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.
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:
- A Healthy Home for Children (1.0 contact hr) The goal of this course is to help nurses, social workers, and health educators identify and prevent health hazards in the homes of children.
- Managing Obesity in Young Children (0.5 contact hr) The goal of this course is to educate nurses, dietitians, and fitness professionals in the acute setting on pediatric obesity and best practices for management.
- Internet Safety for Children and Adolescents (0.5 contact hr) The goal of this course is to provide nurses who work with children, adolescents, and their families in various settings with information about how to support children’s safety on the internet.
- Autism Spectrum Disorder (1.5 contact hrs) The goal of this educational program is to enhance healthcare workers’ knowledge of the diagnostic criteria, common characteristics, clinical interventions, and treatments for patients with ASD.
