School nurses tried to save child from abuse, but...

What a sad horrifying story......

After the fire goes out of the anger, and after the tears wipe away and the eyes dry, I recognize the futility of the epithets, vitriol, and expletives I've been thinking.

This kind of tragedy plays out in all parts of the country, if not the world. The victims are often those who cannot defend or speak for themselves. Children and dependent adults make excellent victims because they are dependent on others, usually their abusers. The question is, what do we as nurses do to make things better, so this kind of situation does not occur on our shift?

I don't know the answer to that. I do know what I myself have done. I started out as a search and rescue volunteer, which opened up seminars that included, oddly enough, sections on "Crimes Against Children". My Instructor for the first courses I took was a Lieutenant with a Sheriffs Department, and he had over 20 years experience. He also taught on the faculty of a well-known medical school, and is believed to have been the only Peace Officer to teach in a School of Medicine. But I digress.

How many of us nurses would attend a class taught by police officers? They are not doctors, or nurses, or NPs. They are cops. What do they know that we would have any interest in? I can tell you; plenty.

I've heard the horror stories over the years. I've also heard some very good stories. What I'm left with is the conviction that the odd, the evil, the sensational, makes the news. The Protective Services people that do their job are often not heard from. It's like that day 10 years ago when millions of children went to school, listened and learned, handed in their homework, went home and did chores, obeyed parents and the basic rules of good living, and went to bed in due time. Those millions did not make the news. Just two guys in Columbine made headline news that day.

In a similar way, we don't hear about the CPS and APS people that do protect children and dependent adults. In the news we don't hear about the worker who spent hours poring over the records and distilled the evidence that ultimately convicted an abuser and saved a life. We don't hear about the men and women who intervene swiftly to provide safety for someone who cannot provide for their own well-being.

In the time I was working in an ED, I called several times. Each time the results were swift, accurate, and effective. The social workers that came were professional, compassionate, and quite efficient. This at a time when their Department was under some pretty horrendous accusations in the media.

My point is that we cannot paint all Protective Services people with the same brush. Yes, there are some rotten ones, just as there are in all walks of life. There are some genuine heroes among them too, just as there are in all walks of life. But they can't do it all alone. We as health care folk, from CNAs through NPs, therapists, technicians, physicians, and all of us who went into this field to make the world better, owe it to ourselves and to those we see and treat to become aware and educated. Our views, our insights, and our speaking out makes a difference. Besides, the better we communicate and protect, the better we sleep at night. At least that's true for me.

We are patient advocates, after all, aren't we?

Unfortunately, CPS and APS workers (even the really good ones!) are ridiculously overworked and underpaid -- communities and states don't want to spend the $$$ it would cost to have a good CPS/APS system, so they spend the bare minimum and pretend they have a decent system. Because of the horrible workload and low pay, personnel burn out quickly and move on to other opportunities, meaning these offices are often largely staffed with inexperienced new grads (who move on as soon as they have some significant experience, and more newbies are hired).

Federal laws mandate that agencies make every possible effort to avoid removing kids from families, and that they work for reunification of the family as the ultimate goal of any intervention, until any possibility of that has been eliminated. A lot of people seem to think this is just random craziness on the government's part, but, like most laws, it's actually a reaction to abuses of the past. It wasn't that long ago that a social worker could (and often did) take kids away from their parents and put them up for adoption simply because the (poor) family didn't keep the house as clean and neat as the (middle class or affluent) social worker thought they should, or because the parents had to work longer hours than the social worker thought was a good idea -- the current laws were passed to put a stop to situations like that. They go too far in the other direction, but no one's ever accused the federal government of finesse ...

Also, when faced with the choice of whether to take a child out of her/his home or not, CPS personnel have to wrestle with the dilemma that, if they do take the child, they don't have any good place to put her/him. There are not nearly enough good foster home placements; lots of foster parents are simply doing it for the money and some are downright abusive themselves -- the CPS worker is well aware that the situation s/he will have to put the child into may not be any better than the one s/he was just taken out of.

It is a sad situation all around, and, unfortunately, it's not really going to change until the general public is willing to pay more to have a meaningful CPS/APS system and that seems to be a v. low priority in most areas.

Guess no one wanted to believe the nurse, after all- nurses are not intergral members of the healthcare team, we are not the MONEY makers of the hospital( making us vastly over paid), ANYONE can do our job( any slub off the street with a smart mouth), we are just hysterical alarmists who go to work in colored pajamas. That poor school nurse should get a bonus for being on top of her assessment skills and a paid vacation for all the aggravation and flac she took from not being believed in by the DHS!!

I have so many thoughts, most of which would probably make people angry so I won't share them. I'm just glad this poor little girl is done suffering.

When I did rotations with a school nurse, in that particular county, a school nurse could not examine under a child's clothing except in case of obvious deformity or bleeding -- kid falls down, and has an obviously broken arm or leg -- but even then, they had to have 2 other adults present, one of which had to be the principal or assistant principal. I was horrified that when we had a kid fall down some stairs and was complaining of pain in his ribs, she could not visualize the site because it didn't meet the criteria; all she could do was call the parent and recommend a trip to the doc's office. They could only tell the CHILD to wash a scrape or cut with soap and water; we could take temps, but not listen to lungs. A child who's been severely asthmatic all their life can't have their inhaler on their person, but has to depend on being able to get to the clinic or have someone get the nurse to unlock their meds and bring it to them if they have an attack. The school nurse's hands are tied, and I was frustrated that we couldn't do more for what little we could actually visualize -- the most they could do was send a note home with a kid saying that until the note was countersigned by a doc, the kid couldn't come back until X, Y, or Z was evaluated.

I'm surprised the school nurse got as much accomplished as she did, operating under the constraints a school nurse functions under. Of course, things may be different in that state, but the responsibility vs. the ability to enact change, at least in my state, are grossly mismatched.

It amazes me that stuff like this is still swept under the carpet much like it was 20 years ago when I was a child, back then it was ignored or the nurse was brushed off because abuse wasn't talked about much. It breaks my heart that these children are still slipping through the cracks and yet good parents are being raked over the coals for "suspected" abuse with nothing even close to this. Children with injuries in the common areas such as bruised shins and scraped elbows and so on. We have time to go after the WRONG people.

Bless this nurse for going the extra mile and trying to help this child. She is a true hero!

One of our homecare agency's perdiem staff works FT as Philadelphia school district nurse. We asked her one day to tell us what school nursing was like along with the the most difficult part. Her reply was documenting injuries and reporting to CPS with resulting heat from parents threatening her along with parental indifference to children she suspected as having undiagnosed medical issues never getting back to her despite multiple notes sent home, outreach phone calls. She told us had very strong support from school officials who backed RN's up. Being responsible for 3 schools and 1500 students isn't easy.

KUDOS to Amy Ozenbaugh RN for doing her job and sounding the alert... especially in light of pressure from outside forces. Since the parents took child to various professionals, instead of single practitioner, much harder to connect all the dots of repetative injuries.

Update to story from Philadlephia Inquirer:

Charleeni's death blamed on her dead father