IEP FAQs: Do Nursing Services Belong in the IEP?

Print Friendly, PDF & Email

If a child is wheelchair-bound and needs a catheter, is this something that belongs in the IEP?

Exactly whose responsibility is it to handle catheters for wheelchair-bound students? I would think it qualifies as a medical procedure and that a nurse would need to do it?

Does the child need these services to attend school?

If he cannot attend school, how will he receive FAPE?

School nurse services are a related service (§1401 (26)) and as such, should be listed in the child’s IEP (§1414 (d)(1)(A)).

The Commentary to the federal regulations (p.46571) says “The public agency also is responsible for providing services necessary to maintain the health and safety of a child while the child is in school, with breathing, nutrition, and other bodily functions (e.g., nursing services, suctioning a tracheotomy, urinary catheterization) if these services can be provided by someone who has been trained to provide the service and are not the type of services that can only be provided by a licensed physician.”

In 1984, the Supreme Court held that a treatment like catheterization
(CIC) is a related service and the school is required to provide it.
(Irving Independent Sch. Dist. v. Amber Tatro 468 U.S. 883 (1984)).

In 1999, the Supreme Court issued a decision on a similar issue in
Cedar Rapids v. Garret F., 526 U.S. 66. The Garret F. case involved a
child who was paralyzed in an accident, and was ventilator dependent.
The question presented in Garret F. was whether the definition of
“related services” in §1401(a)(17) requires a school district to
provide a ventilator-dependent student with nursing services during
school hours. The Court held that that the school must provide these
services. Without these services, the child would not be able to
attend school and would not receive FAPE.

Catheterization is a nursing procedure and should be done by an appropriately trained nurse. Most teachers are not trained nurses so they should not be asked to do this procedure.

The definition of school nurse services in 300.34(c)(13) has been expanded and re-named school health services and school nurse services. The expanded definition clarifies that “school nurse services” are provided by a qualified school nurse, and “school health services” may be provided by a qualified school nurse or other qualified person.

  1. Question
    13 yr old wheelchair dependent, low IQ, in diapers, sezuires precautions and observation, coke hazard, sit to stand transfer equipment, deemed a nursing home level child by medicaid wavier. School allows a private insurance pd CNA to come to school with child, even excused absences when the CNA was not available, yet they refuse to add CNA level care in the IEP as the support that it is…what does this violate. School keeps saying “our staff can do everything a CNA can” School totally ignores three providers saying this child needs CNA level care at school. As parents we are not willing to disobey three Drs orders…and feel like the para does not have the training a CNA does.

  2. My daughter’s new school nurse doesn’t like her medical or feeding plan because it’s too nuanced & varied (depending on how well she is doing on any given day). Things are spelled out & not “willy-nilly” at all but he’s gone so far as calling & arguing with different doctors at our children’s hospital. Now no one wants to deal with him, including us. He’s not allowing teachers to follow the plan as written & telling me it’s fine for home but not school. I can fight, sure. I’ve done it before but what I want to know right now is: Can I can request her personal or palliative care nurse to work with the other school nurse (who isn’t certified to make the same decisions as the problem nurse) and put in the IEP that she will not be working with the problem nurse from here on out. If that makes any sense!

    • If the private nurse is ok with this, you could certainly request this. However, you could run into problems getting this oked if you do not check with the campus principal, and the administrator over the nurses. It appears that the school nurse’s behavior is unethical. Indicating that you are willing to report this to the state nursing board, might help you get the administrators to address this.

  3. My son needs to be catheterized at school. They are providing a nurse twice a day to do so. However, if he needs to go in between those times, they have to phone a nurse to come from another school. Does the need to be catheterized warrant having someone on site who can do it immediately? My son will often wait to tell an adult until it’s an emergency.

  4. I have no comment but questions. We are fighting with the school and them not allowing my child to go to ESY because they do not have a nurse so they will not tube feed him or give him his water even thought we have a health plan. Is this wrong? How ca I advocate for him

    • If your child qualifies for ESY services, then the school is denying him a free appropriate public education (FAPE) during the summer. A complaint to the state education agency is appropriate.

