Students with 1:1 nursing

nycNurse2b · Jun 26, 2019

The district I sub in has a student with similar medical needs. He has a 1:1 agency nurse and a district employee as his 1:1 classroom aide.

nursenmom3 · Jun 27, 2019

Thank you! When you say he has an "agency nurse" do you mean the agency that provides home health care, or a separate agency that the school contracts with?

In an ideal world, I'd love to have someone who has worked in the home with us as a home health care nurse and really knows him in this role. I don't know if that's possible.

Kitiger, RN · Jun 27, 2019

I'm an agency based private duty nurse. When I go to school with a 1:1 student, I do all of his medical care. If he is SXI (severely multiply impaired), I also do many of his classroom activities with him. If he is able to take part in a normal classroom, I stay out of the way and monitor him. I may take him next door, or some private place, to suction his trach. If necessary, I'll suction him right in the classroom, but that can be disruptive to the other students.

With one child, the first thing the school nurse said was, "I don't do vents!" That's OK, because I do all of his medical care. Typically, this is a client for whom I already do home care. I ride the bus with him, bringing all of his equipment with us.

I keep the school nurse informed if he has any special problems (professional courtesy) but she/he doesn't have to do any care.

nursenmom3 · Jun 27, 2019

Thank you!!!!

My son has no cognitive or behavioral issues, but he's got pretty severe arthritis in his hands and wrists, so he can't write, and his stamina for typing is limited. Would taking dictation to fill in a worksheet or do an assignment be something you can do?

Also, do you ever do a shift where you spend time both at home and at school? I imagine we'd probably start with half days at school. In a situation like that, would you ever come to the house, ride the bus, and then ride the bus back and stay for the rest of an 8 hour shift?

Kitiger, RN · Jun 27, 2019

See my answer under Private Duty Nursing.

LPNinGH · Aug 21, 2019

Hello,

I'm a 1:1 school nurse for a medically fragile student, with whom I've cared for over the past two years. My first year was with an outside agency, but the district hired me at the end of 2018, so last year I functioned as a district employee.

My kiddo is cognitively and functionally impaired, wheelchair-bound and has a trach and g-tube. I accompany the student on the bus and then provide all her care during the day. When I discovered she'd had inconsistent attention by paraeducators in the past (through no fault of their own), I took on that role as well. I've been blessed to work with an outstanding SPED teacher and staff.

My student gets PT, OT, and ST on a weekly basis. I've gained an incredible education on these specialties since starting this assignment. I've watched each and, with their help, adapted these strategies as part of my student's daily activities.

There are many adaptive strategies for your son! He can dictate directly into a device and then print out his dictation and attach it to the worksheet. If my kiddo was able to speak, I'd gladly take dictation, though. There are communication devices where words or phrases can be selected instead of typing out each individual letter. The technology available is so amazing! There's one student who is able to communicate using a device that responds to eye gazes.

There is adaptive PE that your son will be able to participate in if it's offered in your school district. Last year we took a bus to a different school, which all the kids enjoy.

If you can, ask to meet with the PT, OT, SLP, and APE teacher to find out what's available in your district. My student gets g-tube feedings at home but also has a diet ordered for school that is chopped to 0.25 to 0.5 inch pieces or pureed. In my SD, no food from home is allowed unless Nutrition Services receives a waiver signed by parents and physician.

Unfortunately, the APE outings for swimming aren't open to my student because of the liability associated with the trach.

Another thing, make sure you have current provider orders for meds, tube feeding, and suctioning turned in to the health room before school starts or your son won't be allowed to attend school until these are submitted. Also, if tube feeds are done at school, usually three days' worth of feeding is required to be stored on campus, either in class or in the health room, in the event of an emergency.

My student has O2 ordered in the event of an emergency as well. I contacted the local medical supply vendor that is associated with my student's provider. They contact the provider for the O2 tank and administration orders, and they deliver it to the school a week before the school year starts. The main school nurse at your son's school may be able to do all this. However, I work in a huge school district and help her out by making the calls and keeping her closely apprised via email.

With regard to continued care after school, if the 1:1 nurse is a district employee, they won't allow this. However, if the nurse is hired by an agency contracted by the school district to provide care at school, you can contact the agency and see about extending daily care after school hours. If you already have a nurse who is already established with him and has a good rapport with you and your husband, you an approach the Health Services Director or Student Support Students at the district office to make arrangements for this person to go through customary school district employee onboarding, i.e. criminal background, fingerprinting, receiving an ID card. They're still a private agency employee, but have to "vetted" to be allowed on school district property.

Oh geez, I didn't intend to write a book. I hope this information helps. With August more than halfway over, you may have already had your questions answered, but I felt compelled to respond just the same.

Best wishes to you and your son!

DawsonRN · Sep 12, 2019

Our district hires all of our nurses, they don't allow agency nurses. At my school we have 1 student that is 1:1 and we have 2 full time nurses. We change weekly who is with our 1:1 student and who is in the clinic. That way we are both very familiar with the student and it won't matter if one of us calls in sick. It works out well and we've really built a great relationship with the family.

Best of luck!