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?
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