When school nursing and student privacy laws clash

By | 2019-03-27T20:01:14-04:00 March 27th, 2019|9 Comments

School nursing is an area of practice that is unique, complex and challenging.

It is often practiced without immediate in-person consultation and support, and is governed by both state and federal laws.

I have highlighted these issues in former blogs that discussed allegations nursing care provided by a school nurse was negligent.

For those of you who practice school nursing in a public institution, another important part of your practice is protecting a student’s privacy.

This duty stems not only from federal and state statutes — such as the state school code and the Family Educational Rights and Privacy Act (FERPA) — but also from the protections afforded by the 4th Amendment to the United States Constitution.

The essence of the amendment’s language is no person can be subject to an “unreasonable search or seizure” and a warrant for a search or seizure must be based on “probable cause.”

Many court decisions have applied protections to students in public institutions.

These decisions, in short, support the principle that any search or seizure in the school setting must be reasonable and based on all the circumstances surrounding the search and/or seizure. A search must not be excessively intrusive in light of the student’s age, sex and the nature of the suspected infraction.

Over the years, courts have further defined the privacy protections granted students as the culture of drugs and alcohol have seeped into the school setting.

Case illustrates when a school search is unreasonable

In one particular decision involving a school nurse, the United States Supreme Court granted the appeal of a 9th Circuit Court of Appeals decision dealing with a strip search of a middle school female student.

The school district had a policy that no prescription or over-the-counter drugs could be brought onto its campus without prior permission.

An eighth-grade female student was asked to come to the assistant principal’s office and, upon arriving, noticed a planner that was on his desk that was lent to another female classmate. Objects that she had not seen prior to her meeting with the assistant principal included knives, a lighter and a cigarette.

The student admitted the planner was hers but the objects in it were not. The assistant principal then drew her attention to a few “small white ibuprofen pills” on the desk. The student said she had never seen the pills before and had never brought any pills onto the campus nor did she provide fellow students with pills.

school nursing

The assistant principal then searched her backpack with the help of a female administrative assistant. Finding nothing, he then instructed the assistant to take the student to the school nurse’s office for a second, more thorough search.

The school nurse and the assistant then conducted what has been termed a “strip search.” The student was required to peel off each layer of clothing, including her socks, T-shirt and stretch pants. Nothing was found.

Despite the student’s insistence that she had no pills, she was then required to pull her bra “out to the side” and shake it. The student’s breast was exposed in the process. Nothing was found.

The student was then requested to pull her underwear at the crotch and shake it, which resulted in her pelvic area being revealed. Again, no pills were found.

The student’s parents brought a suit against the school district in federal district court, naming the assistant principal, the female assistant and the school nurse as defendants.

The U.S. Supreme Court’s decision

The case made its way through the judicial system and reached the United States Supreme Court. The court held that the student’s search was unreasonable and in violation of the 4th Amendment.

Although the court opined that the search of the student’s outer clothing and backpack was justified because of its policy of prohibiting any medication on campus and, due to circumstances at the school prior to the search that suggested pills were being sold or were present on campus, the remainder of the search — the strip search — was unjustified and, therefore, unreasonable.

The student had a reasonable expectation of privacy and she subjectively described the event as “embarrassing, frightening and humiliating,” descriptions often used by young individuals similarly searched.

The court also held that the three school personnel, including the school nurse, were entitled to qualified immunity — no liability for a violation of an individual’s constitutional or statutory right unless “clearly established” — because of conflicting lower and its own court decisions concerning the application of this immunity.

The school nurse in this case was lucky indeed.

What are your thoughts on the court’s ruling?  Do you think the school nurse acted legally and ethically? Do you think she will face any disciplinary action by the state board of nursing? Tell us in the comments.

Take these courses on school nursing:

School RNs Lead Education Efforts for Students With Diabetes
(1 contact hr)
Diabetes is one of the most common chronic diseases in school-age children. In the United States, about 208,000 people under the age of 20 have diabetes (about 0.25% of all people in this age group). Because of this incidence and the federal laws that guarantee students with disabilities access to public education, most school nurses already have students with diabetes on campus — or will in the future. For students with diabetes to have a successful school experience, school nurses must be well informed about the students’ special needs. The school nurse is the most appropriate person to coordinate the care of students with diabetes and to train school staff on diabetes-related tasks and ways to treat any diabetes-related emergency. This module informs nurses about significant factors in planning and initiating care in the school setting for students with diabetes. Overview of diabetes in children and adolescents. National Diabetes Education Program

Forensic Nursing and School Shooters
(1.5 contact hrs)
Many forensic nurses focus on interpersonal violence. At one time, schools — a workplace for students, teachers, and nurses — were considered safe. The reality is that violence on school grounds and inside school buildings is continuing in the aftermath of several high-profile cases of shooting homicides in these settings. Nurses working in the school, community, and emergency and psychiatric mental health settings can play a key role in the prevention of violence by understanding the dynamics and profiles behind these types of homicides.