  5. This is so helpful, thank you!
    My long standing problem is that when the nurses ask to be invited to IEP meetings, whether new or renewal, the director of Sp Ed tells the nurses that we’ll be invited when there are medical needs. We ask the director, how do you know there are medical needs if I am not informed the child is being assessed for Sp Ed, or a renewal whose medical needs may have changed.
    We insert ourselves when we find out there will be a meeting, but this situation is very frustrating. Do we go over the director’s head to the Superintendent? Or are we asking too much? Is it mandatory for a school nurse to attend IEP meetings?

    • I do not believe it is under federal rules. It could be under state rules. However, as a related service information from the nurse are needed during the evaluation process, & development of the IEP. Without this, the IEP might not meet FAPE requirements. So at the least, the nurse should be informed of an evaluation or meeting so they can at least provide written information. Thanks for caring about the students you work with.

  6. I have a son who is 8 years old and is diagnosed with ADHD. He is on medicine for this but we have had to figure out what medicine works best. His medicine sometimes wears off in the afternoon. When that happens the teacher makes him write his name on the board. This happens frequently and it has made my child not want to go to class. He also gets his recess taken away. Is there any kind of rule or whatever for this teacher to not do this since he has an IEP? We have already met with the teacher but it absolutely breaks my heart for him because he will cry at night because he doesn’t want to go to that class and is ridiculed in front of his peers. We are also meeting with a specialist to see if h has any other issues because he has major anxiety issues. Thank you

    • Your child is not being successful at school. In situations like this parents basically have 2 options. You can try working with the principal &/or special ed director to reach a solution & revise his IEP. Or you can make a complaint to the state education agency. It is generally better to try the first before using the second option.

    • Jennifer, for many kids with ADHD, medication does not last a full school day. The child may need another dose mid-day. It’s hard to imagine how a teacher can be ignorant about ADHD and medication issues in 2020.

      You’ve met with the teacher – no help. You need to advocate for your child. How?

      Write a short letter. Use the question you posted here as the basis of your letter. Use facts, not emotions. You want to a person with power to understand what’s happening and want to right the wrong. Describe your boy – strengths and difficulties. Describe what this teacher is doing, the impact her actions are having on your child – that her ridicule is damaging him and causing him to view school as a hateful painful place. He’s only 8.

      Send copies of your letter to the principal, special ed director, and school superintendent. Request a response within 10 days. Provide your contact info. Repeat: your goal is to use facts (not emotions or blame) to persuade a person with power to want to right the wrong and help your child.

      Please read an article we wrote about “The Art of Writing Letters.”

      If you have a copy of From Emotions to Advocacy by Pam & Pete Wright, turn to page 266. You’ll see a Parent Agenda written by parents in a situation nearly identical to yours (child has ADHD, teacher is nasty, punitive, spiteful).

      Good luck and please keep us posted!

  7. Jessica: There are MANY cases about school districts refusing to provide school nurse services to children with disabilities who can’t attend school or receive a FAPE unless they receive these services. Schools will continue to ignore the Courts until parents take the time to learn how to use the cases as part of their advocacy for their children.

    The U.S. Supreme Court has issued two decisions about school nurse services. Both support your position.

    The first case, Irving Independent Sch. Dist. v. Amber Tatro, was published in 1984 … so it has been out there for decades. The Supreme Court held that a medical treatment for CIC is a related service and that the school is required to provide it.

    The second case, Cedar Rapids v. Garret F., is about Garret F., a child who was paralyzed in an accident when he was four years old. He could not attend school without 1:1 school nurse services.

    After the Court issued the decision in Garret F.’s case, we wrote an article,
    “Supreme Court Says, ‘Congress Intended to Open the Door to All Qualified Children.’ ”

    After reading this article, you will know what the law says and what Courts have held. You will be in a stronger position to make your case to your local school officials and your school board.

