So many questions from a new school nurse

[AllyAreYouOK, RN]

I need help and advice, please! A little background: I am new to school nursing this year, previously spent 14 years in the NICU. This is obviously a whole new world to me. Also a bit new for my school, as they only hired a full-time RN starting last year and nothing was in place- no policies, protocols, IHP's, etc. A few policies have been established but not many. It is an elementary school and the only school in its district. No other medical personnel at all.

We have a 3rd grade student with CP with very mild right-sided weakness. Student has no observable issues with walking, writing, carrying a cafeteria tray, etc. When I oriented with the former (first year, new graduate) nurse for 2 days at the end of last school year, she was assisting him with wiping after a bm in the bathroom. I have continued to assist him so far this year, but after more research and discussion with others, am now not comfortable being alone in the boys' student bathroom with him. I expressed this to my supervisor and the school guidance counselor, who completed the original 504. Not refusing to assist him at all, just not without a witness. (I do have my doubts as to whether he really needs assistance at all. He is 8 now and has no other limitations at school as far as recess, gym, etc, but not the point). Just got a copy of the 504 a few days ago after asking for it multiple times. It is 2 years old now and not up for re-evaluation until next year. The only physician documentation included is the original diagnosis of CP when the child was one year old. No orders, limitations, recommendations, etc. Basically, just whatever Grandma said student needed, they included. 504 states "bathroom assistance as needed."

Administration is a little upset about me pushing back on this. They think I should just continue on like it has been done in the past.

Now for the questions:

1) Am I wrong for insisting on a witness with us in the student bathroom? There is no private bathroom in my office.

2) Do I need a doctor's order for assisting him with toileting? And any other limitations or accommodations he might need?

3) Does anyone have any specific legal information I could show my admins about this?

If you made it this far, bless your heart. I would really appreciate any advice and/or information.

I would definitely have someone with you - I make sure to have someone with me if I have to examine anything under the clothing that might be deemed as "private" . I don;t think you need a doctor's note to assist in wiping, but it should be listed in his IHP.

As an aside, I started out like you, new to school nursing, in a brand new school, zero orientation and zero training. I figured it all out with a lot of research online on our state website (I am in MA) and found this board a year later which has been a godsend.

[kidzcare]

Now for the questions:

1) Am I wrong for insisting on a witness with us in the student bathroom? There is no private bathroom in my office.

2) Do I need a doctor's order for assisting him with toileting? And any other limitations or accommodations he might need?

3) Does anyone have any specific legal information I could show my admins about this?

If you made it this far, bless your heart. I would really appreciate any advice and/or information.

1- I have a personal policy that if a child's "bathing suit areas" are exposed, I have another adult in the room. They do not have to be hovering over what's happening but there to be sure that no one has done anything inappropriate.

2- Prob no dr note is required (all staff members wipe butts all day at preschool). But this child is getting older and independence should be encouraged. Just as we would encourage a student with diabetes to take charge of their own accuchecks and insulin.

3- No legal paperwork here. Maybe google info about CP in schools or look on NASN, Journal of School Nursing, etc.