Teacher injury

[Rosie67]

Hello Everyone- I almost made it to the end of the year without more issues-- THEN... A teacher aide sent a student to me for ice. I have her Return to Work Restrictions on file for a non-work related injury but I have no history and don't know what procedure she had if any. She is to have "non weight bearing and elevate leg throughout the day". No ice orders on the form. She actually rented her own w/c. I usually have to tangle about that too.

I called my supervisor downtown who said we are here for first aid for teachers that's it, we "shouldn't" treat teachers, especially without orders. I sent a little note back with the student stating that I don't have orders for ice and an apology (to be nice). I didn't get into the whole "nurses are at school for the students" thing. I She then called my principal to complain about me.

I touched base with my principal. Explained ice is a treatment. How long? How often? Duration? Location? He said to follow policy and write a narrative description of the events. First of all, I can't stand it when they send students down to take care of their personal business. Then she calls to complain about ME!!! Geez!!

[Purple_Scrubs, BSN, RN]

Could she have got her own ice from the cafeteria? Then you are off the hook for it since she is an adult and made her own decision about it.

I totally agree about this. I don't mind giving teacher's band-aids or even taking a temp if they feel ill, but these are adults! What would they do if they were at home? They would handle it themselves!

[SchoolNurseBSN]

No offense to Teachers Aides at all. However, people that have never had to earn a license (and follow the rules to keep it) just don't seem to get it!

I don't blame you. You do not even know what problem she has with her leg. What if ice is detrimental?

[NurseLoveJoy88, ASN, RN]

No offense to Teachers Aides at all. However, people that have never had to earn a license (and follow the rules to keep it) just don't seem to get it!

I don't blame you. You do not even know what problem she has with her leg. What if ice is detrimental?

Thats so true ! I'm studying orthropedics now and there are some injuries where nurses are not supposed to apply ice.

What if she had DM, in which extreme cold or heat would not be indicated especially if there is neuropathy involved.

[LovingOBFutureFNP]

I'm two weeks away from wrapping up my school nurse gig to return to my true nursing love, obstetrics, but since I'm a school nurse for 2 more weeks...

I don't mean to step on any toes, but I feel like this might be a bit of a "teachers don't recognize our nursing expertise" power issue. I also feel annoyed when staff members don't take responsibility for their own care, but it's nice to go above and beyond for people. In fact, serving staff members can be a great opportunity for school nurses because it's a good chance to show them that you do know what you're talking about, which in turn leads to them trusting your clinical judgment with students better.

An adult is capable of making decisions about her own care. If she decides that she needs ice for an injury, has an understanding of her injury and has already sought medical care, requests it, plans to apply the ice herself, and the ice packs happen to be kept in the clinic, where is the harm in lending her an ice pack? I don't see how you could be held liable for any such thing, and technically it's no different than being given a cup of ice by a cafeteria worker since you're not actively participating in her care.

I believe school nurses are there to provide care and education for students, their families, AND staff members. I'm at a school of nearly 1,000 students and can definitely understand how busy our schedules get, but I'm happy to check blood pressures, give Band-aids, make referrals, and counsel staff members regarding medical questions. In fact, I think caring for staff members is even written into the school nurse job description for my district.

[Artistyc1]

I guess I feel that same way, that we are there for the students and the staff as well. In many districts, employee health is part of the school nurses job. In mine, it is more of a courtesy. I don't drop what I am doing for students in order to care for staff members, but if they will wait, I can at least discuss their presenting problem, and give them their options as to how soon they may need to see a physician for it.

The school I work at has a lot of long term employees, and are the atmosphere is much like "family", be it for better or worse. As long as the staff is respectful of my duties, I can respect their personal health concerns, assisting where I am able.

[Maine17]

I agree with the last two posts. Students come first, but I am happy to assist a staff member if I can. The nursing role in a school is usually an individual position-the nurse needs to build her own 'team' within her school. Every encounter with another staff member is important-instead of "power" plays, try to figure out a solution that is a win-win for both of you-it will benefit you in the long run.

[Rosie67]

I thought I should give an update- Some of you are making leaping assumptions- "power play", no, just doing what is right and prudent under my license. I did have communication with the MD, she was to have ice for the first 3 days and then return for PT. Well past the date on her Work Restrictions Form. Nothing in the orders pertain to any care from me at school. This wasn't an issue of giving a bandaid or taking a temperature. Non of that was even mentioned in my post. This was about providing care without orders. Please read my original message again. I'm glad my corporation makes the distinction between first-aid and treatment. I made the best decision with the information I had available. Sometimes "going above and beyond" means doing what's right but not always popular.

[SchoolNurseBSN]

I agree! Also, going above and beyond should NOT put you in a place of going against your state Nurse Practice Act which protects the PATIENT and not the nurse! By going against a doctor order - you are prescribing treatment! if the order says no ice then I would NOT provide ice. If a physician did not write an order for Tylenol for a hospitalized patient, would the nurse be blasted for not giving it? No they wouldn't!

[Purple_Scrubs, BSN, RN]

I agree. I don't see not giving ice to the teacher as an unwillingness to "go the extra mile". I would have done the same with a child! Our first aid protocol allows ice for the first 24 hours after a minor injury. I do not allow it beyond that time frame for anyone without a doctor's order. I get kids asking for ice all the time for bruises or minor injuries that occurred days earlier, and I tell them the same thing. No ice after 24 hours, period! You absolutely did the right thing!

[Maine17]

I guess I am not clear about "providing treatment to staff" aspect. If a teacher asks for Tylenol/Ibuprofen because their back is sore, would you say that you are 'treating' that teacher? If a teacher comes into my office and asks for some ice or asks to borrow a heating pad, I have never thought of that as treating them. Now, if a teacher asks for my advice, I am very careful about what I say and how I say it. What do you all think?

[Purple_Scrubs, BSN, RN]

I wouldn't give Tylenol or anything to a teacher without a doctor's note - it is considered dispensing meds and is against the scope of practice. So, yes, I guess I would say that would be treating. We are not allowed to give any drug without a MD order, not to a student or staff member. It is a shady line, but for the sake of your license you have to stay safely on this side of it.