I have a student who had some sort of issue/procedure that has caused time out of school. In connecting w parent, student has indicated they are not obligated to share info (due to HIPAA/confidentiality) with us. I want to support this student as best I can upon return. I plan on asking for a statement of safety (that they are safe to be in school) and any restrictions they may need while in school.
Is there anything else we as a school can legally ask for?
As a school nurse and certainly from an 18 y/o if they asked for an OTC that you are permitted to give why in the world would you need to look at an incision? Supposed he had an orchiectomy for cancer? Or suppose he has a headache? I'm raising a teen and I would be incensed if a school nurse wanted to see an incision. To me, thats an invasion of privacy.
I hear you...thx and I really am not trying to be argumentative...I worry that if a kid who has had a surgery/procedure and is OK to be back, but has something happen to them. They ask for an OTC and I give it with no assessment. If bigger stuff is happening...and even tho they are 18 and living at home, I leave it at that (because they are an adult), relying on them to tell their provider-and they don't. Who is then responsible?
My notes will reflect what I did. Maybe the students age and them stating they are of adult age and I do not have the right to know is enough. Is it prudent of me to give them something that I have not assessed for? Or to deny any analgesic because I cannot assess them, as a parent I wouldn't be happy with that option either. I do not know.
TBH, I had not considered an orchiectomy (or other types of surgery in that realm). I was simply looking for some guidance and I appreciate everyone's feedback.
As a school nurse and certainly from an 18 y/o if they asked for an OTC that you are permitted to give why in the world would you need to look at an incision? Supposed he had an orchiectomy for cancer? Or suppose he has a headache? I'm raising a teen and I would be incensed if a school nurse wanted to see an incision. To me, thats an invasion of privacy.
This brings to mind the time I had a kid come ask me for pain meds because his arm hurt. So I asked, "why does your arm hurt?" The kid replied that he had been attacked by a rooster over the weekend. So I ask if I can see where it hurts; He takes off his sweatshirt, and I find a 6cm long laceration on the back of the kids upper arm that is clearly infected. So I call home and the family had no idea it had even happened, because the student is a latchkey kid and it didn't bother him that badly, etc. etc.
Or the time a student wouldn't sit down in class and eventually revealed to his teacher that he was attacked by a dog on his way home from school the day before and was bit on the buttock... but he didn't tell his mom because a) he knew she'd freak out b) he didn't want the dog to be put down and c) he wasn't supposed to be in the neighborhood it took place in. Thankfully this bite did not break the skin, but the bruising was absolutely horrible.
So, yes, I ask to see wounds. And I document the hell out of any refusal and I will refuse to medicate if they also refuse to share information about it. If they are needing pain medication following a procedure, their provider can always write me an order!
My background is that of raising a teen who has been severely abused and is VERY private. Even strangers asking questions can panic him. I share a lot with the school but he is aware that if there is an issue he can always call me. Is that an option for your students? To be able to call a parent and then the parent can explain?
My background is that of raising a teen who has been severely abused and is VERY private. Even strangers asking questions can panic him. I share a lot with the school but he is aware that if there is an issue he can always call me. Is that an option for your students? To be able to call a parent and then the parent can explain?
Absolutely; If a student refused an inspection and refused to tell me what was wrong, I would essentially tell the kid that I want them to feel better and I understand that they are not comfortable with sharing, but that I need to make sure they are safe, and that means getting at least some information on what is going on. Because what if the kid had a procedure and ibuprofen was not safe to take afterward? I don't necessarily trust your average 18year old to know what they can and can't take after a procedure. And depending, as I demonstrated before, does an adult at home even know what's going on?? I need to call home and find out more. Often that's enough to make them come forward with more info, but if they still refuse and it seems like a seriously dangerous situation, then I would definitely call home and explain what the complaint is and what I'd like to do, but feel uncomfortable with and why. If the kid is 18 and does not want me to call home, exercising their adult rights, then they can go out and buy their own ibuprofen and self-administer.
To what everyone said above, sharing info with us can only HELP the child. We all want the same thing. We also respect a student's privacy. But knowing if ibuprofen is indicated for supportive treatment at school is valid. Knowing your child has a trauma history is also valid, even if I don't know/get all the specific details there.
