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Going to school with patient

Any wonderful or horrible experiences going to school with a patient? I have alternated between pedi private duty and hospice since 1983 but have never gone to school with any of my pedi patients.

Have been with this three year old for 8 months and mom is pushing to get him started in special ed at local school. Not sure why but I feel less than enthusiastic 😕

Any insider tips on what it's like?

Another level of third party to deal with (teachers, aides) with resultant possible problems. I have found there is little worse than having a third party butt in your job to the point of actually causing you to lose your job (not likely, but possible). Possibilities for physical problems (travel to and from, accidents at school, etc.) Extra energy required to go out in public rather than be confined to patient bedroom. Of course there are the positive aspects for patient to interact socially with others and with their environment. There could be changes in your work schedule hours that interfere with your routine. Try to store some of the patient required supplies (diapers, wipes, containers of tube feeding, etc.) at the school to lessen your daily load as the pack mule. Try to develop a positive relationship with school personnel. If you help them, they will usually help you.

Thank you. Those are exactly the things I have had going through my head. Pros and cons to any situation. I think what is stressing me most is mom. She is decidedly high strung and does things her own way. We manage fairly well at home. Some days are better than others. I just don't see her having a realistic view of this situation. Three hours a day of school is NOT going to free her world for her to get a job outside the home and go to school. Especially with the 5 year old sibling starting kindergarten. She originally thought she could just give me a key, put carseat in my car at morning drop off at school and I would drive pt home and carry on with the shift. When informed that my agency policy does not allow for transport of patients (and something I would not want/take liability for personally) she reconsidered the school bus. I really don't want the school bus scenario for myself. Sorry I'm rambling. The mom waited until yesterday to pick up the paperwork from the school district and is not communicating anything with agency staff. So frustrating. I called the info into staffing coordinator before my shift today so I will just wait and see how it plays out. I just felt really ambushed by mom wanting me to commit on the spot without any concrete details about shift times and travel logistics etc .We shall see...

I would not want to be in a situation where the mom is making arrangements outside of the agency, and your, knowledge, and then planning to spring these changes on you. Go to the home as usual. When the agency tells you otherwise, iron it out then. Until then, tell the mother that you will receive your instructions from the agency because the agency has to ok anything and insure that any necessary changes are made to the care plan. Should this start looking like more and more (and it gives a hint of this already) "change-ups" on the part of the mother, it might be wise to seriously consider a new case. You know now what you are willing and not willing to do. Don't leave it to the mother and the agency to dictate to you things that you don't want to do.

I have been doing home health for about 10 years. I've only been to school twice one horrible experience one uneventful experience. The worse: family moved into a new subdivision that was forced to open up a special ed class upon assistance by mom. They stated there wasnt a need in the neighborhood. the class quickly filled. One year later the parents all commented on how much progress their kiddos made because with the presence of a nurse the teachers were forced to get off their phones and apply splint rom exercises..... when I took on the case they tried to stop me from using my computer. I dont follow their rules so i ignored that. Then they felt I was watching them.... small room hard to not look around so they moved me out of the class and made me sit outside. The window on the door was not at chair height so I had to stand and watch him. They said they would call me if he was having seizures. This lasted a day because when quizzed on how the seizure would present noone had a clue. Also when class was done they made the poor child wait until the whole class was dismissed and buses were gone because mom picking him up disrupted the busline. The worse was when another child was having a seizure and I rendered aid. This in their eyes was a HIPAA violation. Noone else knew what to do amd I knew i had a legal and moral obligation to help. it all ended in a big school board meeting and thats when i said peace out too much.....

Wow! Awful. Did they report that as a HIPAA violation?

Kitiger, RN

Specializes in Private Duty Pediatrics.

I have always enjoyed going to school with my kiddos. All had trachs; several were on vents. All but one were in wheelchairs.

All the vent kids were in wheelchairs, so I just loaded up the wheelchair with all the equipment (Go-Bag, suction machine, oximeter, vent, etc.) and off we went.