    I suggest you make copies of the two cases and include them as attachments to a letter to the school principal, the Director of Special Ed, and your school district Superintendent. If necessary, you may need to send copies of your letter and the cases to your school board and/or State Department of Education.

    You can use the text of the question you posted on the blog as the basis of your letter.


    Please keep us posted.

  8. My son has a Broviac (central line) and requires IV fluids to be administered during the day. His school does not have anyone with a medical background on staff and I have requested a 1:1 RN. They are denying the need and said that despite the 2 dr notes, they have to obtain more data. He has been home now for 20 days and the school said that he can attend but not his nurse, yet, they are providing him “FAPE.” Do you have any cases that are similar to a central line as the situation is quickly escalating?

  9. My daughter is on an IEP and she has a trach and a G-tube. Her IEP says that she needs a one on one nurse with her. Her nurse will be going away on vacation and she will be away for two days of school. I asked if I could attend those two days of school with my daughter so that she wouldn’t have to miss and the school program director told me I would just need to fill out a CORE and show my license when I could go in as a volunteer. Then I received an email from the sped coordinator for the town saying that it would not be appropriate for me to go with her since her IEP requires her to have a one on one nurse. Are there any laws that protect my daughter from being forced to stay home from school?

    • Yes – Section 504 and IDEA. Is there a reason the school cannot provide a substitute for the time the regular nurse is not available? It should be the school’s responsibility to have a contingency plan in place to ensure continuing services for you child – what happens when the regular nurse is off sick, or her car breaks down?

      • Yes Chuck and Peter, if the school nurse stays home then Addie just stays home. They have never trained a substitute on my daughters care. Now they are telling me that they are going to find a sub nurse and send her with Addy but it is way too short of a timeframe for her to be trained on my daughters care since their will only be one week in between now and the time needed for her to be taken to school. My daughter travels with a ventilator a suction machine and has a G-tube as well as is Deaf, has two bone conduction aids, and skeletal dysphasia. I don’t think that one or two days of training would be enough to send her off with someone who has never worked with her before. I would feel more comfortable just doing it myself but I don’t know why they are not allowing it.

    • Since the IEP says one on one nurse, the school should provide a nurse, if they are not willing to let you come. You can make a quick complaint to the state education agency, if they will not work with you. If she stays home, they are not providing FAPE for those 2 days.

  10. What requirements should the School Nurse have in regard to information for an IEP? That is, should Vital Signs be included besides hearing/vision/weight/height? I have spoken to over 35 nurses from 2 different NJ Counties and it seems that every school has their own regulations–this does not make sence to me.

      • I would think that some state or national nursing association would have guidance on this. At one time the TX health dept. required nurses to develop health plans for certain students with disabilities. There was a lot of guidance given for nurses. But this was discontinued some time ago.

  11. What if School district agreed to nursing services in IEP for my daughter’s FAPE and then at start of school has no one hired…….. my child was forced into “administrative homebound” over lack of staffing on their part. They were 100% adamant that she had to return to school……. and they would provide services and now are unable to secure a nurse who wants the position

  12. I am a school Nurse and I often don’t have time to attend IEP because of no coverage, but I am asked to sign the IEP is that legal?

  13. if a child is receiving homebound services from the local school district AND intermediate unit, could this child get nursing services within the home?
    Child’s IEP is from local school district.

  14. well in our school district very few of the schools have a nurse on staff….so it really wouldn’t matter if the child required nursing services….in an ideal world this would be great but budgets get cut and nonessential personal are the ones who dont get hired or get the cut….sad isnt it????

  15. There is a big push for INCLUSION in Hudson County. Not all children belong in INCLUSION.
    How does a parent reach out to the state dept. of education to complain about the excessive power some school district have about placing “ALL”children in INCLUSION.

  16. I found this information to be extremely helpful. I had a student who required a nurse, and I was uncomfortable administering meds in the event of a seizure. Eventually, it was determined that the child requires a nurse. Thanks for the info.

Leave a Reply to adel Cancel reply

Your email address will not be published. Required fields are marked *


Please help us defeat spam. Thank you. *