Cervical Spinal Stenosis Help

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Specializes in Community and Public Health, Addictions Nursing.

I've been stuck on a paperwork issue with a kiddo for the last month and a half.

A pre-k student had surgery for cervical spinal stenosis and returned to school with first a halo and then a soft collar brace. During that time, I called the ortho and received paperwork that included physical activity restrictions- no outdoor recess play or similar activity.

Ever since the neck brace came off, I've been calling multiple times for updated physical activity orders. After calling the first several times, I was finally told I'd have to wait until her next ortho appointment, then get an update.

Her next ortho appointment has come and gone, and ortho still hasn't sent me any updated paperwork. I called again today, and this time the office didn't even want to talk to me- they were telling me to call her neurosurgeon, even though her ortho doctor had placed this specific set of restrictions on her. Supposedly I'll get a call back tomorrow, but I'm doubtful.

At this point it's been a month and a half since I started asking for an update, which feels ridiculous. What else can I do? I feel like this child had some pretty major surgery and it's going to be a big liability if we let her do something that she isn't technically cleared for. I'm tired of waiting for ortho to get back to me, especially because she's pre-k and just wants to run and jump and play with everyone else. Now I've also had neurosugery thrown into the mix, and I'm not sure what to do next.

Any good ideas for me, you fabulous hive mind?

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Specializes in kids.

I would draft a letter on school letterhead and direct it to the person who wrote the original restriction as well as the neurosurgeon. Using the dates and restrictions they outlined, ask when the child can return and/or what modifications they need.

Then I would go on to say that the child will not be allowed to participate in their regualr educational program (which they are entitled to under law) until they are cleared, as the district will not take on the liability. I would include the parents, administration, etc. as well.

I would mail it return receipt requested, so you know that they, in fact, did get the letter. You do not have time to be chasing them with phone calls. I would sic the parents on it!

The squeaky wheel usually gets heard.

Good Luck!!

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Specializes in School Nursing.

I love the above idea. I wouldn't have thought of it, so I'm tucking that away in my brain for future reference!

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Specializes in Pediatrics Retired.
57 minutes ago, NutmeggeRN said:

I would draft a letter on school letterhead and direct it to the person who wrote the original restriction as well as the neurosurgeon. Using the dates and restrictions they outlined, ask when the child can return and/or what modifications they need.

Then I would go on to say that the child will not be allowed to participate in their regualr educational program (which they are entitled to under law) until they are cleared, as the district will not take on the liability. I would include the parents, administration, etc. as well.

I would mail it return receipt requested, so you know that they, in fact, did get the letter. You do not have time to be chasing them with phone calls. I would sic the parents on it!

The squeaky wheel usually gets heard.

Good Luck!!

I wouldn't even go this far but Nutmegge is really spot on. Do this and go on with the restrictions. Forget about it until you get the MD release.

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Specializes in kids.
37 minutes ago, LikeTheDeadSea said:

I love the above idea. I wouldn't have thought of it, so I'm tucking that away in my brain for future reference!

Thx...It just puts everything out on the table and hopefully gets the ball rolling.

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Specializes in Community and Public Health, Addictions Nursing.

Nutmegge, I love your idea and I'm adding it to my nurse bag of tricks.

Update: I just got a letter from the ortho doc on my fax this morning, and it clears the child of all restrictions. I was not expecting this be done, but I'm thrilled that it was- it seriously feels like Christmas came early for me!

Anyways, I'm going to make myself a hard-earned cup of coffee right now, and I hope you all do the same. Happy Friday!

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Just my two cents.......why is it your responsibility to get an updated restriction/release from restriction letter? The parent is the one who brought you the initial restriction letter and are dealing directly with these doctors in their offices face to face, they should be the ones bringing you an updated letter. Telling the parents how upset she is every day now that she doesn't get to play with her friends should light a fire under them to get things done.

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Specializes in Community and Public Health, Addictions Nursing.
18 minutes ago, SchlNrsKrn said:

Just my two cents.......why is it your responsibility to get an updated restriction/release from restriction letter? The parent is the one who brought you the initial restriction letter and are dealing directly with these doctors in their offices face to face, they should be the ones bringing you an updated letter. Telling the parents how upset she is every day now that she doesn't get to play with her friends should light a fire under them to get things done.

Surprise surprise, the parent didn't bring me anything. She literally showed up with her daughter one day, halo and all, to say hi to the class and talk about the surgery. This was after I specifically asked mom to please call me when she thought her daughter would be returning, so that I could get paperwork in place.

I didn't even know about the classroom visit until her teacher told me...the next day. And the teacher was totally ok with the child starting school again sans documentation. I wound up hustling double time to inform every admin I needed to, sit down with mom and review halo care, and call ortho to see if they had any special instructions, which is when ortho faxed me a letter saying no physical activity. Mom was clueless about any of that even needing to be done.

The child has had two or three follow-up appointments since then, and mom has brought nothing for me from ortho. Which is why I've decided to just cover my bum with this situation and reach out to ortho directly. I'm also a softie for letting kids continue their education as much as possible, maybe because I'm in a very low-income community, so that is totally on me if I wind up making more work for myself.

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Specializes in ICU/community health/school nursing.

I have not much to add to Nutmege's good thoughts except (for when this happens again, and it will)-

I always involve my administration with the phrase "what liability does our school have for X?" And if I don't get the appropriate huffing and puffing, I say "Well, should we elevate it to the level of the district lawyers?" I mean...spinal surgery, people. In a kinder!!!

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Specializes in Community and Public Health, Addictions Nursing.
18 minutes ago, ruby_jane said:

I mean...spinal surgery, people. In a kinder!!!

It feels so good to be validated and know that all of you here understand our kids' health needs!

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Specializes in OB.

As a parent, it is mind-blowing to me that you had to shoulder all this responsibility and the parent did nothing. Dropped their kid off with a HALO on and didn't think they needed to touch base with the school nurse??? I would have approached it from ruby jane's POV and gone directly to admin to ask about liability, to see if that helped me get any more support behind my requests for clarification from the parents and/or physicians. But you should not have had to do any of that.

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Specializes in ICU/community health/school nursing.
2 hours ago, UrbanHealthRN said:

Surprise surprise, the parent didn't bring me anything. She literally showed up with her daughter one day, halo and all, to say hi to the class and talk about the surgery. This was after I specifically asked mom to please call me when she thought her daughter would be returning, so that I could get paperwork in place.

I didn't even know about the classroom visit until her teacher told me...the next day. And the teacher was totally ok with the child starting school again sans documentation. I wound up hustling double time to inform every admin I needed to, sit down with mom and review halo care, and call ortho to see if they had any special instructions, which is when ortho faxed me a letter saying no physical activity. Mom was clueless about any of that even needing to be done.

The child has had two or three follow-up appointments since then, and mom has brought nothing for me from ortho. Which is why I've decided to just cover my bum with this situation and reach out to ortho directly. I'm also a softie for letting kids continue their education as much as possible, maybe because I'm in a very low-income community, so that is totally on me if I wind up making more work for myself.

I've been thinking about this. I would have been so shocked that this happened that I would not have had all my wits about me. I mean....HALO.

BUT - if/when this happens to me (and I'm sure it will) - I will remember this and I will ask immediately for that release to be at school, and, depending on the severity (HALO!!) I might tell parent that the kid cannot be here without doctor's clearance.

Fortunately I have always had parents who've let me know well in advance when their kid had something hugely challenging so it's felt like a collaboration. Like we're all in this together. Thank you for posting this!!

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