosed asthmatic (mom later said she noticed some funny sounds when he was playing hard) who had been at recess then became really SOB. Again, called 911.

Very scary, IMHO, to not have at least an EMT/Paramedic on the staff.

BluegrassRN · Jan 18, 2011

I understand being angry about the fact that the secretary lied. Short of an apology for the lying, though, what does your friend now expect to happen? They aren't going to hire a nurse for the school.

I see no problem with a secretary or other non-medically trained person providing nebulizer treatments, performing blood sugar checks, and giving insulin in accordance to a specific set of instructions. Who else will perform these duties? It really isn't difficult to do these correctly; children, for example, do it all the time. If a 10 year old can check his blood sugar and administer insulin, an adult secretary should be able to handle it.

Perhaps your friend can lobby the school board to have a medical aide available at each school when a nurse is not physically present in the building. Typically these are people who have completed CNA training, as well as BLS and first aide. Or she can request that the secretary receive first aide training, to increase her knowledge and capacity to recognize an unusual health situation.

The reality is, most schools don't have nurses. If you send your kid to school with an acute or chronic condition, you either need to be available during school hours to manage it, or accepting of the fact that a licensed medical or nursing professional is most likely NOT the person who will be responsible for administering the medication and caring for your child. The world does not revolve around a few kids and their inhalers and insulin pens.

My youngest has severe asthma. She has a health aide at her school. Now she just carries her own inhaler in her backpack. When she was younger, even as a kindergartner, she knew to hit the office for her inhaler prior to gym and if she started feeling tight. If it didn't work, she knew to request to call me at home. I made it very clear to the overseeing nurse, health aide, and secretary that I wanted to be notified if my daughter requested my involvement with her care. Never had an issue. It's my responsibility to ensure that my child understands her chronic condition and how to handle it within her abilities, and when to ask for help from the secretary or health aide. It's the school's responsibility to handle it within their abilities, or contact me or an ambulance if it goes beyond them.

I'm curious as to what outcome your friend is desiring. An apology for the lie? Additional training for the secretary? It might help her case if she can articulate a reasonable outcome. Otherwise, nothings going to come of it. The school board is not going to hire a full time nurse for each school. They aren't going to call the ambulance to come and have the paramedics administer the meds. Your friend is going to expend a lot of anger and energy, as well as make others angry and potentially alienate her child's school administrators, with no clear positive, realistic goal in mind if she doesn't think this through carefully.

TWUgrad · Jan 18, 2011

I just found the statutes about it. They are required to have her sign a consent giving permission to a non-medical personel to do the meds, which they did not do. They flat out told her a nurse does the meds. They are also not legally allowed to do any invasive treatments, including finger sticks and insulin injections. Which she does do.
I understand it's just a nebulizer treatment. It was more that they flat out lied to her, and she knows for a fact they are doing blood sugars and insulin.

Of course the school should follow the law with regard to obtaining permission slips for interventions. I also think it should be required that anyone administering meds or treatments be BLS certified and should have a consultation with the parent regarding the child's needs.

Do remember, however, that the majority of people on the planet who do finger sticks and administer insulin are in fact NOT medical professionals of any kind. This includes children who manage their own care, parents of affected children, the elderly, etc. It's not rocket science.

noahsmama · Jan 18, 2011

I just found the statutes about it. They are required to have her sign a consent giving permission to a non-medical personel to do the meds, which they did not do. They flat out told her a nurse does the meds. They are also not legally allowed to do any invasive treatments, including finger sticks and insulin injections. Which she does.

Does the statute specifically mention finger sticks and insulin injections, and does it identify these as "invasive" treatments?

The reason I ask is that, although it might make sense to consider these things as "invasive", (they certainly seem invasive to me!), for the purposes of the statute, these might not meet the legal definition of "invasive".