I cannot tell you how many 18 year old students I have seen bring me in meds after having a procedure done or an infection treated and they have ZERO idea how/when to take them properly. And they are 18, so sometimes they haven't shared everything/anything with parent and neither has their doctor. That is my concern. I want them to recover well and support them there while in school. In fact, part of the health curriculum I teach at my school is helping the seniors transition to managing their own health after they graduate.
To what everyone said above, sharing info with us can only HELP the child. We all want the same thing. We also respect a student's privacy. But knowing if ibuprofen is indicated for supportive treatment at school is valid. Knowing your child has a trauma history is also valid, even if I don't know/get all the specific details there.
I cannot tell you how many 18 year old students I have seen bring me in meds after having a procedure done or an infection treated and they have ZERO idea how/when to take them properly. And they are 18, so sometimes they haven't shared everything/anything with parent and neither has their doctor. That is my concern. I want them to recover well and support them there while in school. In fact, part of the health curriculum I teach at my school is helping the seniors transition to managing their own health after they graduate.
This, 8 days a week. I do a lot teaching with them re being able to call their PCP, carry their insurance card etc...
My son is 18 and a senior in high school. He can not write his own excuse notes or sign himself out early without my permission. As far as the school is concerned, he is a student that has to follow the same rules all the other students in the school follow.
Having said that, your newly minted adult needs to provide release to return to school stating any restrictions, or stating no restrictions.
The student might be embarrassed about the condition or reason for the surgery and that is why he is not revealing the nature of his absence.
For the most part, the parents are making those decisions regardless of age, while they are still enrolled in school. It is far and few between when they exert this after they turn 18. Should we be more proactive in advising them of their rights? Maybe/probably/ofcourse! LOL!
As a school nurse and certainly from an 18 y/o if they asked for an OTC that you are permitted to give why in the world would you need to look at an incision? Supposed he had an orchiectomy for cancer? Or suppose he has a headache? I'm raising a teen and I would be incensed if a school nurse wanted to see an incision. To me, thats an invasion of privacy.
Adjust the script (a bit): Say you gave tylenol each day for 2 weeks to an 18 y.o. reticent student with type 1 diabetes who had a wound that was steadily getting worse and worse, but you never asked to look at it, and they never told their provider or family. What do you suppose could come out of that situation? As a parent would you also be incensed that the nurse didn't follow-up with your child's situation?
Also, you certainly have an obligation to ask why you're giving tylenol-it's given with nursing discretion/judgement, even in school.
Specializes in ER/School/Rural Nursing/Health Department.
Hopefully the documentation given to you was thorough enough to make it safe for you to medicate/observe at school.
To the other poster concerned about privacy--Obviously if a kid indicates that injury is in a sensitive area I don't ask to see it but I might call home to ask if the parents know whats going on/keeping on top of situation and medicate accordingly. However there are many situations where our observation of WHY a kid comes to us helps indicate abuse, injury parent is unaware of/getting worse, or changes our strategy on how we help.
I have had more than one kid who came in for pain and upon inspection had an injury that needed to be seen by a physician.
--A girl had arm pain and when asked to look at arm and talked with her she disclosed she attempted suicide, parents didn't know, she had a complex laceration showing a wrist tendon and after discussing with her and parent ended up need complex repair and inpatient mental health stay.
--Boy came in with "sore leg". Looked at it and had snagged it on barb wire-didn't tell parents because he didn't think it was a big deal but injury was open with purulent drainage oozing from under a 3 day old bandaid and ended up on antibiotics and a fresh DTap.
So you can see why school nurse's need to have due diligence in why a kid wants meds, to rest, to leave school.
NutmeggeRN, BSN
2 Articles; 4,743 Posts
I hear you...thx and I really am not trying to be argumentative...I worry that if a kid who has had a surgery/procedure and is OK to be back, but has something happen to them. They ask for an OTC and I give it with no assessment. If bigger stuff is happening...and even tho they are 18 and living at home, I leave it at that (because they are an adult), relying on them to tell their provider-and they don't. Who is then responsible?
My notes will reflect what I did. Maybe the students age and them stating they are of adult age and I do not have the right to know is enough. Is it prudent of me to give them something that I have not assessed for? Or to deny any analgesic because I cannot assess them, as a parent I wouldn't be happy with that option either. I do not know.
TBH, I had not considered an orchiectomy (or other types of surgery in that realm). I was simply looking for some guidance and I appreciate everyone's feedback.