Tigard-Tualatin nurses raise liability questions over school requests Tips For Your Family's Health

Tigard-Tualatin nurses raise liability questions over school requests

August 26th, 2010 Leo Dicks Leave a comment Go to comments

TIGARD Share This is not a hypothetical situation.

Last school year, school administrators told Tigard-Tualatin School District nurses on three occasions to work with a medically fragile elementary student who needed her tracheostomy tube suctioned while at school. In each instance, a contract nurse who normally cared for the child was absent.

A district nurse performed the procedure each time, but the nurses said they worried about liability issues that came with handling equipment they were either unfamiliar with or had not inspected. They also said the procedure was not one that they normally came across in their 3,100-student caseloads.

The issue is fraught with complexities for everyone involved of Tigard did not provide a nurse for the student, Executive Director Barbara Wood said. The first nurse didn’t work out. Another time a nurse got into a car accident while heading to work. Once a nurse was sick. Each time, the agency had no replacement, Wood said.

Although the child’s mother signed a form with the agency saying that she would keep her child at home in the event an agency nurse couldn’t make it to school, the mother took the child to school anyway, Wood said. Each time, a district nurse performed the procedure. A fourth time the district sent the child home, said Ernie Brown, district director of human resources and operations.

The student’s family could not be reached for comment.

Nurse Paula Peterson, who was called in to suction the child’s tube once, said she learned the skill in nursing school but would not consider it a current skill.

“It wasn’t hard for me,” Peterson said. “I was a recovery room nurse, so I suctioned all the time. But it had been 21 years since I did it. … We have the skills, they are rusty and they can come back, but they are not current.”

Edwards, who has been a nurse for 37 years, said school nurses are not always prepared to care for a high-needs student.

“We’re not universal ‘plug us in to do anything’ people any more than a teacher can be plugged in to do physics if she is a second-grade teacher,” Edwards said. “They don’t put teachers in the classroom if they aren’t capable of doing the job. I don’t know why administrators would ask us to step up and do things that in our professional judgment are not part of school nursing.”

But administrators have their own laws to follow. Federal law says that students are eligible for a “free appropriate public education” and cannot be denied based on their medical condition, regardless of the severity of their disability. Sending students home from school because the district cannot provide medical care is not an option, Saxton said.

The nurses argue that strictly following nursing practices is equally important because they could run the risk of losing their state licenses. One guideline is their “scope of practice,” which dictates what nurses can or can’t do depending on their experience and training.

Leslie Currin, the school health services specialist with the Oregon Department of Education, said the state’s Nurse Practice Act, a set of statewide rules for the profession, essentially “leaves it up to the nurse’s discretion” to decide whether he or she can perform a task.

“Of course, the school official is not going to be an expert on that,” Currin said. “The nurse has to be an expert on what she can do under the Board of Nursing.”

Nurse training

The district employs two types of nurses , which licenses and disciplines nurses, does not get into the middle of employer-employee disputes, said Marilyn Hudson, a board nursing practice consultant.

However, the board does provide informational training to help people understand how nursing guidelines may apply and affect certain jobs.

“The board’s concern is, is the client going to be safe because the nurse is educationally prepared,” Hudson said.

Tigard-Tualatin officials say part of their plan for the upcoming school year is to pay for training for the nurses if they are needed as substitutes for medically fragile students.

At least two nurses will be identified as backups for each medically fragile student, according to a memo sent to the nurses in July. The nurses will train with the student while managing their caseload and be required to record practice sessions to document they are up to date and ready to perform the skills for the student at all times.

The district expects to have two students who need continuous care throughout the school day starting in the fall, spokeswoman Susan Stark Haydon said.

Saxton said the district intends to have nurses provide any care that is needed to keep the children in school.

“If a medical procedure comes up for which they need training, in order for us to provide services for us to keep kids in school, we want to provide the training so that they can perform the task,” Saxton said.

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