Obesity and the School-Aged Child
(1 contact hr)
The increasing prevalence of childhood obesity is a major public health concern in the U.S. Approximately one-third of American children are overweight or obese. Obese children are more likely to become obese adults, with an increased risk of developing type 2 diabetes mellitus (DM), hypertension, dyslipidemia, coronary heart disease, and many other diseases. Diet and lack of physical activity are two main causes of childhood obesity, but dietitians, nurses, and health educators need to identify other contributing behaviors, such as lack of sleep, skipping meals, and excessive use of screen devices, especially at bedtime. Healthcare providers play an important role in the treatment of pediatric overweight and obesity by providing education, monitoring/following up, and referral to other providers. An individualized plan that includes the whole family is most effective when working with overweight and obese children.


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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.


  1. Avatar
    Carol March 31, 2019 at 11:41 am - Reply

    You have got to be kidding me. I am a school nurse and this is beyond inappropriate. The pills were not even narcotics. I would never participate in such a thing. How could the school think that this is in any way ok to do?

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    Sandy E March 31, 2019 at 4:19 pm - Reply

    In Texas, school nurses must obey the BON rules, but are also obligated to obey the school principal. When I was a school nurse, I declined to do as a principal directed sometimes and would give clear reasons as to why. Then, one day I was fired. The principal would make assumptions based on TV shows or hearsay as to medicine and nursing, and some actions would have harmed a student. At the time, I was a nationally certified school nurse and certified pediatric nurse. My care was more than competent. But obeying the principal’s opinions at all times was what was expected. I don’t think nurses should participate in strip searches. However, be prepared that it might cost you your job.

    • Avatar
      Cynthia E. April 1, 2019 at 5:58 pm - Reply

      Refusing to follow a principal’s instructions could cause you to lose your job if you are considered an employee at will. But remember this…if your principal is telling you to do things based on what he/she feels is a medical/nursing responsibility, they can be held libel for practicing nursing without a license. It is never the nurse’s role to partake in an activity that is detrimental either physically or emotionally to a student. Especially one that borders on assault.

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    Margaret Oliviero March 31, 2019 at 11:41 pm - Reply

    The school nurse’s actions are shameful and extremely unprofessional. Her responsibility is to patient care. The nurse did not follow the rule of “do no harm” as it is evident that this student suffered psychological harm.
    If there was evidence that the student had drugs, the parents should have been contacted and asked to come to the school. The child is a minor!! This child’s rights were violated. The nurse’s actions are unethical and unwarranted.

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    Lisa Petersen April 2, 2019 at 8:35 am - Reply

    The nurse’s actions were unethical and wrong. I would never conduct a strip search. My principal and assistant principal would never make such a request. However, if they did, I would have no difficulty in telling them no and why. I agree with a previous comment that her parents should have been contacted.

    Students bring acetaminophen and ibuprofen to school and common sense should prevail when we find out about it.

    A few years ago, my principal asked me to take photos of a student who he suspected had an injury inflicted by the parent. I told him I could not take photos and that he needed to contact OCS and let them take photos. He accepted that advice. I am very careful to protect my student’s privacy and my license.

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    B Coleman April 2, 2019 at 12:58 pm - Reply

    I am am school nurse in Virginia. Taking a child’s clothing off is not allowed by nurse in school.. A strip search was uncalled for . I would have refused to do this. Realizing it could result in litigation.

  6. Avatar
    DMDMD April 12, 2019 at 2:07 pm - Reply

    I am not a school nurse but I find the ‘strip search’ beyond ridiculous and demeaning. The male assistant principle even being in the room and requiring the student’s bra and underwear search causing her to be exposed is beyond humiliating. He needs to be fired!! What was he thinking!!! The nurse in question should’ve known better as well. I find All the adults at fault. This is a ridiculous example of what our society has devolved to. As for the acetaminophen and/ibuprofen, the medications don’t matter. This is a horror story for this young girl. PTSD much?

  7. Avatar
    tll67 April 17, 2019 at 7:56 pm - Reply

    Do they not have a police liaison? This matter should have been handed over to the police, and had the parents come in at that time. I would think that their policy would have the police involved if there was suspected narcotics?

  8. Avatar
    Rae January 8, 2020 at 4:35 pm - Reply

    It is no part of nurses scope of practice to diagnose anyone at anytime! So when schools especially at the high school level are having school nurses determine whether a student is under the influence of drugs bothers me nowhere in the scope of practice kind of nurse ever make a diagnosis of any person no matter what their age sex creed or anything else.

    So where does the school nurse get the power to determine students are under the influence and whether they should be expelled from school? This is happening in Scottsdale schools to students for things such as 1 minute late to class or if their heart rate is increased or because they are emotional. They are teenagers they are going to be emotional!! How dare our government system give power to a position who has no rights education or abilities to make determinant or diagnosis on anybody!

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