Daily Health Reviews

Tigard-Tualatin nurses raise liability questions over school requests
account!

To me the critical issue is the district’s failure to enforce the parent’s agreement with the service provider. The child should not have been at school on the days when the nurse was unavailable, as agreed. The school nurses (4 for the entire district!!) are not intended to be on-call. It sounds as though the Mr. Saxton is uninformed when it comes to the reality of implementing school level services. The district needs to support their nurse employees and at the same time provide for the welfare of the students, but it requires that agreements are clear and enforced.

Completely agree.

Schools are not hospitals nor should they ever be. When you have special needs kids like this and the situation arises where their special need cannot be met adequately and that is a life or death decision by the parents to send them … ridiculous to expect an untrained school nurse to step in an do things he/she is not comfortable with and thus carries a huge personal and professional liability.

Why didn’t Mr. Saxon step up and do the suctioning? Because he is not trained to do so. To expect his school nurses (who are not ICU nurses, not home care ventilator nurses, not trach care nurses, not chronic wound care nurses, not ostomy nurses, and on and on and on) to do so is nearly as ridiculous. They are trained to take care of minor injuries, mildly sick kids until the parents come to get them (or call 911 if they are really sick) and pass out/administer chronic medicines.

Just like any other kid who is too sick to be at school, these type of special needs kids who literally have potentially life threatening conditions should be deemed too sick to attend also if their trained care provider is not present.

hmmm?….It’s not a matter of “they choose not to do what they don’t want to do”….it’s a matter of being comfortable and trained on the specific equipment. These types of situations always try the schools, nurses and parents to the extreme. The person that was going to be gone should have let the parent know and the parent “should” have just taken the day off and stayed home with the kid…..now that’s how it should go……but a lot of high needs parents won’t play that way and force the school’s hand to take care of the child……..personally, when it gets to such a HIGH degree of medical care, and constant, wherein a kid could die anyday at school, maybe the IEP team should be discussing a home placement or shortened day, at least…….volatile issue at the schools, for sure!

These kids a very high needs. I have worked with them. kingmike81, duckramone, and rumpled said it all perfectly. It is a tricky situation and protocols have to be discussed thoroughly and agreed upon.

The law says that they must provide “free appropriate education” but nowhere does it state that must include medical care. If a student does not have appropriate medical care it’s the job of the parent to ensure she is taken care of, not the school. If that means she misses a day so be it.

You may be surprised to find out that the “free and appropriate” rule would mean the school is responsible for the health care of this kid. My school has two students who need an attendant with them every moment of every day — in neither case is the attendant a nurse. But these students couldn’t attend school without someone with them — and the school has NO CHOICE, but to accommodate. A few years ago we had to spend nearly 0,000. to have windows covered with a tinting film for ONE student who had some kind of sunlight disorder. This student also had a special transport vehicle (paid for by the district). All this stuff is expensive and takes away from the education of the whole.

I once was requested to resign (fired) for refusing to perform tasks that were specifically spelled out in my employment agreement-that I would receive intensive training before being assigned such tasks. (The facility still owes me severance pay.) Another time I refused an order to protect my license. It was easier to find another job back then. Unless the student is in a life-threatening situation when you call 911 for medical support, it is best to not jeopardize your license to keep your job.

“Last school year, the district contracted with a nursing agency, at an hour, to provide for an elementary student who needed one-on-one care during the school day.”

an hour??? Geez, no wonder my property taxes are through the roof!

IMO, the parents should provide the medical care. It’s their kid.

that is kind of nonsense…..office RN’s and school RN’s have the nice 8-5 jobs or even less….no weekends…many holidays….long summers off…..they choose to work at the schools….I find it almost amusing that when they’re called on to do actual RN work, they’re aghast……what the heck do they think they get paid for and get all those benefits for?…..

if you can’t be a real RN, then stop pretending….

leelee- I am a critical care RN and am rigorously trained in this specialty, but if I showed up at work one day and was assigned to the role of school nurse, I would have to refuse. As stated above it would be like asking an English teacher to teach Algebra for the day. Nursing is multifaceted; there are many specialties. Each position from critical care, home health, school nurse etc… require its own specialized training and being an expert in one field does not equate to competence in all fields. School nurses are experts in their field of nursing; and for you to state “if you can’t be a real RN, then stop pretending” shows not only your rudeness, but your ignorance as well.

