Role of and Rules Regarding the School Nurse

It’s school time again across America! Are you ready? One way to get ready is to think about medical needs during school hours.

The school nurse is often your first line of defense when seeking a partner for good medical treatment during school hours. You might be able to infuse your child in the nurse’s office or involve the nurse in the infusion.

But when you meet with the school nurse, either alone or with your child’s team of teachers, it’s probably safe to assume that the school nurse doesn’t know much—or anything— about hemophilia. Some nurses may have a passing familiarity with hemophilia, but because hemophilia is so rare, most do not.

If you’re unsure of the school nurse’s understanding of hemophilia, ask your HTC nurse to intervene and act as a resource. Is the school nurse willing to be involved with hemophilia and assume some responsibility for your child? If so, then this nurse will be helpful.

Unfortunately, not all schools have part-time or full-time school nurses. According to the National Association of School Nurses (NASN), only about 40% of all US public schools have a full-time nurse; just 35% have a part-time nurse; and 25% have no nurse at all. And if your child attends a private school, it’s likely your school will not have a nurse. In schools with a part-time nurse, the district may have a full-time nurse, but the nurse rotates among several schools in the district and may visit your child’s school once a week at the most.

There are no US federal laws governing school nurse requirements, and school nurses are not all equal in education or professional abilities. School nurses fall into two types: registered nurses (RNs); and licensed practical nurses (LPNs) or licensed vocational nurses (LVNs). LVNs and LPNs are the same; they just go by different labels in different states. RNS have a bachelor’s degree from an accredited nursing program. LPNs normally complete a year of coursework, and they work under RN supervision on the job. In most states, LVNs/LPNs are not authorized to give IV meds, including factor. Check the regulations in your state.

Ask your school nurse if they are authorized and comfortable giving an IV infusion. Some RNs will not give IV medications, and you should not expect, or ask, any school nurse to access a port. Why? Because ports require special procedures that, if not followed correctly, can increase the risk of infection. In schools without a nurse, the nurse’s office is usually staffed by a nurse’s aide or health clerk—neither is qualified to administer IV meds. Although state laws vary on giving medications at school, your child with hemophilia is protected by federal laws. So if your child’s school does not have a nurse, it is the district’s responsibility to provide a nurse to assist your child at school and on field trips.

Excerpted from Raising a Child with Hemophilia, 2023

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