Should I report this?

BrisketRN, BSN, RN · Sep 6, 2019

I'd report to the supervisor right away! My blood pressure & HR would go up too if I'd been accused of doing drugs.

caliotter3 · Sep 6, 2019

I would report this to my supervisor, voice my concern, and look for a new job, as the administration Is not likely to change their policy over my objection.

BettyGirard, BSN · Sep 7, 2019

We all typically have two masters: the medical chain of command (your supervisor and often a physician who set up the school programs), as well as the building administration.

You do have to understand that your medical role comes first.

I guess we're slightly fortunate here in that the administrators are obliged to listen to our assessment of the student health (as reflected in 501/IHP and IEP documentation) before applying any disciplinary measures. That and most of our students are obligated to the drug testing program. A few ounces of urine would rule out that concerned.

I've got my doubt about their arm-chair medical analysis. While there may be some initial hypertension at the outset, usually marijuana results in decreased vascular resistance (lower blood pressure and pulse).

bluebonnetrn, BSN, RN · Sep 9, 2019

I have the same problem.
When teachers or admin are suspicious of a kid they send them to me for a drug assessment. It's called the Dibrep and is used by LEOs on the side of the road. They always say "we need you to do this so you can tell us if they are on something". Medically it's total crap. LEO's use it as a legal tool to establish reasonable cause. And I ALWAYS tell them that this assessment does nothing to tell if someone is using or not and what they might be using. The only definitive proof is a drug test done by a lab. As you stated, there are multiple reasons for abnormal VS and anxiety is a huge one. Also, like you said already, it falls on deaf ears. It's so frustrating.
Last year I had to do an assessment on a kid because the teacher thought he was using. Turns out the kid had not eaten anything that day, had also slept very little the night before and was stressed about school work that he was behind on. Instead of checking to see if this kid was ok they immediately jumped to drug abuse. I was livid and let them know it.

ruby_jane, BSN, RN · Sep 10, 2019

School probably doesn't have a leg to stand on here.

And next time you'll know to say something along the lines of "I cannot tell if the student is under the influence of (insert substance here). I can assess his/her vital signs and I found them (WNL, insert results here)."

I hated this part of my HS nurse gig.

rzyzzy · Sep 10, 2019

On 9/6/2019 at 5:15 PM, Mavnurse17 said:
Hi all,
Yesterday I sat in a parent meeting for a student that was being "charged" by the school for "being under the influence of marijuana." When mom asked how the administrator came to the conclusion that he was under the influence (the kid was not seen smoking and was not found with any substance when searched), admin responded, "he had a strong marijuana odor and the vitals that the nurse took showed that his blood pressure and pulse were high."
I have no idea if this kid was using or not, but I don't have a blood or urine lab to confirm if he was or wasn't. How is it responsible for an administrator with no medical background to make this determination based on numbers she does not understand? The kid's been diagnosed with panic/anxiety disorder, so it's no wonder his VS were what they were when I assessed him.
I want to report this to my nursing supervisor, but I'm afraid of catching backlash from my school administrators here. How many other kids are being "charged" with this offense and subsequently being punished because admin determines the VS I obtain to be out of normal range? I've tried telling admin that there are multiple reasons VS can be elevated in that situation: anxiety, ADHD meds, the fact that they were just frisked by the campus officer...?? It all falls on deaf ears. I am merely a tool that they can use to make these disciplinary decisions.
What would you do?

I’d speak up.. obviously the “educators” in the room are misinformed, and surely they would be grateful for the opportunity to upgrade their knowledge. Vitals without a baseline for that person are meaningless - especially when the patient is in an emotionally stressful situation. I’m only surprised the student wasn’t accused of being a witch.