Hi all, I would like your opinion on what you would do if you thought (knew) that the treatment recommended by a PA was not appropriate? I have a kinder student with tinea captitis (ringworm of scalp) and the PA's note to the school states that Ringworm is not contagious due to treatment with topical antifungal cream. It is my understanding that when ringworm gets into the hair follicles, the topical creams are ineffective treatment because they do not penetrate deep enough. In the case of scalp ringworm a prescription for an oral antifungal is required. This is what I told the parent (twice, a week apart), and when they finally took the kid into be seen, the PA did nothing! Said keep treating with the otc athletes foot cream. School policy is exclude until appropriate treatment is started and keep ringworm covered at school. Hard to do that- have student wear a hat?? Also same kid had irritated left eye, red sclera, cloudy exudate in inner canthus and crusted matter in lashes and skin surrounding eye. When I sent home to be evaluated for both possible pinkeye and ringworm without appropriate treatment, mom is not happy. Student returns next day with note from PA that says "ringworm not contagious- treated with topical agent, left eye not conjunctivitis, may atttend school." What would you do?????? Help.
Ensure the PA's note is in the file and document the heck out of it. If you had further discussions with the parents, document those too. As noted, the PA is a "higher medical authority" but at the end of the day, we have to live with her diagnoses and instructions. There have been times that i've pulled "school nurse law" (my school, my call type of thing). Most recently was a child with some sort of intestinal virus who's mom came to my office to tell me was still producing liquid diahhrea /child couldn't eat - BUT the dr said he could go back to pre-k. Uh no... use your head. In this case, because there is some srot of a treatment happening AND the PA cleared the kiddo, i'd probably hesitantly let him / her in, but the second it looks like it's getting worse or not getting better, the it's school nurse law.
I counsel my parents to take student to an MD. I had a student continually treated with antibiotics for a cough at the largest pediatric clinic in our area by PAs and NPs when seen for sick visits, he was treated for GERD after being seen by a physician. Mid levels don't know what they don't know, and that is the breakdown in our health care delivery.
This same thing could well happen with an MD, but it is discouraging
This same thing could well happen with an MD, but it is discouraging
I personally refuse a mid level if it involves diagnosis, OK for follow up. Doctors spend two years giving diagnosis assessments during their training, mid levels have weeks.
Sticky situation! I would educate mom that from your understanding, oral antibiotics are required--and show her the research that proves this.
I took my son to a PA for scalp ringworm when he was 3 and it was treated with oral antifungal (griseofulvin) and the PA informed me that topical agents won't work to treat it. Sounds like that provider is misinformed.
My son had a perfectly circle bald patch on the top back of his scalp where it was. I would think it would be nice for the child to be able to wear a hat until it is resolved in any case due to possible ridicule, but I suppose that's up to the school. I think it took several weeks for the hair to grow back.
Specializes in Oncology, Med/Surg, Correctional, and School nursi.
Treatment protocols for my district are a combination of oral and topical antifungal cream, lotion, or shampoo. As stated by OP, oral treatment is necessary because the fungus invades the hair shaft and goes beneath the skin. Medications are taken for 4-8 weeks. Selenim sulfice shampoos such as Head and Shoulders and Selsun Blue may help since another medicated shampoo was not prescribed.
Silly, silly person. Sometimes I want to complete the NP just to tell them they are a silly, silly person.
The PA trumps the Nurse? No and Hell no! As a nurse you are the patients advocate and if you don't advocate you are failing in your responsibility.
When my PA ordered a 1 mg dose of epi for a severe allergic reaction I questioned it and told her in a friendly coworker voice that it was a very big dose and suggested that 0.3 mg was the usual dose. She thanked me and let me know that she had never actually prescribed it in the past.
PA with six moths on the license versus RN with 20 years on her's and they are working in the ER? That PA better listen if making an error and if he or she doesn't the RN WILL be going over his or her head to the MD. If she doesn't and there is a bad outcome do you think the nurse will not be included in the law suit? Failure to advocate could be grounds for forfeiture of a license as well as forfeiture of savings and future income.
I really want to call the clinic charge nurse or clinic manager and ask her if SHE considers topical treatment appropriate for scalp Ringworm. And not say student's name as to not violate confidentiality. Mid level providers are the only ones who do walk-in clinic/urgent care around here. It takes 1-2 moths to see an MD. sad.
If they make the appointment now, the month or 2 will soon pass and the kid can see the MD.
Or, what does your supervisor say? Perhaps he/she would approach the PA or PA's boss and just "clarify" the situation. Or could you "clarify"? Not challenge or argue, just ask to be taught. LOL
But I'm serious.
Also, I thought that a pt who sees a mid-level can more or less insist on being seen by the MD that same day. Is that a law where you are? Parent will have to stand up for the child, stand her ground. Or just nicely but persistently say that she wants a 2nd opinion, just to be sure, as the signs and symptoms are not improving.
Hi all, I would like your opinion on what you would do if you thought (knew) that the treatment recommended by a PA was not appropriate? I have a kinder student with tinea captitis (ringworm of scalp) and the PA's note to the school states that Ringworm is not contagious due to treatment with topical antifungal cream. It is my understanding that when ringworm gets into the hair follicles, the topical creams are ineffective treatment because they do not penetrate deep enough. In the case of scalp ringworm a prescription for an oral antifungal is required. This is what I told the parent (twice, a week apart), and when they finally took the kid into be seen, the PA did nothing! Said keep treating with the otc athletes foot cream. School policy is exclude until appropriate treatment is started and keep ringworm covered at school. Hard to do that- have student wear a hat?? Also same kid had irritated left eye, red sclera, cloudy exudate in inner canthus and crusted matter in lashes and skin surrounding eye. When I sent home to be evaluated for both possible pinkeye and ringworm without appropriate treatment, mom is not happy. Student returns next day with note from PA that says "ringworm not contagious- treated with topical agent, left eye not conjunctivitis, may attend school." What would you do?????? Help.
I would be calling the PA and nicely get him to tell you what is the eye DX? And what about the need for p.o. Rx because it gets into the hair shaft, as stated in ... and give him a couple of recent references. Then tell him you faxed the refs over to him.
If I got nowhere with the PA, I'd be talking to my Sup.
BTW, is the tinea capitis improving at all? And the eye?
You could call your local/county/state health department and see what their communicable disease specialists say about the matter.
Flare, ASN, BSN
4,431 Posts
Ensure the PA's note is in the file and document the heck out of it. If you had further discussions with the parents, document those too. As noted, the PA is a "higher medical authority" but at the end of the day, we have to live with her diagnoses and instructions. There have been times that i've pulled "school nurse law" (my school, my call type of thing). Most recently was a child with some sort of intestinal virus who's mom came to my office to tell me was still producing liquid diahhrea /child couldn't eat - BUT the dr said he could go back to pre-k. Uh no... use your head. In this case, because there is some srot of a treatment happening AND the PA cleared the kiddo, i'd probably hesitantly let him / her in, but the second it looks like it's getting worse or not getting better, the it's school nurse law.