I was responsible for the seatbelt, and for the chest restraint (if needed). I rode the bus with the child, as I was also responsible for any medical needs the child might have. The bus aides were responsible for loading the wheelchair & securing it, and seeing that the seatbelt & chest restraint were on. They also unloaded the bus, and I took over outside the bus.

In the classroom, my first priority was the child's safety, and seeing that she got all of her routine treatments. The teacher ran the classroom, and I helped with "my" kiddo; I didn't do anything with the other kids in the classroom. Sometimes, I was just nearby, ready to intervene if needed. Usually, that would be for trach suctioning, etc.. Sometimes - especially in a special-ed type of classroom - the teacher would have me do hands-on activities with my kiddo, things like range of motion, sensory activities, working with standers, or maybe using a Little Room. I found it interesting, and I learned a lot.

You do need to have your agency involved, and school should be included in the care plan.

Thank you all so much. Yes. My agency is involved and doing their thing with school district and nurse supervisor. I have basically told the family that I will not ride the bus but will walk through the process with them to see if it is a good fit or not, logistically and schedule wise for me. On that note, let family and agency know that a back up nurse oriented to this patient is well overdue. Mom requires meet and greet and for a month now has not had a nurse if I am not on duty. It will all unfold as it will. Kudos to traveling with all the baggage with vent patients. I am only 5 feet 1 inch and a 105 pounds and find that daunting!

One is always concerned that they will accidentally leave something behind somewhere. One of the worries of the nurse pack mule.

I go to school with my pt and I love it because the teacher and the aids are great people to be around. If they were unpleasant I still would like it better because my pts mom is quite unpleasant I’m always trying to get her to leave so she can leave me alone while we are at home. As long as your agency approves and you are willing to do the extra, my patient lives about 15 minutes from her school and I still go home with her after school. The only con is that she is in a class with other special needs kids and the bathroom is constantly occupied and some of the other kids can be alarmingly noisy and annoying but at the end of the day I am the nurse and she is my patient and I don’t butt into classroom affairs I’m just a visitor

Notmyscreenname, RN

Specializes in Current PDN. RN for 5 years..

Does anyone know what to do when the Teacher's are super nice to your face, and you have a feeling (an a strong one) that these teacher's (main and aid) are spreading exaggerations to your pt's parents?

Example: Pt wants to tell me she isn't feeling well. Teachers say I'm keeping the patient from the class.

Notmyscreenname, RN

Specializes in Current PDN. RN for 5 years..

On 8/12/2019 at 6:37 PM, NurseCelia said:

I go to school with my pt and I love it because the teacher and the aids are great people to be around. If they were unpleasant I still would like it better because my pts mom is quite unpleasant I’m always trying to get her to leave so she can leave me alone while we are at home. As long as your agency approves and you are willing to do the extra, my patient lives about 15 minutes from her school and I still go home with her after school. The only con is that she is in a class with other special needs kids and the bathroom is constantly occupied and some of the other kids can be alarmingly noisy and annoying but at the end of the day I am the nurse and she is my patient and I don’t butt into classroom affairs I’m just a visitor

Question: What if the teacher asks you to help with something? Like playing (Insert Game Here) with groups of children. Then you find out its actually measuring if they can do a certain task or not. I'm not a teacher, I am a nurse. I always try to make my immediate surroundings 100% comfortable (like getting along with the other adults) however I truly think these 'women' (more like children!) are setting me up for failure... What's your take?

They are only setting you up for failure if your supervisors take what they say over you. If you are that uncomfortable in getting along with these people on a day to day basis perhaps you should find a different venue. You could just as easily be working on a case in the home with other nurses who happen to act like witches. Are you going to let their behavior run you off from your paycheck? Keep your boundaries and do your job with a little give and take here and there. You should be fine.

Notmyscreenname, RN

Specializes in Current PDN. RN for 5 years..

@caliotter3

Sound advice... time to set those boundaries in stone. Document (personal file) everything, and do as I need to!

