In the ever-evolving landscape of healthcare and general wellness, school nurses are increasingly facing a unique challenge: addressing parent requests for the administration of non-traditional and alternative treatments for students during school hours or at school-sponsored events. These requests can range from herbs and homeopathic preparations to essential oils, drugs that have not received approval from the U.S. Food and Drug Administration (FDA), and other experimental medicines. Since the safety and effectiveness of these types of products still require much research, NASN states, "It is important that the school nurse first determine what is known about the product, such as ingredients, precautions, recommended dose, and any potential adverse effects. Secondly, determine whether the administration is allowable under federal and state law, including applicable state nurse practice acts and district policy."
Alternative and complementary medicine includes treatments and practices that are not traditionally part of Western medical curricula but have been found to have healing effects. Alternative medicine refers to therapeutic approaches individuals may seek independently, often as substitutes for standard medical treatments. These practices have yet to be assimilated into routine medical care protocols, largely due to varying degrees of evidence regarding their efficacy or safety. On the other hand, complementary medicine consists of practices designed to be used in conjunction with, rather than in place of, traditional medical treatments. The goal is to enhance the efficacy of conventional care, address symptoms, or improve overall well-being through a more holistic approach to health.
Homeopathic or naturopathic practitioners often recommend alternative and complementary treatments. The FDA does not regulate these treatments and may not conform to the standard labeling requirements regarding product safety. Thus, school nurses may wonder whether they can follow medical orders for these "natural" products under their state's laws governing nursing practice. In general, as part of their scope of practice, school nurses must ensure they know the active ingredients, proper dose ranges, therapeutic value, side effects, and actions of any medication they administer. Experimental medications, on the other hand, are approved for use within an FDA-authorized clinical trial.
In recent years, the use of medical marijuana has become legal in many states, but its administration in schools poses several challenges for school nurses. Only some states permit the use of medical marijuana in schools, and the regulations surrounding administration vary. While some schools require the student to leave the school premises before receiving the treatment, others allow it to be administered on school grounds but only by a parent or guardian and not by a school nurse (due to the prohibition of administering illegal substances by the state's Nurse Practice Act). All standards and protocols for safe medication administration still apply.
In their Clinical Practice Guidelines for medication administration in schools, NASN recommends clear and established policies for administering medications that are not FDA-approved and for those that are being used for off-label purposes. Federal, state, and local laws and regulations must be followed, and appropriate information must be provided to the school nurse to ensure safe administration. Because appropriate dosing is not available for alternative or homeopathic medications, the NASN guidelines discourage administering these treatments in the school setting. It can be tricky to balance respect for parental preferences and adherence to legal requirements and evidence-based practices. For school nurses, this involves a rigorous process of verifying the safety, legality, and potential efficacy of alternative and complementary treatments within the parameters set by federal and state laws and school policies.
