School nurse questions whether ‘ill’ student should drive home from school

By | 2020-06-29T16:07:33-04:00 June 24th, 2020|0 Comments

A school nurse asked how she should respond to high school students, who regularly drive to school and ask to be dismissed because they don’t feel well. They have no fever or other symptoms.

Her position is that if they are well enough to drive home, they should stay in school. The school nurse did not include any further details about her dilemma. My response, therefore, focuses on general information in this situation.

Driving to and from school

When schools allow students to drive to and from campus, they adopt a policy governing the students’ driving and parking on school grounds. This is so everyone is clear about the rules surrounding all aspects of this privilege.

For example, some schools require the student to sign a contract that explains all applicable rules before issuing a parking permit.

Another consideration is whether the school campus is open or closed. If open, students are usually free to leave at lunch time or during free periods. When driving is permitted to and from school in an open campus, the student can theoretically drive his or her car off campus at any time.

In the case of a closed school campus in which driving to and from school is allowed, students are unable to leave during the school day unless they permission from the school and the parents or guardian.

I assume the school in this situation has such a policy and that the school nurse has access to driving contracts.

I also assuming the school campus is closed, since she indicated students come to her office so they can be dismissed because they say they are not feeling well.

School nurse’s physical assessment

There is no doubt that when a student comes to the school nurse’s office and complains of not feeling well, the nurse must do an assessment to determine his or her overall state of health.

In order to ensure the school nurse has permission to conduct an assessment, most schools will require the parents/guardian sign a written consent form that explains what routine care will be provided by the school nurse.

The assessment is necessary as part of the school nurse’s decision-making concerning what, if anything, is wrong with the student and if anything is found, to initiate the appropriate treatment.

During the assessment, the nurse can determine if the student has specific symptoms that would be grounds for the student to go home. For example, if the student has a fever, sore throat or is vomiting, the nurse can make the decision to dismiss the student.

However, the nurse must also assess the student’s ability to drive home with the presence of these symptoms. If not, it would be best for the nurse to contact a parent or guardian so the student can be picked up and driven home.

The emotional assessment

If the student has no specific symptoms and the school nurse determines the student is not ill and does not fit the required reasons in the school policy to be dismissed from school, a second assessment is in order.

This assessment would be focused more on emotional rather than physical concerns.

This includes exploring if the student is upset about something, if the student is being bullied or made fun of by other students, or if the student is lonely or depressed. The school nurse will need to delve into these issues.

Suggesting a counseling plan with the school social worker or psychologist and/or other appropriate action (e.g., working with the school health team to end the bullying) would be in order.

Notifying the parents of the assessment and intervention(s) also is in order unless the student is legally provided the right to consent to certain treatments, such as counseling.

States vary on the requirements of parental notification or consent. Check your state’s requirements online at School Nurse Connection.

Implications for your practice

As a school nurse, it is imperative that your overall objective is the well-being of the students. This requires you to do so in a fair and impartial manner, consistent with professional standards of practice for your specialty area and with an eye toward your legal and ethical obligations.

If you have fulfilled all of your responsibilities and determine the student is not ill and can drive home safely, do you think it is part of your role to keep the student from going home?

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. 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. 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
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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
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The increasing prevalence of childhood obesity is a major public health concern in the U.S. 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.


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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.

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