handling a willful child

[basketball13]

Let me give you a quick background. My county only ever employed 1 school nurse at a time. They finally added a second school nurse (me!) a few months ago. There is a diabetic student in 4th grade. She gets insulin around lunch time. THere is no set sliding scale as to how much coverage she gets. It's up to the parents and at school it's up to the school nurse to decide how much she gets. She also gets rechecked at the end of the day and if her number is over a certain number, she gets 1 to 2 more units. Her blood sugar can be very unpredictable at times but I have gotten her fairly figured out.

Here are my issues. When I am checking her blood sugar and deciding on how many units to give her at lunch I have a hard time getting her to do what I ask her to do. Whether it be to actually check her blood sugar, to actually take her insulin, how much insulin to take, to tell me what she had for lunch, etc. Sometimes she will argue with me about how many units she needs (and I do listen to her and her rationale and there have been a couple times that I wanted to give say 3 units, but she wanted 4 so I did go with 4, but then she was a little bit low at the end of the day so I rarely do what she wants unless it's in agreement with me anyways,) I spend a good 5-10 minutes at lunch time arguing with her about how much insulin to take. The thing is, she is almost always a good number in the afternoon so I don't understand why she always argues with me at lunch time anyway.

This was the big kicker last week though. On wednesdays I am at another school at the end of day and only come back over if she is above that certain number and needs covered. The teachers text me her number. Last week though she lied to her teacher and said she was 127 (no coverage or intervention) which was texted to me. However, the next day at lunch I came in and looked back at her blood sugars and saw it was ACTUALLY 280 (requiring 1 unit of insulin). I questioned her about it and called her out on it (explaining how dangerous doing stuff like this is for her) and talked to her teachers. She had lied (though she claims the meter is just wrong blah blah blah). Anyway, I told her from now on she had to show her number to her teachers which made her mad and she tried arguing with me AGAIN. I spoke to the principle as well and we called the parent to explain what had happen and also explained the trouble I've had with her. I don't think anything was said or done to her though at home. However, she is incredibly angry at me still today and argued with me again over everything and again argued about how much insulin to take today at lunch. I was incredibly firm with her, even raised my voice (something I don't really do. I am an easy going person), etc. I'm at a loss. She likes to say "the other nurse doesn't do this or that." The other nurse is in her 40s and I'm young and in my 20s so I don't know if that's part of the issue? Or if she just got so used to the other nurse and doesn't know how to take me? The other nurse and I switch schools every month so I only have to handle her a month at a time, but I just don't know what to do with her. Any advice??? Sorry for rambling and I hope that made sense? lol I'm just so frusterated, and don't want something bad to happen related to all this.

[Farawyn]

Why in the world are there no DOCTOR'S ORDERS for this?

Insist upon it.

[Farawyn]

Oh, and the MORE EXPERIENCED NURSE in her 40s should be on top of this as well.

(Don't know how you intended the young/older nurse thing, but don't do that, please.)

[BeckyESRN]

You need clearly stated orders from the doctor. My oldest diabetic is not on a sliding scale, but has a clear cut formula to decide his coverage. I'm inclined to say that arguing over 1 units is sooo not even worth it!

[Farawyn]

You need clearly stated orders from the doctor. My oldest diabetic is not on a sliding scale, but has a clear cut formula to decide his coverage. I'm inclined to say that arguing over 1 units is sooo not even worth it!

With

a

9

year

old.

[MrNurse(x2), ADN]

She is a typical teen. (Just saw the fourth grade! Oh my)She wants control and this is the best place to exert it. As Far said, stick to doctor's orders and don't deviate. When she goes to argue, make her aware that you are bound by the orders and she needs to discuss it with the doctor. The more she argues, the more enjoyment she is getting; shut it down by acknowledging she is probably the best one to know how her body works, but orders are orders. Continued arguing past that point needs a stern reminder that she is being disrespectful and then a reminder that anything further may escalate to discipline. Stay consistent with this and follow through if you must. Talk to your Principal to give a heads up and see if this is an issue with the other nurse, you will probably find it to be the case.

[basketball13]

Let me rephrase. There is a sliding scale, but there is a clause that also says up to parental and nurse discretion as well (I can't remember the exact wording). If we followed the sliding scale to a T, she would not be controlled at ALL. That is why there is that clause in the order.

As far as the more experienced 40 year old nurse statement goes, I just meant that I wondered if the student looks at the other nurse as more of a mother type figure (and therefore, listens to her better), and looks at me more like a teenager (and therefore, does not listen to me as well). It was not meant to be offensive at all. And I am not sure why offense was taken to be honest. So please ask me to clarify something if you don't understand what I meant. It is difficult to explain everything via a keyboard.

[Farawyn]

She is a typical teen. She wants control and this is the best place to exert it. As Far said, stick to doctor's orders and don't deviate. When she goes to argue, make her aware that you are bound by the orders and she needs to discuss it with the doctor. The more she argues, the more enjoyment she is getting; shut it down by acknowledging she is probably the best one to know how her body works, but orders are orders. Continued arguing past that point needs a stern reminder that she is being disrespectful and then a reminder that anything further may escalate to discipline. Stay consistent with this and follow through if you must. Talk to your Principal to give a heads up and see if this is an issue with the other nurse, you will probably find it to be the case.

No.

She's in 4th grade.

Take all control away from all of you.

Dr. Orders.

[Farawyn]

Let me rephrase. There is a sliding scale, but there is a clause that also says up to parental and nurse discretion as well (I can't remember the exact wording). If we followed the sliding scale to a T, she would not be controlled at ALL. That is why there is that clause in the order.

As far as the more experienced 40 year old nurse statement goes, I just meant that I wondered if the student looks at the other nurse as more of a mother type figure (and therefore, listens to her better), and looks at me more like a teenager (and therefore, does not listen to me as well). It was not meant to be offensive at all. And I am not sure why offense was taken to be honest. So please ask me to clarify something if you don't understand what I meant. It is difficult to explain everything via a keyboard.

Oops.

I misread.

Sorry.

I would suggest a meeting with mom and the other nurse present with a copy of the most updated orders.

[MrNurse(x2), ADN]

No.

She's in 4th grade.

Take all control away from all of you.

Dr. Orders.

I missed the fourth grade comment. Oh my, she is wonderfully parented. Agree, strict doctor's orders and no deviation. Have her bring lunch before and after eating to spare the lows. One blessing of lunch being right outside my door.

[Flare, ASN, BSN]

I agree - she is in 4th grade. The leash gets tightened and the orders go by the letter of what the doc wrote. Oh, and guess who gets a new buddy standing by her side during BG check time. A new buddy with a nursing degree, that is

[grammy1]

Sometimes the "at nurse's discretion" is useful if they're on their way to PE or recess. One of our Type 1 we always drop down a unit if it's right before PE or recess, otherwise she drops. Other than that, it's drs. orders only. We will give in to the one without a pump if it's time to go home and she only needs one unit, not worth taking a shot now and another shot with her snack when she gets home.