I agree with pbandnv…I’ve been an RN for over 25 years and am very good at what I do, however, a nurse can’t be expected to be current on every skill. If there are these types of kids with special needs, then the school district should at least provide some way that the nurse can be inserviced periodically to stay current on particular skills. If the district can’t do that, the parent should be respecting the agreement that they signed, to keep their child home if the nurse is not available. I think that the parent who ignores that agreement is very neglectful.

It really doesn’t matter if one is a nurse, a pesticide applicator or a truck driver. You don’t do things you don’t know or are uncomfortable with, it’s your license. Maybe you need more or different training, or to quit, or to get fired and sue.
Now, a boss should listen to, and respect his / hre workers that are trained, certified and licensed in their field while he is not. If say, 3 out of 4 follow his orders and do something, and the fourth says “no”; it’s his job as well-paid management to figure out if the three will follow any orders (right or wrong) and the one has integrity – or if the fourth needs ore training, or is just a trouble-maker. I do have to add that my experience as a pesticide applicator, and as a truck driver, has ade it very clear that no boss’s direct order is an adequate excuse for me to do anything that I don’t believe is right.

Oh, and about that per hour? That’s an example of contracting out (privatization) of government services. (At least the nurses aren’t getting PERS.) The nurses are getting paid, plus benefits, and someone is getting a profit on top of that. I believe in the consideration or ‘threat” of privatization, the use of it when appropriate, and competitive bidding.

And last, we have to provide the opportunity of education for everybody, regardless of disabilities. So now that has morphed from teaching English to people from all four corners of the earth into providing medical care that should be the responsibility of the parents? Obama rules, universal health care, paid for by those who pay for their own, or don’t need it, or both.

Whoops, my prior note needed proof-reading. Many, way too many, errors. ‘Twas passion.

I posted this as a reply to a comment, but I’d also like to post it as a general comment:

You may be surprised to find out that the “free and appropriate” rule would mean the school is responsible for the health care of this kid. My school has two students who need an attendant with them every moment of every day — in neither case is the attendant a nurse. But these students couldn’t attend school without someone with them — and the school has NO CHOICE, but to accommodate. A few years ago we had to spend nearly 0,000. to have windows covered with a tinting film for ONE student who had some kind of sunlight disorder. This student also had a special transport vehicle (paid for by the district). All this stuff is expensive and takes away from the education of the whole.

And just this week we found out that we will have NO health assistants this year. Our secretaries will be on the hook for dealing with every medical issue that comes up. Not sure how long that new policy will hold up.

School Nursing is a specialty practice with job responsibilities that are different from school district to school district, depending on the staffing level of nurse to students.
Some schools have one nurse per school, others have one nurse for a district of 6,000 students, others have no nurse at all.
Federal law requires that schools provide any services that are medically required for the student to be able to attend school.
State law regulates nursing practice.
If a school employee provides nursing care without the benefit of a licensed nurse overseeing that care, then that employee is practicing nursing without a license. This is illegal. It is also very dangerous for the student.

The solution to Tigard-Tualitin is to have a bank of back-up substitute nurses who are trained and ready to step in as needed.
Teachers have substitutes. School nurses and private-duty nurses should have substitutes as well.

The role of the school nurse may include:
Case Management of high needs students – training staff to do daily tasks, planning the student’s daily activities, instituting protocols for urgent or emergency situations (eg life threatening allergies, diabetes with insulin injections, colostomy care, tube feedings, catheterization, etc)

Consultation to educational staff – to help them understand any restrictions or any special accommodations that may be needed for students with medical diagnosis (Hard of hearing, ADHD, asthma, short term orthopedic impairments, cancer, etc)

Public Health -working with public health officials during outbreaks of illness from chicken pox to meningitis, to whooping cough, ensuring that students receive immunizations, managing and hosting flu clinics (did your school offer H1N1 clinics? Many school nurses worked double days for months to ensure that their students got an opportunity for vaccination).

Medications – students come to school needing a variety of medications, more complex each year. The school nurse might actually give the medicines if s/he is full time in one school, otherwise she has to train and intermittently supervise secretaries for this task, as well as review the medication orders for accuracy and safety.

Health screening – school nurses do vision screenings and refer students who don’t pass to professional eye care providers, and the same for hearing screening and a variety of other screenings depending on resources. Nurses make referrals to private medical providers when necessary. It is very common for the school screening to be the only episode in which a child is found to have a significant vision impairment, or hard of hearing, or…..
It’s common for one nurse to check over 1000 student’s vision in one school year.

