Providing Safe Health Care:
The Role of Education Support Professionals

Section 4: Taking Action

Take action to ensure the safety of the children in your care-and your own safety as well. If your local Association doesn't have a negotiated contract, you can take action to work out an agreement or change school board policies and state laws. And if you do have a negotiated contract, your local Association, with support from the state and national organization, can negotiate, as part of your contract, what procedures your district may request or require you to do to care for students with special health care needs.

With or without collective bargaining, your local Association creates opportunities for Education Support Professionals to be empowered and successful. It can work with members to increase awareness of your school system's practices regarding administration of medication and health care procedures, and it can design and implement a process to deal with these concerns.

Avenues for Change

Whether or not your local Association has a negotiated contract, you can take action to ensure that medication and health care procedures are administered safely.

What can you do?

• You can work to encourage your local to negotiate an agreement or to change local school board policy to better safeguard the well-being of students and employees. In Prince George's County, Maryland, school employees, through the local Association, negotiated with the Board of Education to create a more comprehensive protocol for the administration of medications in schools. The new plan delineates procedures that parents, physicians, and school personnel must follow to ensure the safety of students who must use medication during the school day.
• You can work with other Association members to develop and/or change state laws to protect student and employee rights.
  A state affiliate may, for example, advocate passage of legislation which would (a) prohibit school districts from requiring the delivery of non-emergency school health services by anyone other than a properly licensed school nurse or (where allowable under state law) a properly trained and supervised paraprofessional, and (b) require school districts to specify such duties in the relevant job description and provide the appropriate training.

How can you foster local and state policy changes?

• Identify a goal.
  Organize local staff, leaders, health care providers, pharmacists, physicians, administrators, parents, and other concerned citizens to identify a goal, such as "to provide safe health services to all students." Your state representatives can become powerful allies-reaching out to them during the planning stages can lay the foundation for changing state laws. Most politicians do not know what schools are like day to day. By inviting them to your school, and including them in your planning, you can develop powerful allies in your efforts to ensure safe health care for all students.
• Develop a plan.
  Solicit support of those who will be affected by the goal and develop a plan to make the goal part of school board policy, or preferably, an agreement between the board and the Association. The goal of providing safe health care services to all students, for example, might involve any of the following components:
  
  • To provide one school nurse for a certain number of students.
  • To establish a medically acceptable procedure and protocol on the delivery of health services to students in schools.
  • To clearly define the roles and responsibilities of ESP staff in the delivery of health services to students to ensure students' health.
  • To develop a training curriculum for ESP who work with students with special health care needs.
• Monitor the plan.
  Create a watchdog monitoring group that includes parents and other health care providers to assure that the plan is implemented and working.
  In Bath, Maine, the Bath Education Support Professionals Association, in conjunction with the Board of Education, developed a policy mandating the development of an Individualized Health Plan (IHP) for all special needs students in the system. The new plan clearly defines the rights and responsibilities of school staff who provide health care for students.

Collective Bargaining

If your local Association has a negotiated collective bargaining agreement, administering medication and performing health care procedures are considered part of your working conditions, and therefore can be part of contract negotiations. Your local Association might negotiate with the school district how your work will be defined, including:

• Job descriptions. Your duties and responsibilities regarding health care should be included as part of your job description. So can stipulations that you receive proper training and supervision.
• Career ladder or promotional considerations. When an ESP takes on the responsibility of administering medication or performing health care procedures, that person can and should receive higher pay and promotion opportunities.
• Training. The contract can define:
  • The type of training the ESP will receive.
  • Who will provide the training.
  • When the training will take place
  • Who will pay for the training. Ideally the school district will pay the cost of training.
• Disciplinary procedures. A contract can delineate standards for your protection in the event of a problem.
• Positions needed to meet students' needs. A contract can list new positions a district will create to address students' special health care needs.
• Nurse-student ratios. A contract can define appropriate nurse-student ratios that would assure that support employees are neither overworked nor asked to do tasks for which they are not qualified. The National Association of School Nurses recommends that the ratio of students to nurses be no more than 750:1 for the general student population, 225:1 in the special education population, and 125:1 for the severely chronically ill or developmentally disabled population.
• Grievance procedure. A contractual grievance procedure enables employees to protect their rights, including the right to grieve if they are asked to perform tasks for which they are not qualified.

As part of your contract, your local Association can also negotiate protection from legal liability, including:

• A "hold harmless" clause.The contract can include a clause that holds the ESP harmless in the event of an accident.
• The right to refuse. A right-to-refuse clause allows you to refuse to perform a procedure you haven't been trained to do. This clause can stipulate that in the event you must do it anyway, you are paid at the medical technician's wage level.
• Precautions if student's body parts are exposed during a procedure, such as toileting, diapering, or catheterization. Your contract can include a guarantee that you will have a witness present during the procedure, or it can prohibit providing certain health care procedures-such as catheterization and toileting-for adolescents of the opposite gender.

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