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.

[Rubor]

I had an diabetic update training at my children's hospital this past year. Doctors definitely encouraged nurses to reach out to parents as they will have a better understanding of the child and my standing orders have similar language. With that in mind, the orders need to be clear. This definitely sounds like a meeting needs to take place and your concerns addressed. Good luck and keep us posted!

[NurseBeans, BSN, RN, EMT-B]

I feel like this has been more than covered, but this might be helpful to consider:

I have a T1D who was diagnosed at age 2. He's 9 now. I have been his school nurse since he was 6. I have had similar issues with him, although he likes to let me give him his insulin, then not eat all the carbs he was supposed to. (his doctor and parents have designed this management plan and I can't change it, otherwise I would let him eat and then tell me what he ate and dose accordingly, but that's another thread entirely) Then he returns later very low. And the snacks for low bg that his parents send? Juice and Hershey's kisses. Which he loves. I get the sense he is manipulating things so he can eat a bunch of chocolate every afternoon. Very dangerous.

Anyway, when I really think about it, he has a disease he cannot cure, only control. And sometimes he can't even do that. He's a kid with all the normal kid emotions, plus this disease he can't get rid of. It makes him different. No kid wants to be different. So I feel like he does manipulative and argumentative things in order to feel in control.

Does it help at all to frame her behavior that way? She can't change her diabetes. Can she be allowed some choices in order to feel in control and maybe she'll argue less?

[grammy1]

And the snacks for low bg that his parents send? Juice and Hershey's kisses. Which he loves. I get the sense he is manipulating things so he can eat a bunch of chocolate every afternoon. Very dangerous.

Is the mom open to conversation? It took me a year and a half, but I finally got a parent to understand that the chocolate she was sending in wasn't the answer for her daughter's lows. FINALLY she is sending a carb snack and a protein to help keep the BG up. Mom says that no one ever told her chocolate wasn't the right snack...well, when you don't listen you don't hear those things.

[NurseBeans, BSN, RN, EMT-B]

Is the mom open to conversation? It took me a year and a half, but I finally got a parent to understand that the chocolate she was sending in wasn't the answer for her daughter's lows. FINALLY she is sending a carb snack and a protein to help keep the BG up. Mom says that no one ever told her chocolate wasn't the right snack...well, when you don't listen you don't hear those things.

If only. Mom is a nurse, dad is a T1D. Older brother is T1D as well. Mom is very argumentative, has a history of accusing district nurses of being terribly incompetent nurses who know nothing about diabetes and are overdosing her sons. She unfortunately is the reason one sub refuses assignments at my school. She is never wrong. So I allow the stinkin' chocolate as hypoglycemia management because I have to choose my battles. At least I got her to back down on the mandatory three phone calls a day to check dosages

[grammy1]

Ugh, that's the kind that usually show up every day too.

One thing about our school, it's 7th and 8th grades only. Most of the time we feel bad that we only have the student for two years. But with parents like that, we're glad that we only have to deal with them for 2 years!!

[canoehead, BSN, RN]

to the OP:

Have you talked to the other nurse? I wonder if she just does what the child wants, and that's why you get so much arguing. You need to be as consistent as possible. What does Mom do when the child argues about insulin with her?

A lying child would push my buttons. If she doesn't give you the correct numbers or carbs she could do her testing and eat her lunch in the boring old nurses' office for a few days. I'm sure the cafeteria would send you a bag lunch, just for her.

[MrNurse(x2), ADN]

Sigh, see above.... There IS a doctor's order... I've clarified this a couple of times. If I knew how to edit the original post, I would. I'm a new user on here.

I have called the mother, but this doesn't seem to scare her... probably because she's got this same bossy attitude at home and doesn't face much consequence at home regardless. The discipline system at this particular school is to go to the principle's office pretty much. I've never actually done this, but perhaps I should go this route? I don't know.. I just feel weird sending a kid to the principle's office...

No hesitation here. Respect is one of our core anchors, I warn the child and will have them talk to administration if the disrespect continues. Luckily administration is keen on this and backs up staff. Do it once and she will not do it again.