Health Care equity – school nurses often know which children live in poverty, have no insurance, no health care, and help families connect to community agencies that will help.

Consultation to parents – many parents look to the school nurse for health information and a consultation about minor health issues they are experiencing.

School nursing is a specialy practice. This story illustrates why the National Association of School Nurses advocates a ratio of 1 RN to every 750 healthy students.

An appropriate RN to student ratio is necessary for student safety.

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Source article Read more on The Oregonian

Local green salons offer natural beauty

She researched the ingredients listed on the bottles in her salon and was surprised to learn of the impact they might have on the body, the environment and the well-being of salon staff.

“As I read more and more, I realized how many chemicals were in my beauty products,” said Harris, who owns Girl Gotta Do Hair Salon in West Manheim Township.

“My salon’s in my home, so I wanted a safer environment for my family.”

A year ago, she went “green,” adopting a hair-care line and cosmetics that claim to use more earth-friendly ingredients and practices.

Some of her inventory costs more than conventional products, but it’s because natural ingredients are more expensive than synthetic chemicals, she said.

Harris’ home-based shop is among a growing number of beauty salons that describe themselves as organic, although no government agency or independent organization certifies such claims.

To Harris and Karrie Earnst, owner of Organix Hair Salon in Springettsbury Township, “organic” describes their step away from petroleum-derived and other synthetic substances and toward organic products.

Ecological activists have questioned as possibly harmful many of the conventional chemicals found in salon products, such as ammonia and p-Phenylenediamine in hair colorants; chemical fragrances and parabens, a widely used class of preservatives; and toluene in nail products.

Of particular concern is how efficiently the scalp, skin and hair absorb such substances.

“In hair school, they don’t tell you about anything organic,” Earnst said. “They said the smell of chemicals is the smell of money.”

She read up on toxic chemicals and suspected carcinogens after her always-healthy grandmother died of breast cancer. She was opening her own salon and noticed some of the same chemicals listed in hair products. So she sought alternatives.

However, manufacturers can make “green” or “natural” claims without checks by federal regulators. Both Harris and Earnst were cautious Earnst uses the Shear Miracles by Robyn product line from Lancaster because it contains no synthetic chemicals or irritants. (DAILY RECORD/SUNDAY NEWS – PAUL KUEHNEL)when shopping for a supplier who used natural ingredients and whose products maintained professional-grade quality.

They found what they were looking for in Robyn Atticks, a Lancaster-area stylist who started her own line of products after she couldn’t find anything that met her standards on the market.

Atticks packs her Shear Miracles by Robyn products with “good-for-you” natural ingredients such as botanical oils and nut butters.

“So pure, you could eat them,” Atticks says on her website.

She promises they are not tested on animals and most are gluten-free and vegan (free of animal products).

Since 2002, the Agriculture Department has enforced the organic claims made by food producers, but it does not do the same for Karrie Earnst, owner of Organix Hair Salon in Springettsbury Township, perms the hair of Washington Township resident Kayla Rishel. (DAILY RECORD/SUNDAY NEWS – PAUL KUEHNEL)personal care products. Manufacturers may apply for the agency’s National Organic Program label, but no one checks on their claims.

Shear Miracles products do not carry the agency’s organic seal, and Atticks has no plans to pursue it.

“Our products far exceed that seal of ‘approval’ and to get that seal would require so much paperwork, time and money that we would naturally have to raise the price of our products,” she said.

Atticks gives her customers a chance to become one of her Organic Vision Salons. To belong, a salon must pledge to use only nontoxic hair, skin and body care products and no air fresheners or candles containing synthetic fragrances.

They also commit to environmental projects such as donating hair clippings to be made into oil spill cleanup mats or containment booms (hair absorbs oil).

Clients seek out green salons for various reasons. Some have allergies, asthma or sensitivities to harsh chemicals or synthetic fragrances. Others are cancer survivors or have other health issues and try to avoid carcinogens and other toxic substances.

Some doctors advise pregnant women to avoid coloring their hair because the colorants could be absorbed by the fetus and cause damage.

Ashley Hindman, a 25-year-old expectant mother, didn’t get such a warning from her doctor but was excited to learn Earnst could dye her hair without the usual cloud of stink.

