UAP's in our school clinic

[RNPATL, DNP, RN]

I am a parent of 3 children (all in middle school right now - 6th, 7th and 8th grade .... yes, I know you feel my pain!). Anyway, I received a call yesterday from the "school nurse" to tell me that my son had a terrible case of bronchitis and if I had taken him to his doctor. She also added that he needed to be picked up ASAP. As an RN and a parent, I am pretty reasonable with my kids if they do not feel well and want to come home. But there are times when I think they use "I am Sick" as an excuse to come home and have the day off.

My son has allergies and for whatever reason he gets post nasal drip which causes him to cough. I am treating this with his normal allergy medicine. Ok - getting back to the story, when I went into the school to pick him up, the "school nurse" was irritated with me and said, "aren't you an RN? He has been coughing like this for a week now. Have you taken him to his doctor, he has a terrible case of bronchitis." Of course, her tone was totally inapprorpiate and I asked her if she had listened to his lungs? She said, "well no, but you can tell by the way he is breathing. I then looked at her name tag and it said "Clinical Assistant." I asked her if she was a nurse and she responded no. I then asked her what qualified her to make a medical diagnosis and was she aware that there are children that have allergies.

To make a long story short, I took my son to the doctor and of course, he told me to continue the course of treatment that he had been on and wrote a clear note to the Clinic Aid, that my son was suffering from seasonal allergies and NOT bronchitis.

My question and reason for the post is to ask REAL school nurses .... what is happening to the school health clinics? Are they being staffed with UAP more now than in the past? Also, are these people giving our children medications and a treating illness in our schools? Also, how they can represent themselves as "Nurses?" In NC, in order to use the term "Nurse" you need to be licensed in the State as an RN or LPN.

Just was wondering if anyone out there has an opinion on this. I am sure there is a thread similar, but I did not see it. Thanks for your input. Patrick

[traumaRUs, MSN, APRN]

Extremely sore subject with me! In central Illinois - there are NO school nurses, no clinics, no nothing. My sons are adults now, but this is appalling!

[bergren]

The manning of the health office by non licensed persons is is a growing trend due to the increasing lack of adequate funding for schools. I am not up to speed on NC state law, but it is very likely that this assistant has a RN supervisor under whose license she is operating. Since the note about the inappropriate recommendation was sent to the clinic, I'd be pretty sure the nurse will not learn of it. If I were you I would call the nurse and share your story with her in a quiet, "I thought you would want to know" tone. Having supervised many non licensed persons in schools, I would be shocked if the RN is not already watching the aide and since she is likely elsewhere most of the day, needs you to call her to know about issues that are going on. Even thought they work under our license, the hiring and the firing of the aides is often NOT the purview of the nurse. many of the jobs have been filled by a friend of the administrator or a teacher's spouse, so getting rid of them requires a lot of documentation. You are correct, it is illegal to identify yourself as a nurse if you are not licensed in most states. In Minnesota, they passed a law that an aide cannot even answer the phone "school nurse's office" if they are not a nurse. Research has shown that because the aides do not have assessment skills, they are much more likely than a nurse to send a child home from school inappropriately. Your situation was a perfect example. This adds up to missed classes, increased costs on the part of the parent for physician and emergency room visits, and the parent's lost time from work. I would emphasize those negative outcomes when you call. If you can find the NC state statute that outlaws misrepresenting yourself as a licensed nurse, that would be helpful also. I am sure your Board of Nurisng or your state nurses association would be happy to help you with that. If by any chance you have a copy of that note, I'd share that too, but the nurse could look in your child's chart - the aide should have put the note in it.

[RNPATL, DNP, RN]

Martha - thank you for your thoughtful response and I will take your counsel and talk quietly with the school nurse using the approach that you have recommended. Again, I think that we as nurses and certainly as a society need to recognize the importance of school nurses. There must be adequate funding. I can not imagine that in central IL, they do not even have school nurses. There is something terribly worng with this picture.

Thanks again for your comments and I will let you know how the conversation goes.

Patrick