What Legal Issues Do Today's School Nurses Face?
Nadine Schwab, a registered nurse who served as Connecticut State Department of Education Consultant for Health Services, regularly consults and writes on legal issues in school health. In fact, she co-edited the new book Legal Issues in School Health Services: A Resource for School Nurses, Administrators and Attorneys (Sunrise River Press). The following Q&A, adapted from School Health Alert, is partly based on material from that book.
To what types of liability are school nurses subject?
School nurses are subject to civil, administrative and criminal liability. Most civil cases against school nurses are related to questions of negligence and are settled out of court, making it difficult to find written details. The finding of liability in a civil case does not require proof of intent to do harm, but rather, failure to meet the standard of care of another reasonable school nurse in the same situation. Of cases decided in court, frequent causes of liability include failures to (1) perform an adequate assessment, (2) intervene effectively in emergencies (especially anaphylaxis and asthma) and (3) document evidence of appropriate nursing care. Additional causes of liability include failures to keep clinically up-todate, follow district policy, delegate safely and communicate with parents.
School nurses can be subject to administrative liability if referred to their state's board of nursing for investigation of possible failure to meet state practice standards. A finding of liability can result in discipline, including temporary or permanent loss of one's license to practice. Involvement in a special education due process hearing on behalf of school districts may be considered a type of administrative liability. While it is the district, not the nurse, that is liable for a heating officer's finding that it did not carry out its legal responsibilities to a student, the nurse's actions or recommendations to the school team may contribute to the finding of school district liability. The same concept applies to investigations by the Office for Civil Rights, U.S. Department of Education. Finally, school nurses can be subject to criminal investigation for actions that are prohibited by law, such as theft of controlled drugs or practicing medicine without a license. If charges are brought and a nurse is found guilty, he or she is generally sentenced by the court and may be required to pay a fine or serve a jail sentence, or both.
Parents may have different expectations of what school nurses can and should do. How can nurses minimize conflicts with parents?
The keys to minimizing conflicts with parents are focusing on students' needs and family priorities, collaboration and communication. When one is sued for negligence, usually a series of things have gone wrong, particularly communications. Developing a sound working relationship with parents, beginning with their priorities and preferences, is key. Building trust requires deliberate actions to promote joint planning and problem solving, open discussion of recommendations and concerns, and parental notification of changes in student health status and district procedures. It is critical to communicate without conveying disapproval of a parent's position, and to document all communication. Explaining (in lay terms) the scientific basis of specific recommendations, including potential benefits to student learning, and addressing both pros and cons of differing positions advances understanding and collaborative approaches.
Medications at school raise legal concerns: What practices and products should be allowed, who can dispense them, and who decides about giving medications-the physician, RN, parent or principal?
In general, the answers vary according to the state laws where the school nurse practices. It is critical to know and understand the relevance of various state laws and regulations that apply to medication administration in schools, including the nurse, pharmacy and medical practice acts, regulations related to controlled drugs, applicable education laws, and declaratory rulings or guidelines of state agencies and boards. …