Teacher in 911 call

[guest83140]

We try to be prepared for it all but sometimes we are found in a unknown situation. Friday, other RN left early in large high school. 2 hours later, teacher call on 2nd floor for student Emergency, fainting and possibly seizure. I ask who it is, not familiar. My office aide, run with w/c. APx 3, teacher and students friend there. A student on floor writhing with eyes, mouth closed. As soon as I kneel down a teacher who states she is a nurse starts yelling out commands. Turn her over, call 911,...breathe, I told you to move her back from the wall, 911 is going to put oxygen on her when they come. Print out a face sheet. I'm tired but I soon say over her comments and instructions, she is breathing, she has a pulse. She is very assertive, and I've seen her stop and chat with the other nurse but I don't know her. I am 57 and new to this school. She is 35ish and a health teacher. None of the assistant principals tell her to be quiet or stand back. So I hesitate to tell her to shut up or professionally stand back or I got this. It happen so fast and some listened to her before I made my assessment. So I went with the flow but felt she was out of line big time. I requested student inhaler, office aide couldn't find it so I offered to go but female AP said no stay here and send another. I felt big teacher nurse was taking over I would call her bluff not intending to leave. She almost tripped over students legs when paramedics came. I was on my knees yelling out she has good hand grips, she is breathing, good pulse, talking some, nodding her head while this teacher used her cellphone flashlight to check her pupils. Finally paramedics arrive, talking with me ask student to stand up and get on stretcher and she is talking a little. I ask AP female to call parent and I speak to both. 2 hours later on phone, Grandmother thinks it was asthma but still running test. I sent AP this update. But I felt abused and discredited. My husband says I should have straightened her out right then but my focus was the student and I didn't know how a confrontation would play out. What are your thoughts?

[emtpbill, ASN, RN, EMT-P]

I am in nursing school but have been working as a paramedic for the last 18 years. What should have happened was anyone not involved directly with the patient should have moved along, so basically you should have been the only one touching the patient(assessing pulse, resp. BP if you have a cuff. )This other teacher/nurse should not have been flashing anything in the patients eyes. Her "assessment" pretty much will mean zero once the medics get there, we have a whole list of protocols and ways we do things. It's very methodical , we start with the head and end with the feet and it happens so fast we usually have it done before anyone realizes it.

As a medic , when I get on scene, I will take report from one person, and that is the officials ally recognized school nurse, not a health teacher.

[Flare, ASN, BSN]

I suppose if there was no nurse available, then teacher/nurse may have some validity and a duty to act. Just as any of us may feel compelled to pull over and help if we see a car wreck on our way to work. But - as we all know, once the rightful help gets there for that scene - the emts in the case of my hypothetical scenario and in your actual scenario it would be you or any other school nurses assigned to the building - we'd take a step back unless asked to continue helping. I suppose though, not everyone has this philosophy.

I would probably debrief with the teacher/nurse to find out what exactly went on - in the course of that, I'd look to find out her qualifications and whether or not she still has an an active license. I know it seems picky- but i've worked in schools where i've had "former emt's" that were there at the ready when there was an emergency but also needed to be reeled in a bit. It's nice to have someone there who is willing to help during an emergency - lots of schools have a hard time getting willing epipen delegates and cpr certified staff or even people willing to meet ems at the door and show them the way to the scene - but then there's the whole 'nother side of the coin.

[OldDude]

What an unfortunate event for you. Very good advice from above. I will say if the teacher has the credentials she said she does, she should understand her role and the flow of the scene. As emptbill said, when you showed up she should have given you a report, backed off, and awaited for further instruction from you. If she doesn't realize that, now would be a good time to tell her; however uncomfortable that may be for you (with administration present of course). It sounds like EMS might not have even needed to be called with the assessment you describe. On two occasions, that I can recall, I have instructed staff to "call off" an ambulance that had been summoned before my intervention and assessment. Regardless, your focus WAS on the student, you were were there for her, and she received medical attention so don't spend too much time worrying about what you should have done. It's a good time to debrief and educate all involved.

[ixchel]

I'll preface by saying I'm not a school nurse, so it possible my thoughts are a bit irrelevant. However, in the off chance they could be helpful....