“I didn’t want to sit in the smells of the chemicals,” Hindman said.

Harris believes it’s important to educate her clients — especially mothers — about what’s in their personal care products.

She urges moms to read ingredient labels and decipher exactly what they’re applying to their family’s skin and scalp. If you can’t pronounce it, it’s probably not good for you, she advises.

A client, Colleen Small, 43, of Manheim Township said Harris opened her eyes to how her shopping choices on everything from food and personal care items could affect the health of her family.

“I never really knew what ‘organic’ meant before,” said Small, a mother of two.

“It’s not cheap because everything is natural. But think about our cars: We have them for a short time, but we maintain them and take them for tune-ups. We have our bodies for a lifetime. You have to take care of them.”

mburke@ydr.com; 771-2024

What’s that label mean?

Federal guidelines that regulate organic food labeling don’t apply to skin- and hair-care products.

Manufacturers may apply for the Agriculture Department’s organic label, but the agency doesn’t enforce regulations if a producer makes unsubstantiated claims.

Read labels closely, and note that many claims are not regulated by the government or an independent organization. Some are not meaningful and could potentially mislead consumers.

Alcohol-free

The Food and Drug Administration (FDA) has reported that manufacturers have used the term “alcohol free” on cosmetic products that are only ethyl alcohol free; however, there are other types of alcohol that could be found in cosmetics labeled “alcohol free.”

Check the ingredient list to make sure that the product is truly free from any alcohol. Generally, ingredients that end in “-ol” are likely to be a kind of alcohol.

Dermatologist tested

According to the FDA, manufacturers are not required to perform any tests or provide supporting evidence to demonstrate that products labeled “dermatologist-tested” were actually tested by a doctor and produced fewer allergic reactions than other products.

Nearly all cosmetics are likely to cause an allergic reaction in certain sensitive people.

Manufacturers are allowed to consider fragrances as trade secrets, so the government does not require them to list the specific ingredients. Thus, consumers might not be able to identify the specific agent causing an allergic reaction from a cosmetic product.

Fragrance-free

This label can be deceptive, implying that the product does not contain any fragrances. But neither the FDA nor any organization independently certifies this claim.

Products labeled as “fragrance free” can contain fragrances that are used to cover up the chemical smell of the other ingredients in the product.

According to the American Academy of Dermatology, fragrance is the No. 1 cause of allergic reactions in cosmetics.

Hypoallergenic

This claim implies a product will be less likely to cause allergic reactions, but the FDA has no standards that govern the label.

Manufacturers of cosmetics labeled as hypoallergenic are not required to submit substantiation of their claims to the FDA.

No parabens

Generally, this claim implies a product does not contain any parahydroxy-benzoate (paraben) preservatives, such as methylparaben, propylparaben, ethylparaben, butylparaben, benzyl-paraben.

Parabens are the most widely used preservatives in the United States, commonly used in hair-care and skin-care products.

No organization or government agency verifies the use of this claim other than the company manufacturing or marketing the product.

No sodium lauryl or laureth sulfate

No organization verifies the use of this claim. Sodium lauryl sulfate and sodium laureth sulfate are used in many cleaning products and personal hygiene products because of their cleaning ability and foaming capacity.

Both can produce eye and skin irritation and allergic/sensitivity reactions. Rumors that they cause cancer or blindness are false.

Sodium laureth sulfate can be contaminated with 1,4-dioxane, considered a probable human carcinogen by Environmental Protection Agency.

Vegan

Products labeled “vegan” imply they do not contain any animal-derived ingredients, but that may or may not be true. They may or may not have been tested on animals. Check the ingredient panel for details or contact the producer for information.

No organization verifies the use of this claim other than the company manufacturing or marketing the product.

Source: Organic.org,

Organic salons
Girl Gotta Do Hair Salon, 2537 Blackrock Road in West Manheim Township, 632-4983

Organix Hair Salon, 3755 E. Market St. in Springettsbury Township, 751-0158

Online

Organic Consumers Association, www.organicconsumers.org
Environmental Working Group, www.ewg.org

Eco-Labels, www.greenerchoices.org/eco-labels

Cosmetic Safety Database, www.cosmeticsdatabase.com

USDA Organic Program, www.ams.usda.gov/AMSv1.0/nop

Organic Trade Association, www.ota.com

Source article Read more on York Daily Record