Cindy has been a RN in a middle school for a large school district for the past 12 years. Currently she has approximatel

[answerhappygod]

Cindy has been a RN in a middle school for a large school
district for the past 12 years. Currently she has approximately
1150 students and 120 staff in her school building. One of the
special needs students that she cares for has a severe seizure
disorder. Cindy has spent a great deal of time developing and
implementing the Individualized Health Plan (IHP) in collaboration
with the student’s physician and parents. She has worked to educate
the teachers and staff on seizure disorders, including recognition
of an aura, recording of signs and symptoms, safety during a
seizure, use of rectal medications and when to notify school nurse
and EMS. Up until recently the rectal medication prescribed by the
student’s neurologist had been working. During the last several
months, the student’s seizures have worsened with no relief after
rectal administration of diastat and twice the school nurse has had
to activate EMS, both times the student was transported to the ER
and remained in the hospital for several days. The parents arrive
at the school one morning with a new medication that they would
like to leave at school. The inhaled sedative, to be given during
the aura phase of a seizure, has not been approved by the FDA in
the US for use in children with epilepsy. The father is an
anesthesiologist and is aware of studies in Europe where this
medication is being used with some success. The father is
prescribing this medication for his child and has instructed Cindy
that the student’s neurologist is not aware that they are trying
this medication and she is not to call him. The father also
instructs Cindy that she is not to call EMS anymore, only the
parents, when the student has a seizure. Cindy is concerned about
this new development and tries to discuss with the father her duty
to provide for the student’s safety. The father becomes angry and
leaves the school building. Cindy reports the incident to her
building principal and to her Health Service Coordinator and
discusses with them that she plans to invoke Safe Harbor.
• Can Cindy invoke Safe Harbor if she works as a school nurse in
a large school district? Can she invoke Safe Harbor if she is in
the middle of her school day?
• Do you think Cindy is invoking Safe Harbor in “good faith”?
(Why or why not?)
• What standards in Rule 217.11 have the potential for being
violated if Cindy accepts the assignment? Where on the Safe Harbor
Quick Request Form would Cindy document these standards?
• What protections are provided when a nurse properly invokes
Safe Harbor?
• As she completes the Quick Request Form, Cindy decides that
she cannot accept the assignment of administering an experimental
drug to a child. She considers that she does not have life-saving
equipment available in the school health clinic and she has not
been trained to intubate a patient, should the inhaled sedative
cause the student to lose her protective reflexes after slipping
into deep sedation. According to Rule 217.20, what must Cindy do
when invoking Safe Harbor and refusing the initially requested
assignment? What section of the rule contains this information?
• Assuming a safe assignment is worked out between Cindy and her
Health Service Coordinator, what other critical actions must be
completed prior to Cindy going home in the morning?