Substitute care
Teachers, paras forced to take on medical care of chronically ill students

On any given day at Chinook Elementary School in Anchorage, Alaska, Sharon Baker can be found patching up students with minor bumps and bruises that come from normal playground roughhousing; or she might be dispensing medication for an array of medical conditions that range from allergies to attention-deficit hyperactivity disorder (ADHD) to heart conditions. But Baker is not the school nurse, she’s the school’s administrative assistant. Although Chinook has a school nurse, Baker is asked to step in to provide medical care in the nurse’s absence.

Providing students with medical care is not in her job description, but it has become part of the job. And Baker is not alone. An online survey of 2,100 teachers and PSRPs conducted by AFT this past spring found that 31 percent of teachers and 53 percent of paraprofessionals have been asked to perform a medical procedure in school.

The increased demand for accommodations for students with chronic medical needs highlights a concern that school nurses have had for years: delegating duties to nonmedical staff. Most schools lack consistent school nursing care; as a result, staff members—with little formal training—are being asked to step in to provide medical care.

The most common medical procedure delegated to teachers and paraprofessionals is basic first aid, followed by dispensing oral medication, according to the AFT survey. A smaller number, less than 35 percent, said they were asked to test blood glucose or be trained to use rescue medication such as EpiPens (a device that has a needle that injects epinephrine to quickly reverse symptoms of a severe allergic reaction), or glucagon for diabetics.

“EpiPens are scary, whether it’s your child or someone else’s” says Baker, who is president of TOTEM, an affiliate of the Alaska Public Employees Association/AFT. “I’ve never had to [use an EpiPen], but the responsibility is always lurking in the back of your mind.”

Medication is the part that most of the nonmedical school personnel have a problem with, says Baker. “We are trained every year, but very few of us are comfortable with giving medication. Heaven forbid you grab the wrong bottle or overmedicate someone. To me, that’s why we have school nurses.”

Baker’s apprehension mirrors those of the teachers and support staff who responded to the AFT survey. The majority of respondents said they did not feel adequately trained to perform certain medical procedures. And even those who did feel prepared still worried about making a mistake.

“We hear this concern from our members—teachers, paraprofessionals, office employees, bus drivers—over and over, says AFT PSRP director Tish Olshefski. “We’ve monitored this issue for many years and compiled sample contract language and strategies to assist our affiliates in protecting members’ rights. But I’m not sure we’ll ever be able to do anything about their comfort level unless we can stop the practice completely and have all health services provided by a school nurse.”

Rights of delegation
“Some procedures require too high a level of professional knowledge or skill to be delegated,” said Pat Christie during a workshop on supporting medically fragile students in the classroom at the AFT QuEST conference held in July. Christie is a school nurse in Watsonville, Calif., and a member of the Pajaro Valley Federation of Teachers.

When a medical procedure is delegated, it must be the right task under the right circumstances, done by the right person with the right directions and right supervision, said B.J. Darby, a school nurse and member of the United Federation of Teachers in New York City, who also was a presenter at QuEST. “Our goal is to have a clear outline of what can and can’t be delegated.”

The solution is not to delegate but rather to hire enough nurses to meet the demand, say many school nurses.

“There is no way to adequately ensure the safety of a student when we have to delegate,” said Darby.

Louise Currin believes that having a full-time nurse would be the best-case scenario for any school.

“We have a school nurse, but she’s not here enough,” says Currin, a school secretary at East Sylvan Middle School in Portland, Ore. The school nurse comes to the school a half day each week, but when she’s not there Currin, the school’s only secretary, is responsible.

Currin, who is also a member of the Portland Federation of Teachers and Classified Employees, and executive vice president of AFT Oregon, knows that some of her colleagues are being called on to do more-invasive procedures, but she’s thankful that she hasn’t gotten that call—yet.

“There are limits to what a school should ask its employees to do. There are some things I’d rather not do,” says Currin. “I do know my limitations.”