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!!

[Artistyc1]

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.

I don't feel that by having these items in my desk drawer, and the teacher, an adult, taking out two tablets of tylenol of their own volition is the same as "dispensing". I don't "give" them anything, but I allow them to take the available, labeled meds. I feel that as adults, they can decide what they can safely take and can't take. I would never offer medication, however.

Also, back to the ice for the ankle issue- have you never used a warm pack or cold pack yourself without a physician's order? I have. I don't see the harm of it, if an adult asks for it, gets it for themselves out of the freezer, and goes on their merry way, that I am in any way liable for them using their own judgement. I am not in any way examining the limb, making diagnoses, giving them opinions, or prescribing or dispensing treatment for them. It may help an uncomfortable person get through their day more easily....

[SchoolNurseBSN]

I don't feel that by having these items in my desk drawer, and the teacher, an adult, taking out two tablets of tylenol of their own volition is the same as "dispensing". I don't "give" them anything, but I allow them to take the available, labeled meds. I feel that as adults, they can decide what they can safely take and can't take. I would never offer medication, however.

Also, back to the ice for the ankle issue- have you never used a warm pack or cold pack yourself without a physician's order? I have. I don't see the harm of it, if an adult asks for it, gets it for themselves out of the freezer, and goes on their merry way, that I am in any way liable for them using their own judgement. I am not in any way examining the limb, making diagnoses, giving them opinions, or prescribing or dispensing treatment for them. It may help an uncomfortable person get through their day more easily....

While I completely understand what you are saying......I still must disagree. True, the adult staff member does have the right to do whatever they choose such as taking a Tylenol,hot packs, cold packs, etc. Therefore, they have every right to stop by the store and get what they need before coming to work that day. Who pays for this Tylenol, etc. we dispense? The nurse herself? The school? Either way - it is coming from the staff nurse while on the job which to me just puts you in a really bad position. If your school wants to provide these things to staff without an order. My suggestion is it not be kept anywhere near the nurse or the health room.

My license is too precious to put on the line for a Tylenol. Human nature is to look for blame to place if an adverse event happens. I can hear it now. "My nurse let me get out of her drawer, why didn't she tell me this could happen? She should know better! Why, she didn't even bother to look at my arm."

[Purple_Scrubs, BSN, RN]

Artisttyc1, please check with your BON and whoever is in charge of school health services on this. Your license might depend on it.

[Artistyc1]

Artisttyc1, please check with your BON and whoever is in charge of school health services on this. Your license might depend on it.

Now, that is downright insulting. Why do you assume that in the past 33 years I have worked as an RN that I don't check things out before I do them?

[Purple_Scrubs, BSN, RN]

I did not mean to insult you, I am truly concerned. You have had several people tell you that they do not believe this is good practice, but you keep defending it. I am not going to argue, but I think you should look into whether or not this is considered dispensing meds in your state. In my state it would be and I would be risking my license. I apologize for offending you, it was not my intent, but I stand by my statement.

[Purple_Scrubs, BSN, RN]

Here is an excerpt from School Nursing: A Comprehensive Text (available from NASN bookstore)...

"The practice of providing staff members with over-the-counter (OTC) medications...is an accepted practice in many schools...This practice should be carefully reviewed and based on local statutes, guidelines, and needs...If the school district is willing to accept liability for OTC drug provision for school staff, a policy should be developed and standing orders may be needed..."

The bold is my emphasis. The key point here is the district being willing to take the liability. Unless there is a written policy that states that, or there are standing orders, I still think you are taking a risk with your license.

[Artistyc1]

Here is an excerpt from School Nursing: A Comprehensive Text (available from NASN bookstore)...

"The practice of providing staff members with over-the-counter (OTC) medications...is an accepted practice in many schools...This practice should be carefully reviewed and based on local statutes, guidelines, and needs...If the school district is willing to accept liability for OTC drug provision for school staff, a policy should be developed and standing orders may be needed..."

The bold is my emphasis. The key point here is the district being willing to take the liability. Unless there is a written policy that states that, or there are standing orders, I still think you are taking a risk with your license.

1) You are STILL assuming that my school, and all other school's policies are exactly the same as yours. Not to mention the Nurse Practice Act is the same in every state as it is in Texas, and those that have different ones must be ignorant.

2) You are STILL assuming that my school doesn't have standing orders and policies that cover my stated actions, because your school doesn't have them, and that I am ignorant of my own district's policies and procedures.

3) I have a copy of that same book that you are quoting, I used it to prepare for the certification examination. I know it pretty well, actually.

HENCE: I still think that you are insulting someone based upon your own ignorance.

[Purple_Scrubs, BSN, RN]

I don't recall saying anyone was ignorant??? Did I miss that??? I can only go by what you state in your posts, and you have not said anything about standing orders or your state's policies when you were defending this practice. That speaks volumes to me. If you want to be defensive, go ahead, I was simply trying to help and make sure other less experienced school nurses don't read your posts and think this is acceptable practice. I'm out of it.

[Artistyc1]

Somehow it isn't worth it to me to continue to argue regarding apples and oranges with you, either. It seems that you need to be right, so be right. It didn't seem important enough to me to start quoting state nurse practice act statutes, and stating my own school district policies ad nauseum, quoting from books, etc. I guess I should, next time, if it seems like a tremendously worthy argument. I think that new nurses should plan to read everything they can get their hands on regarding statutes for student health in their own state, and make sure that they follow their own school's guidelines and policies regarding rendering care to their students. I don't remember stating otherwise in any of my posts, but the new school nurses that I mentor (imagine that, I, of all people, am considered good enough by my own home district to precept new nurses!)