So annoyed/offended right now

Specialties School

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As you all know, I have been dealing with a very difficult, non-compliant mother of a Type 1 diabetic. He was finally able to start school yesterday, but there are a lot of issues going on. Mom is determined he come to our school vs. his neighborhood school. Our school hours are 7:30-4. No nurse after 1:30. His old school is 8:15-1:45, 2 blocks from home. Mom wants him to take the bus to and from school, so he would be getting ON the bus at 6:30 am and get OFF at 5:15 pm. There is no bus monitor so if he got into trouble, things would go downhill quickly. His grandmother who has been significantly involved confided to us yesterday that she has almost called CPS on her daughter (the kid's mother) a few times b/c she has not done what she is supposed to do for him. She also said she has lied on several occasions to the doctors and nurses. Based on the several failed meetings last week, I am pretty sure there will be some non-compliance issues. He also showed up for his first day of school having not eaten breakfast!!!! So grandma runs out and buys him DUNKIN DONUTS!!! Of course his mid-morning BS was 316!

Mom agreed that she would bring him in the morning and pick him up when we spoke, but then went behind my back to try to make bus arrangements. Luckily the bus coordinator came and asked me what the deal was. We are not denying him the right to ride the bus, but he just started yesterday and we need to make sure he is safe and also make sure that we have a plan in place for the bus. Right now we have no monitor and we are working on that.

So now for why I am annoyed/offended...mom told me to call the nurse at the diabetes clinic to discuss any issues/questions I had about his care and that she was happy to talk with me. So I just called to essentially get a feeling for their experience dealing with the family (compliance, etc.) and also to make sure they were aware that there is no one to administer glucagon in an emergency for the last 3 hours of school, or on the bus. I want to know if they really think a 9 1/2 hour school day plus an extra hour on either end of that is safe and ok for him b/c mom doesn't seem to think it is an issue. I told her about the last week and a half I have spent running around trying to plan/coordinate and mom failing all the meeting and appointments, not bringing in the paperwork I needed, not providing the keytone meter, etc. and asked if she had a similar experience since they have known them for a year. So the nurse sort of hufs and says "I don;t think you seem to appreciate the fact that this mother is parenting a child with a chronic illness and will be doing so for the rest of his life. So you questioning how she is managing him and his illness is not your place". I was shocked! Isn't our job during the school day to make sure our kids are safe? Isn't it my responsibility to make sure that he is being protected from bad outcomes from his diabetes if they are preventable? Maybe it was her tone, which was extremely condescending, like I am "just the school nurse and who do I think I am". I calmly told her "Yes, I absolutely can agree that this mother has a long struggle ahead of her, but I am concerned for her son if he is arriving having not been fed, eating grapes, fruit gummies and chips for lunch and being put on a bus for 45 minutes after a 9 1/2 hour school day. If you have advice that would be helpful in dealing with this family to put the safety needs of the child first I would greatly appreciate it". She then just hufed again and said she would have the "other" nurse call me later.

Am I wrong to be offended? I have seriously invested hours of my time over the last two weeks training staff, preparing the school and classroom and setting up meetings with this mom which she has failed all but one.

Anyway, thanks for reading if you made it this far. I am just exhausted and feeling like no one gets how much we as school nurses do for our chronic kids.

Part of me wonders if that nurse was, in fact, a nurse. I also imagine that this time of year the clinic has been dealing with a lot of phone calls from school nurses, health staff, and parents. She was definitely condescending, but I would just brush it off. If it happens again, talk to their supervisor. Anyone can have a bad day, but consistent rudeness is another matter entirely.

I have a child with a chronic health problem and another who carries and Epi-pen to school, so I guess I can see both sides. I'm surprised a new 504 hasn't been formulated by now.

I assume she bought him a doughnut or a muffin. DD breakfast wraps look pretty diabetes-friendly. The Egg and cheese wrap has 13 grams of carbs. Does the school serve breakfast?

Yeah, it was a bag full of munchkins...we do serve breakfast, but mom has been arriving late, after breakfast is over and class has started. It would also mean having him remain on an empty stomach until arriving which is not the best idea for him b/c he drops BS levels.

She said there is no one who can do glucagon because it can't be delegated in her state. The school district would have to hire another nurse or pay her overtime. I have several diabetics in my school who have glucagon ordered, but didn't bring it to school (ditto with epipens, inhalers, benedryl, etc). In my district, the plan is to call 911 in an emergency and let EMS take over for students who don't being medications. Ideally, every student would bring their medication to school and every school would have a nurse to give it, but we don't live in an ideal world.

THIS!!! You hit the nail on the head "We don't live in an ideal world". Yes, ideally we would have a full time RN (in my school's case this would mean me walking in at 7 am and leaving at 4:30). I do not work full time. We have been looking for a second nurse to join our already completely overstretched LPN in the middle school and high school. There just aren't enough school nurses here. They can all work in Boston and make $50-75/hour. Why would they give that up to work here for pennies...

Specializes in NCSN.