You're right, took me a little to calm down. Best thing I felt was get another's perspective. As we all know our can be skewed one way or another from time to time.

TL;DR: Thank you. I will take all the advice you handed my way. Thanks again!

16 hours ago, Notmyscreenname said:

Question: What if the teacher asks you to help with something? Like playing (Insert Game Here) with groups of children. Then you find out its actually measuring if they can do a certain task or not. I'm not a teacher, I am a nurse. I always try to make my immediate surroundings 100% comfortable (like getting along with the other adults) however I truly think these 'women' (more like children!) are setting me up for failure... What's your take?

You could always do it and then when they ask you questions pertaining to if they can do something just say you don’t know. Half the time I would participate just to have something to do but it’s not on you to know if they know how to do certain tasks and yes after working in the classroom with the aids and the teacher I ended up disliking them because they just use the nurse as an excuse to not deal with that student and they act like chickens with their heads cut off and don’t understand priorities with the other students

Since starting this thread I have actually begun going to pre-k in a special deaf education program with my 3 old patient. Loved the advice to keep some stuff at school. They are very kind about giving me some room for supplies. Rolling suitcase I purchased does the rest and navigates well in hallway.

The teacher is deaf and the aide signs and hears so we muddle through and really communicate very well.

PT wears a backpack with feeding pump and teacher and aide know that if he starts scanning the room for me it is because he hears the pump beeping. They think it is adorable.

The first day I let them know that I would be handling all of his incontinence care,feeding pump ,meds and any nursing interventions that were needed but try to do so in a way that would not disrupt other students and also keep him engaged as much as possible. I would NOT intervene with teaching/ redirecting over classroom issues so as not to undermine the bonding he needed with teacher and aide.

It has worked out very well so far and I do enjoy the mornings out of the house.

Why would the teacher think you were trying to keep the pt out of school?

Notmyscreenname, RN

Specializes in Current PDN. RN for 5 years..

@Nursee1234

The pt likes to hang around me and does visit me frequently, I've told her to go back to class, and i can only say so much because discipline isn't my area.. Its not my job really. So I try to redirect her back to class and look for the teachers to help in that area because i have told her 10 times once and it doesn't matter... idk maybe she is over school or something, bored?

Don't get me wrong, I do love my job! I love my patient! Its just the balancing act with the adults. lol. Who would have thought adults are more challenging than children? lol

I'm over it, I go. I do my job, I document! Done lol

Amen to the challenging adults. It has taken a year on this case to set the boundaries with mom.

I guess I have a good situation being in a pre K class with only 8 kids and an aide and good teacher. If all the demons are having a wil day I will sometimes step in to discipline with my kiddo. Just simple things like signing no or stop that or kneeling behind him if he is wiggling and won't sit still during circle time on the floor. And I only do that if the aide is doing the same with two other kids who are not mine to touch. It's a balancing act.

Not a horrible way to earn a paycheck. Some days are better than others!😏

ruby_jane, BSN, RN

Specializes in ICU/community health/school nursing.

On 11/14/2019 at 1:56 PM, Nursee1234 said:

Since starting this thread I have actually begun going to pre-k in a special deaf education program with my 3 old patient. Loved the advice to keep some stuff at school. They are very kind about giving me some room for supplies. Rolling suitcase I purchased does the rest and navigates well in hallway.

The teacher is deaf and the aide signs and hears so we muddle through and really communicate very well.

PT wears a backpack with feeding pump and teacher and aide know that if he starts scanning the room for me it is because he hears the pump beeping. They think it is adorable.

The first day I let them know that I would be handling all of his incontinence care,feeding pump ,meds and any nursing interventions that were needed but try to do so in a way that would not disrupt other students and also keep him engaged as much as possible. I would NOT intervene with teaching/ redirecting over classroom issues so as not to undermine the bonding he needed with teacher and aide.

It has worked out very well so far and I do enjoy the mornings out of the house.

Kudos to you! The school nurse appreciates your presence in the classroom (at least, I would if I were that school nurse)!!

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