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Student’s tragic death underscores implications for school nurses

According to a recent news report, a 13-year-old student at Cecil Avenue Middle School in Bakersville, Calif., collapsed while doing sprints in his physical education class.

Two physical education teachers saw the student, Jose Manuel Beltran Salas, collapse, but did not administer CPR or call 9-1-1, according to the parents, Livia Salas and Jose Beltran. Rather, they called a district nurse whose job responsibilities required her to cover several schools and who was not at Cecil School when the incident occurred.

When the nurse was reached, she reportedly told the teachers to call 9-1-1 and immediately went to the middle school herself. The 9-1-1 call was directed to “Northern 9-1-1” in Canada. After this misstep, the call was re-routed to the appropriate local agency.

The nurse arrived at the school before the paramedics and found Jose lying face down on the gym floor. She placed him on his back and began CPR, which according to the complaint filed by the parents, was the first time any medical care was initiated and some 10 minutes after his collapse.

The boy was taken to the hospital by paramedics, where he was pronounced dead.

The parents’ wrongful death suit, filed Nov. 12 against the Delano Union School District, five employees of the school district, the city of Delano, Kern County and the state of California, alleges responsibility for their son’s death, alleges negligent hiring and seeks funeral and burial expenses.

Now that the case has been filed, it is certain that additional facts, information and the circumstances surrounding the boy’s death will emerge.

Whatever the outcome of this case, the death has implications for school nurses. First and foremost, you are responsible for ensuring your school personnel are correctly trained in CPR and/or the use of defibrillators. If your state does not mandate defibrillators in schools, contact your legislators and convince them of the need in all schools.

Educating parents and the community of this need, and of their participation in contacting legislators, also is essential.

School personnel should be regularly certified in the proper use of CPR and/or defibrillators. This can be easily done through training programs provided by outside vendors who are experts in this area.

Another duty for school nurses is to emphasize the importance of school personnel immediately calling 9-1-1 when an incident occurs. This call can be placed by a designated school employee who does so while resuscitation efforts are initiated. And this priority should be followed whether you are on-site or off campus when an incident arises.

When calling 9-1-1, the caller must identify himself or herself, state the correct name and address of the school and the nature of the emergency.

All school personnel need to know the correct number to call when a medical emergency occurs in the school setting. In this case, the proper number may have been called, but it may not have been routed correctly. For more resources, read the National Association of School Nurses’ Issue Brief, “Emergency Equipment and Supplies in the School Setting.”

This young boy’s death may have been averted or perhaps his cardiac condition could not have been reversed. That fact may never be known for certain. But fulfilling your obligations as a school nurse consistent with your overall standard of care to your students is essential.

Editor’s note: Nancy Brent’s posts are designed for educational purposes and are not to be taken as specific legal or other advice.

By | 2020-05-12T08:17:49-04:00 December 23rd, 2015|Categories: Nursing careers and jobs|16 Comments

About the Author:

Nancy J. Brent, MS, JD, RN
Our legal information columnist Nancy J. Brent, MS, JD, RN, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Her posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.

16 Comments

  1. Avatar
    Ronnie Cobb LPN January 5, 2016 at 1:47 pm - Reply

    Just found your website through School Nurse Alert, Love it! I will be following

    Thanks for your advice,
    Ronnie
    Pine Log Elementary

  2. Avatar
    CB January 5, 2016 at 3:22 pm - Reply

    I disagree with your comment, ” First and foremost, you (the school nurse) are responsible for ensuring your school personnel are correctly trained in CPR and/or the use of defibrillators.” It should be the district that is responsible for mandating ALL staff be properly CPR trained. The school nurse is not the one responsible for this. Fortunately, I work in a district where all schools have a school nurse. All districts should be requiring all staff be trained “correctly” by the proper AHA classes. The school nurse could help coordinate the AED team and keep an updated list of all staff who are CPR trained and when their certifications expire. The school nurse communicates with staff regarding student health conditions and emergency information. Your statement makes it seem that it would be the school nurse’s fault if the staff are not trained in CPR. That should be the district’s responsibility. And wouldn’t a CPR class instructor be “properly” training their students anyways?

    • Avatar
      AR January 7, 2016 at 2:36 pm - Reply

      CB said exactly what I thought. All school systems are set up differently and it may not be the school nurse who is in charge of teaching CPR to staff.

  3. Avatar
    Jeri Gooding January 5, 2016 at 3:58 pm - Reply

    I have a question about liability for the other staff members. If there is a Nurse Assistant at a school is a registered nurse responsible for all of her actions even if she is not in the building at all

  4. Avatar
    Margaret Chisham January 6, 2016 at 7:40 am - Reply

    I agree that we as school nurses have this responsibility both legally and ethically. We also have an obligation to educate the parents, community and legislators about the importance of having full time school nurses.

    • Avatar
      RLS January 7, 2016 at 2:48 pm - Reply

      I agree with CB!! By putting all this on the school nurses, many are going to walk away!….It should be implemented UPON HIRING in the districts as part of their job i.e. physicals are required, CORI checks are required and even fingerprinting is required!! So this also should be!!

  5. Avatar
    N January 6, 2016 at 3:09 pm - Reply

    “Another duty for school nurses is to emphasize the importance of school personnel immediately calling 9-1-1 when an incident occurs.”

    Really? That statement is absolutely ridiculous. How about some common sense from the witnesses??

  6. Avatar
    Brandye Gossett January 6, 2016 at 4:24 pm - Reply

    The staff did not act appropriately. The student was found by the nurse face down on the floor. The staff should have had enough common sense to roll the student over and examine him. They should be held responsible for not calling 911 sooner.

