‘Crossing boundaries’: Sask. union says school workers performing medical procedures outside their scope

A CUPE survey says many Saskatchewan school support workers are administering medications and other medical care without proper training. Donovan Maess reports

The Canadian Union of Public Employees (CUPE) says some education support workers are performing a wide range of medical procedures inside Saskatchewan schools.

“Education workers come to work every day because we care about the students. We support learning, build relationships and create safe and inclusive schools,” said Karla Sastaunik, CUPE chairperson for the Saskatchewan Education Workers Steering Committee.

“But today, education workers are being asked to do more than ever before. Across Saskatchewan, our members are providing increasingly complex medical care to students.”

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According to a survey of 980 CUPE members working in the provincial education system, respondents were asked what medical procedures they provide as part of their jobs, whether they received training for those medical procedures, and if so, who provided the training.

Workers who participated varied in classification from administrative to educational assistants, counsellors or even bus drivers and caretakers.

The survey found educational support workers across the province performed a wide range of procedures including:

• Giving oral medications
• Giving injection medications / insulin
• Epi-pens
• Tube feeding
• Wound care (dressing changes)
• Suctioning
• Tracheotomy care
• Catheterizations
• Seizure related care
• Monitoring blood sugar for diabetic students
• Physiotherapy
• Administering medications through feeding tubes
• Inhalers / eye drops
• Basic first aid

The most common medical procedures performed by surveyed CUPE members were giving oral medications (28 per cent), Epi-pens (18 per cent), Tube feeding (16 per cent) and wound care or dressing changes (13 per cent).

“In one school, education workers were told they’d be supporting a student with complex needs, but not that they would be responsible for the student’s medical care,” vice-chair of the Saskatchewan Education Workers Steering Committee Shandel McLeod described.

“In reality, they’re setting up tube feedings, administering multiple medications through a feeding tube and monitoring for seizures. They are also responsible for full day daily care, lifting, cleaning, watching for signs of pain and responding if something goes wrong. But many had less than a week of training; some had less than an hour of training and they are left asking, ‘What if something goes wrong?”

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The survey also found some staffers had little to no training to perform certain procedures.

According to the report, education workers were least likely to have received training for giving oral medications, with 48 per cent responding they had received no training. Of those performing wound care, 42 per cent reported they had not been trained.

Training rates were higher with other medical procedures; however, between seven and 24 per cent of workers reported not being trained in each of the nine listed medical procedures.

“The data shows us what we’ve been hearing for years,” said Sastaunik. “Sometimes with absolutely no training, there are schools that will say to the mom, ‘Come in and show us what to do for one hour,’ and then that’s it. There’s no professional person.”

“School divisions are responsible for assessing individual student needs and making operational decisions, including staffing,” a spokesperson for the Government of Saskatchewan said. “These decisions are made locally to ensure flexibility and responsiveness to community needs, and are made in the best interests of the overall health and safety of students.”

CUPE officials have formed a series of recommendations based on the survey’s findings which they hope the government will be open to implementing.

• Establish a taskforce that includes education workers, school divisions, and qualified health care professionals to review medical and personal care duties in schools and develop safe, consistent standards, at no cost to education workers or school divisions.
• Clearly identify medical procedures that must be performed by certified health care or home care professionals and ensure those professionals are integrated into the school setting as needed, so students can attend school safely and inclusively without placing inappropriate medical responsibilities on education workers.
• Ensure education workers are not required to perform procedures without choice and that any training or certification related to such procedures is voluntary, appropriate to the role, and fully supported by the employer, including paid time and costs.
• Ensure that only properly qualified and certified professionals provide training related to medical procedures, ensuring education workers’ rights, scope of practice, and workplace safety are fully respected.
• Provide clear policies, documentation protocol, and training so education workers understand their responsibilities, limits, and protections while supporting students with personal or medical needs.

“We’re crossing boundaries that are in roles or scope of what LPNs do,” Sastaunik said. “And so that’s a problem. It’s ultimately not safe for anybody who’s involved in education who’s being asked to do this.”

NDP education critic Matt Love pointed to the pandemic as a recent example of inter-agency collaboration related to health care in schools the province.

“The medical needs of students are being offloaded to school divisions to solve on their own, and they simply can’t do it on their own,” he told reporters at a press conference Tuesday. “They can’t pass it down to these education workers that work on the front lines of education.”

“This is a real opportunity for the provincial government to step up and say, ‘We can bring healthcare to the table, we can bring education workers to table, we can bring the school boards to the table and solve this together.’ We’ve done that before.”