I work with foster kids, and the court in our county delegates most routine, non-invasive health care to the foster parents and whatever doctors the foster parents choose, but we must get a court order for anything the court considers "invasive". This includes surgery or any procedure that requires anesthesia (e.g. MRIs for otherwise squirmy toddlers). However, we don't need a court order for every finger stick, injection, or blood draw that one of our kids may need (can you imagine if we did!), because as far as the court is concerned, these things are not "invasive".

So, unless the statute specifically identifies finger sticks and insulin injections as "invasive", I would not assume that these are considered invasive for the purposes of enforcing the statute.

Simply Complicated · Jan 18, 2011

When she first called me, she had just left the school and was really upset. She is not making a huge deal out of it. She just wants to be sure things are being done safely. She also has a son who has Tourettes Syndrome, as well of a handful of other things, so she has dealt with a lot of issues and problems with these schools. Way more to the story, but she gets very apprehensive with these things, given what she has dealt with in the past. (bad enough people were fired)

Her biggest thing is them flat out lying to her. It just makes her question things. She found out that the secretary is supposed to be BLS certified, she also told her she has some sort of certificate from the county. That and her son is only in kindergarten, so she just wants to make sure that if he has an asthma attack that he will be properly cared for.

It is specifically mentioned about fingersticks and insulin.

Anyways thanks for the replies. I didn't know to much about this, so I just wanted to find out.. so I wasn't telling her false information.

GreyGull · Jan 18, 2011

That and her son is only in kindergarten, so she just wants to make sure that if he has an asthma attack that he will be properly cared for.
It is specifically mentioned about fingersticks and insulin.
Anyways thanks for the replies. I didn't know to much about this, so I just wanted to find out.. so I wasn't telling her false information.

Several associations fought for years with state and national legislation to get children with very common diseases like asthma and diabetes to get the help their needed quickly in the school systems and not to be discriminated against.

If a child has an asthma attack, 911 will be called. In the meantime someone in that school system can also initiate treatment such as giving a nebulizer, administering oxygen or even performing CPR and using the AED. There is no reason a child should suffer for 10 minutes waiting for an ambulance which might also only be Basic Life Support and not able to administer a nebulizer.

The legislation also allows for children who are old enough and have demonstrated an understanding of their medications such as Albuterol MDIs to carry these meds with them instead of them being locked up in the nurse's or Principal's office out of reach. It allows for teachers and administrative help to be trained to administer medications with much the same technique as the parents would use. There are forms and proof of prescriptions with a physician's acknowledgement that accompanies each child who requires medications.

The school district should have all the information parent need. There is probably a school nurse for that area but may be covering several schools at one time which may total over 2000 students easily. Yes, it is too bad there is not a nurse for every school but even if there were, a large campus would be extremely difficult for one person to cover. The school nurse will probably maintain the records and oversee the training of those who administer the medications in these systems. Most of these diseases are chronic conditions that the parents and child will also have to adjust to and so will the school systems. They can not always depend on a nurse or doctor to be at their side 24/7.

Often the staff will attend a class for child care providers which can be 16 - 36 hours in length which can be through the county, ARC and I think the AHA may also have something similar to offer. It includes BLS and focuses specificially on identifying pediatric problems before CPR is needed. It is a good course and I would recommend EMTs and anyone working/living around children to take it even if they have regular CPR.

If this parent has a problem then the other alternative would be finding a school with a dedicated RN but that school might not have the academics available for a child who does not have a learning disability. The parent could also make themselves available for routine medications.

The local American Lung and Diabetic Associations should also have more information about the school systems , legislation and the training programs or at least a good start for those who might want more information.

Yes it is sad there are not more school RNs but in some places we are lucky to still have schools at all. Every month there is another announcement for another school that is closing in California.

nurse0520 · Jan 19, 2011

I have not even read all the posts yet but because of budget cuts etc most schools do not have nurses anymore. I live in one of the biggest school districts in my state and there are a few nurses spread around the district but for educational reasons not nursing. It states in the parental handbook that the school secretary or staff administers the meds. Even in the Day Cares in my state the staff is allowed to administer meds. Though the person should not have told you that a nurse does it at the school.