  7. Avatar
    Karen January 7, 2016 at 10:34 pm - Reply

    I have taught CPR and First Aid since the 80s; I have worked advanced life support in a rural mountain area for 25 yrs; I have 15 yrs clinical experience as an RN PHN; now I am the new school nurse in a District with 11 campuses. I know firsthand the importance of CPR and First Aid being initiated before the professionals get there. All staff working with children should be trained in CPR as part of their job requirement – my personal opinion that I voice frequently. The school nurse in this unfortunate incident should not be held responsible for the lack of training (and therefore any prompt action by the staff), unless it is specifically in the job description. Shame on those who did nothing and those trying to point the finger in the wrong direction.

  8. Avatar
    DHullRN January 8, 2016 at 5:38 pm - Reply

    I have big problems with this story and its message.
    •First the RN acted appropriately, if not heroically.
    •Doesn’t the article imply (by its theme and tone) that she didn’t ensure her teachers were CPR/AED certified, and/or that she didn’t train them to act appropriately?
    •There was no accountability from the author for the gym teachers who were completely negligent in responding. Gym teachers are almost always certified to coach, and therefore, certified in first aid & CPR/AED. But you don’t need to be certified in anything to have human compassion and common sense.
    •There is no accountability from the author for the district which allowed this to happen, without safeguards or immediate protocols.
    •Ensuring that teachers and staff are CPR/AED certified is not the RNs job, that is for politicians to mandate, or districts to require. She couldn’t even ensure that there was an RN in the building.
    – For it to written as fact by an RN with legal training is deeply troubling.

    That’s just to start… but if the article is used to show that not having an RN on-site can have fatal consequences… than I suppose it has some merit. School nurses prevent this kind of outcome EVERYDAY.

  9. Avatar
    Sue C January 8, 2016 at 8:45 pm - Reply

    Having been an Emergency Room Nurse for over 30 years and new to school Nursing; I am amazed at how quick people are to assume they have all the facts. Firstly, I would NEVER/EVER have taught untrained personnel how to perform CPR in the ED if I was not certified as a CPR Instructor through the American Heart Association. That is simply malpractice, and I would have been terminated immediately. So why would it be different in the school setting? The school Nurse cannot train anyone in CPR if she is not a certified instructor as well. Second; Individuals that may have been certified in CPR but did NOT take action should be charged with Failure to ACT. Individuals that help are protected from litigation under the Good Samaritan Act. Shame on those that did not act if they were certified. Who is responsible for ensuring individuals are trained in CPR? It should not fall solely on the School Nurse’s shoulders. To train someone takes money and who pays for this? If she is unable to be compensated for certification as an Instructor as well as for teaching a class, then there is a bigger issue here and her hands are basically tied. Responsibility falls on the School District and Board of Education for not providing the necessary resources for ensuring the safety of ALL students. Finger pointing cannot solve this problem. Appropriate responsibility is to be shared across the board.

  10. Avatar
    Robin January 25, 2016 at 12:47 am - Reply

    The point that the school nurse should or shouldn’t have been responsible for training staff in CPR/AED skirts the underlying issue that this tragic situation wouldn’t have happened if there was a nurse staffed in each school campus. However, being a former school nurse in a district where the same situation exists, it is a difficult position for the district. Ethically, legally and practically, each school should have a dedicated nurse to attend to the various health needs of the school’s occupants. However, financially, many districts struggle to afford this. My district has several elementary schools with enrollments well below 100 students–as low as 50 students. This district claims it cannot afford to staff each school with an RN. My question is, after reading about this tragedy in Bakersfield, how can the district NOT afford to do as such?

  11. Avatar
    Katie January 26, 2016 at 1:23 pm - Reply

    The biggest thing that pops out of this story is that there was one school nurse covering multiple schools which is inadequate staffing in my eyes. Secondly, the story is something school nurses can learn from but as other people have mentioned I do not agree that the responsibility of ensuring staff is adequately trained falls soley on the school nurse. One nurse is covering multiple schools and the workload is probably more higher than it should be. The school system should have ensured that there was adequate staffing of nurses at the school in the first place. Hopefully the school system will learn from this but I do not believe the blame lies on the shoulders of the school nurse.

  12. Avatar
    Marcy June 12, 2016 at 3:23 pm - Reply

    Yes I have a problem with this article as well, when I worked as a school nurse the superintendent ran the school, it was her decision to have the teachers trained in CPR and AED. Believe me when I tell you the teachers wanted nothing to do with the nursing office or anything medical, it was like pulling teeth just to train them on an Epi-Pen and some of them wouldn’t even touch it. My heart goes out to this child and his family, it is horrible that no one stepped up to do CPR on him. I was at my school for only 2 years and instituted emergency boxes everywhere of emergency AED, Epi-Pen’s Rescue inhalers, and pushed for the CPR teaching and then I left because of the bullying by all of the teachers in the school. Too bad because I loved the kids.

  13. Avatar
    Jadira September 30, 2017 at 9:43 am - Reply

    My child had a bad allergic reaction his face swelled up lips everything and the school nurse did not give him his epi pen or called 911 what can be done about this

  14. Avatar
    Youcancallmebetty May 23, 2018 at 2:02 am - Reply

    The school district administrators should accept complete responsibility for this tragedy. Don’t let them fool you into thinking that the budget does not allow to hire a fulltime nurse per school because MANY districts have more than enough funds but are not mandated to hire nurses so they don’t. The waste of funds will infuriate the hardworking taxpayers of California. . As far as school employees they are often afraid to do the wrong thing and be blamed and sued if some thing is to go wrong. A school nurse is professional that is desperately needed in every school and parents should demand it.

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