First - safety. If this woman actually is a nurse (what more do you have than her word, really, and to me, that doesn't feel like enough to be behaving the way she did), it's reasonable she provide for the safety of the child by minimizing environmental dangers while awaiting assistance. If there are non-invasive ways to assist the student, such as turning if there is a risk of aspiration, then that seems reasonable as well. She is not employed by that school to provide nursing care, which, I would think, makes it a financial liability if she intervenes in other ways.

I'm honestly questioning her definition and credential of "nurse". Surely an actually licensed nurse wouldn't use a cell phone light in a person's eyes, and I would think she would understand the "chain of command" when the student's now primary nurse is present. By your description, it seems like she was a bit more wound up about this than one would expect a nurse to be. Was she?

At any rate, I think a person like this will respond best by ensuring recognition of her efforts and role, regardless of how grating it seems she was. I think I'd try to quietly (if possible) say, "thank you so much for your help. From one nurse to another, you know how jacked up stuff like this can get - since I've been called in as the nurse intervening for (student), it could get complicated if there ever was a law suit and the record shows I wasn't in charge of the situation until EMS arrives. You have done an awesome job! I'll take it from here, and you'll be the first to know if I need help."

Sometimes a little flattery will go a long way. I hope the student is doing well!

[bebbercorn]

Yikes... what a touchy situation. FYI, I have seen even neurologists use cell phone lights to evaluate pupillary response. I'd use it in a pinch if I had to. There are apps for it, even.

[tining, BSN, RN]

I agree with ixchel a positive spin on the 'debriefing' will go a long way. I would also tell the lead nurse about the situation so a protocol for this situation will be in the hands of all. This could soften the blow if it does not come from you. You acted professionally and on the other hand the nurse/teacher was too gung ho. I prefer the calm approach.

[MrNurse(x2), ADN]

A possible angle you may want to take is expected roles. The school system expects you to function in the health matters of the students, to provide care. The school system expects her to function in educating the students in her care. Your role envelopes all the students, hers a select few. The school stands behind your actions, not hers, so there may be a liability issue for her that is not there for you. For all you know, she may have gotten her B.S., went immediately for her M.S. and works in education, never having practical experience. I have also seen many who call themselves nurses, but are CNA, med techs or MA's. I would definitely discuss this with her, hopefully your non-confrontive response during the event may set a more accepting tone for the conversation.

[NutmeggeRN, BSN]

I think that I would do this

"Hey , I had NO Idea, you were a registered nurse?!"

Wait for the response. She MAY be a nurse, she may have been an LNA in HS.....

Then I would say "I appreciated the help, but I think we need to be careful about our roles as far as an emergency goes" (see ixchels post), explaining that you, as the hired medical professional in the building, are charged with the emergency care of the students and staff, and that you would not want to see her get in trouble or get yourself in trouble for NOT doing something you would have and she didn't.

What would a reasonable nurse do in this situation? When the lawyer asks why you did or did not do something, you dont want to answer well, "So and so said she was a nurse.....so I......"

This should be addressed at an emergency planning meeting as well, we have a pretty well defined algorithm as how to respond in an emergency.

Good Luck and do this with an administrator or your lead nurse.

[guest83140]

Ok, here is what transpired the same day I came back to work on Monday. Called mom and it was a panic attack. I told the other coworker who urged me to tell the boss. Had a meeting with boss, me and Principal. He said one female AP thought I took too long to get up to 2nd floor so she knew Health teacher was a nurse ( she was school nurse last year) and asked her to help. Co-worker had left at noon and Principal thought I probably took longer to get there clearing students out and that he was not informed that other co-worker had left and need to know this in the future. I told him health teacher nurse should have stepped back of arrivingwithin 3-4 minutes and that she yelled for 911 while I was present. He said that would never happen again. I told him I appreciated her help but did NOT appreciate her disrespect of my position and that the other nurse also had her question her nursing judgement as well. So,...all is well for now but we do have only 1 Sub for whole district, but that's another subject. Thanks for all the great comments and suggestions!:)

P.S. I saw the health teacher passing in the hall and she asked how the student was and I told her, oh it was just a panic attack. She said, for all that? I said, yep. (Oh, our office aide has her class and she says she often tells stories of calling 911 a lot). Student didn't really need 911 imo, she returned to school the next school day looking the same, with no new orders. Her mom said she takes doing Final Testing real serious. Really?

[NutmeggeRN, BSN]

Student didn't really need 911 imo, she returned to school the next school day looking the same, with no new orders. Her mom said she takes doing Final Testing real serious. Really?

Really!!! Gotta love our job!!