Nurses have an extensive amount of knowledge. We know what will happen when our patients or those caring for them fail or make less than optimal choices. We want them to avoid those. However, the reality is nurses can't change choices, only influence them when and if people are willing to listen, consider and then change actions. This is tough on our hearts especially when children are involved. In the end, we need to: Foster trust without judgement; Be willing to let our patients/caregivers fail; Be open to allowing them to progress and learn at their pace; Evaluate and cooperatively plan how to make their reality better on their terms; and while knowing the potential negative outcomes, revel in the improvements, no matter how small, when they occur.

This is wonderful. I feel like we all struggle with giving certain families all of the information on how to succeed but then get frustrated when they just ignore it or don't take it in.

But failure with a type 1 diabetic can be a VERY SERIOUS thing. It's not just a document the failure and hope we learn from it event. And as a school nurse, we try to keep the safest environment possible for all of our students. Medical neglect is an unfortunate but real thing we need to keep an eye out for and report on if necessary.

Specializes in School Nursing, Pediatrics.

I totally get the frustration! I hate that people think I just give out band aids all day, it pisses me off!!

Anyway, what does your principal think? Why does this child have to come to your school, when there is one closer to him? In my district, (in MA) this would not fly at all, (and my principal would NOT tolerate this, she would be on the phone complaining in a second) (she is good at it!) they would make him go to the closer school, even if he has a 504 and needs transportation that doesn't mean he (the parents) can pick the school he goes to. I think it is time to get the administration involved and see about him going to the school closer to him. I cannot see a good outcome for him, that is too long a day for a 6 year old! Something will happen on the bus at some point, and it is not safe.

Why does this child have to come to your school, when there is one closer to him?

I was thinking that too! What is the reason that he is bussed so far?

I was thinking that too! What is the reason that he is bussed so far?

We are a charter school in an urban area with otherwise extremely underperforming schools. He applied and got in via lottery so she wants him to come here.

I totally get the frustration! I hate that people think I just give out band aids all day, it pisses me off!!

Anyway, what does your principal think? Why does this child have to come to your school, when there is one closer to him? In my district, (in MA) this would not fly at all, (and my principal would NOT tolerate this, she would be on the phone complaining in a second) (she is good at it!) they would make him go to the closer school, even if he has a 504 and needs transportation that doesn't mean he (the parents) can pick the school he goes to. I think it is time to get the administration involved and see about him going to the school closer to him. I cannot see a good outcome for him, that is too long a day for a 6 year old! Something will happen on the bus at some point, and it is not safe.

It's funny b/c I was thinking that the fact that our school does not have a FT nurse, nor is there anyone to give him glucagon after 1:30 pm would be reasons he should not come, but we are being told that that is discrimination b/c of his disability and that we need to accommodate for him. We are in MA too.

Specializes in School nursing.
It's funny b/c I was thinking that the fact that our school does not have a FT nurse, nor is there anyone to give him glucagon after 1:30 pm would be reasons he should not come, but we are being told that that is discrimination b/c of his disability and that we need to accommodate for him. We are in MA too.

It technically is. It was a case like this, though not exactly, that made my school invest in full time nurses. I cover the entire school day and at least 1 hour after school.

Frustrated I understand, offended not really. She is not doing this to you personally is she?

You are doing your work, which you are hired and paid to do.

Maybe it's going to take a visit from CPS to get this mother to open her eyes. Single, chronically ill kid, too bad.

Many people are in the same boat. Time for her to shake off her issues, whatever they are and get with it for

her son's sake. If she is allowing the type of diet you describe, that right there is abuse. And maybe CPS can

require her to get counseling or whatever intervention will help her and the boy.

So you do what you have to do, document every failure on Mom's part, and pick up the phone and call CPS if

it has come down to that.

Use all of your resources, including Administration.

Has the boy had a dietician's teaching? Not just one class. Has he been to diabetic summer camp? He can learn

a lot there and meet other kids with DM and learn how they handle it.

Specializes in NCSN.

Has he been to diabetic summer camp? He can learn

a lot there and meet other kids with DM and learn how they handle it.

We applied for a grant to send my type 1 student over the summer and she LOVED it. She learned how to count her own carbs, and why we don't always want to depend on insulin to make up for poor diet choices.

But based on what the OP has said, it doesn't sound like the student or family has had enough education yet.

We applied for a grant to send my type 1 student over the summer and she LOVED it. She learned how to count her own carbs, and why we don't always want to depend on insulin to make up for poor diet choices.

This is awesome!!

Specializes in School nursing.
We applied for a grant to send my type 1 student over the summer and she LOVED it. She learned how to count her own carbs, and why we don't always want to depend on insulin to make up for poor diet choices.

But based on what the OP has said, it doesn't sound like the student or family has had enough education yet.

Diabetes camp is the best! I have one student that goes every year and just loves it. Next year, she will transition into being a counselor.

And carb counting is a large part of the battle. My one student that went to camp loves her carbs and sat down there with a nutritionist to help balance her carb-y meals a bit more. Granted this student is now a high schooler and the carb-counting didn't hit home for her until she was in middle school.

6 years old is really young to expect a diabetic to be fully independent (but no too young for camp!). There are some great resources (free even) in some areas to give to parents to help with their own education on there child's needs.

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