Teacher aides or nurses?

Teacher assistants at a Prince William County school were told recently they would be required to change urinary catheters for a student who had recently undergone reconstructive bladder surgery, according to Meg Gruber, president of the Prince William Education Association, who refused to name the school.

Why teacher assistants and not medically trained nurses? Because it’s their job, according to Thomas Carter, director of special education for Prince William County Public Schools.

And now after the complaints this spring, the personnel office is planning to have newly hired teacher assistants sign a statement that specifies what kinds of health-related services could be required of them.

Not all schools have a full-time nurse on hand to administer daily health services for students, so performing procedures like catheterizations and gastrointestinal tube feedings are part of the job for teacher assistants, Carter said.

A set of school health care guidelines, provided by the Virginia Department of Education, state that only nursing professionals should perform such services as gastric-tube, or stomach feeding tube, insertions and catheterizations, or the placing of a tube into the body to extract urine.

To Carter, the guidelines are not laws.

“That’s one of the reasons you have teacher assistants, for these types of things,” he said.

Along with typical duties like helping teachers with classroom activities, the job description for teacher assistants at Prince William public schools states: “Delivers non-emergency health-related services as specified in student’s health treatment plan.”

Carter estimates that about 100 students in Prince William schools require daily health services ranging from five-minute asthma treatments and insulin and glucagon injections to catheterizations that may take up to 45 minutes.

The complaints are nothing new, Carter said. “They usually come from a teacher assistant who never had to do it before and now has a student in their class that needs the service.”

But Gruber says some of the services are too invasive to be deemed “health-related services,” that they should rather be called “medical procedures.” “[Teachers assistants] felt, and continue to feel, strongly that they are not qualified to perform such procedures and to not possess the requisite medical background to make medical judgments that could precipitate further medical action,” Gruber said in an address to the Prince William County School Board on May 22.

Catheters and gastrointestinal tubes are similar in that they involve exterior tubes for urinating and feeding, respectively, for students.

Some teacher assistants have been threatened with termination if they refuse to perform some of the services, Gruber claims.

Carter said that if a teacher assistant does not do what is required of him or her, he or she could lose their job or be transferred, depending on the situation.

State law protects teachers and school workers who refuse to perform health-related services for students, unless it is in their job description, said Gwen Smith, a school health specialist with the Virginia Department of Education.

Smith said that particular law was passed after teachers from three Virginia school districts, with no nurses on staff, complained that they had to perform health services they did not feel qualified to do.

Money to hire 10 additional school nurses was allocated in the county school system’s fiscal 2003 budget with the goal to hire 10 nurses every year until there is a school nurse in every school. Currently, school nurses travel between schools weekly.

Before a teacher assistant can be required to perform a health-related service, the child’s doctor must give the school system permission to provide the service, according to school regulations.

School health officials then must approve the service. The teacher assistant, along with three other school staff members as backups, are then trained by either a nurse, a doctor or a family member, Carter said.

Upon hearing of the complaints concerning the urinary catheterization, several School Board members said the issue will be investigated.

“I doesn’t seem to me to be something we should require teacher assistants to do,” said School Board member Steven Keen, R- Woodbridge. “If we have trained medical personnel we should be looking at them to do it,” he said.

School Board Chairwoman Lucy S. Beauchamp said because students with medical needs are in regular classrooms in regular schools countywide as opposed to concentrated in a special school, teacher assistants are needed to perform health-related services.

“That’s why we have the goal of putting a nurse in every school. I think a trained medical professional needs to be doing this,” she said.

Legally, a teacher assistant cannot be held liable in a lawsuit if something goes wrong with a procedure, Carter said, unless that employee is negligent.

Carter said he is confident that some of the services, including catheterizations, are simple enough for teacher assistants to perform. “If a parent can do it, and some students can do it on their own, then [teachers assistants] can do it,” he said.

Staff writer Louise Cannon can be reached at (703) 368-3101, Ext. 123.