How to assert yourself?

amoLucia · Aug 30, 2020

Not the school nurse here.

My concern is how these teachers are so knowledgeable about student health care issues. Like where's their pipeline?

With your FERPA regs, I guess all you should do is just smile and politely respond with a 'thank you for your concern. I'm on top of things'.

'Tain't NONE of their business what you're doing! Nor do you owe them any explanations.

And good thoughts to all you SNs as the new academic year starts.

RatherBHiking, BSN, RN · Sep 12, 2020

Teachers are concerned and want action/changes immediately and they always seem afraid to call parents. I tell them anything behavioral related (depression, adhd or any inappropriate behavior) they need to first call the parent and discuss the behavior they are seeing in the classroom. I can’t do it for them because I’m not the one observing the behavior(even if they have a health problem). Then the parent and teacher can work together for a solution. If things don’t improve I recommend them setting up a 504 plan. I also get the counselor involved.

Hygiene is a tricky subject because it is kind of health related. I usually ask the student if they have running water, a washer, soap, clean clothes, etc. Some will say no so we try and help the family if possible but it’s just not a high priority in some families and we can’t force a kid to come to school clean. I usually ask the teacher to have a health and hygiene lesson for the whole class and talk to the parent but nothing ever seems to change. It’s frustrating for everyone. Some things you just can’t fix.

As far as the diabetic they are just worried for the child. I would make sure all my info on this child is up to date and then reassure them that you’re monitoring the situation but you are not going to tell the Dr what to do or go behind the parent’s back and make them not trust the school. If they are still concerned they are welcome to call and talk to the parent but you see no reason to at this point (unless you need to get more info on his meals and snacks or being monitored while eating ).

I try to throw it back on them as much as possible whenever I’ve taken care of my part. However, I always listen to the teacher because they are with the kids more than me and can catch issues and sometimes there are red flags that need investigated so don’t automatically dismiss them. That being said, you don’t have to do what they ask. They aren’t not your boss and you don’t work for them but you are a team so it’s best to be kind but reassuring and stand your ground. Once they gain your trust it will go smoother.

I’ve had teachers say well since you didn’t sent them home they better not throw up in my class. I always say well based on my assessment at this time they are fine to stay but you know things can change and I can’t predict if they will and I can’t send kids home on the off chance they MAY throw up today so if you’re worried then put a trash can by them.

I also send an email every year that says “If you forgive me for sending a sick child back to class, I’ll forgive you for sending me ones that aren’t truly sick.” I have teachers that always say oh you’re right, I’ve never thought of it’s that way.

Its OK to say with a smile, “I’m sorry I can’t do that.” or “ I’ve done all I can do with this situation.” and then give suggestions on where to go from there. Keep your principal in the loop as well so the teacher doesn’t go to them and say she’s refusing to do anything because then the principal will know exactly what the situation is and can’t diffuse it or work with the teacher to figure it out. Don’t be afraid to talk to your principal and do NOT complain about the teacher (that will get you nowhere and they will side with the teacher’s point of view if backed into a corner) but say here’s the issue, what I’ve done, what the teacher is concerned about, and do you have any other suggestions or just wanted you to be aware or whatever the situation warrants.

Best wishes to you!

guest464345 · Sep 13, 2020

On 8/29/2020 at 4:18 PM, Mavnurse17 said:

A looooot of teachers think they know better than me and try to get me to do certain things they think are my job. For example, last year we had a student with very severe depression, and for whatever reason mom was adamant about only keeping her on a small dose of her antidepressant; her teachers found out about this and wanted me to 1) call the treating psychiatrist to up the med (?) and 2) file a CPS report for neglecting the child because they felt mom was withholding the med. I told them if they were so concerned, they should be the one to file (which, is it even appropriate to??) but they said “but it’s about medication and you’re the nurse.”

...

Another example is that there’s a SPED kiddo with DM2 and has a genetic/metabolic condition that causes morbid obesity and compulsive eating... mom and doctor are adamant (Via documentation) that he doesn’t need diabetic orders at school as he’s managing twice daily at home. Teachers are baffled and always ask me “are you sure? Could you call and see if that’s right??” despite them knowing he doesn’t have orders...

Those are ALL hard situations that most of us have faced - I sympathize.

My approach is usually to try engaging the teacher, and also helping them understand how the medical world works. They just want things solved, and they think more mg of meds=solution. So for the kid with depression:

1). As @Blue_Moon said.....is a 504 an option, and did they even talk to the parent yet? They have to talk to the parent. If they did, and parent is reasonably willing to work with you

2) "So on the one hand, I hear your concern about how his mood looks in your class - it seems to be affecting his academic performance and social life. On the other hand, in my role as a nurse it's not really an accepted practice to call up a physician and tell them to change their orders. They might have picked that dose for specific medical reasons we don't know about, and honestly some people don't have 100% symptom resolution on *any* dose. Some people don't tolerate certain meds or doses well - medication is not perfect. BUT, maybe this situation can be improved. If parents will sign permission for us to send over information, would you be willing to write up a short paragraph or a few bullet points about what you see in class? I never want to diagnose something or tell a doctor what to do, but they want to know how their patients are functioning - and you're the expert who sees him every day."

A lot of times, they are happy to do this, and occasionally it even helps (assuming the teacher has discussed the same info with parents - ideally the adolescent student is also in the loop) ? I have sent notes quoting teacher concerns to mental health case managers and psych NPs who were very thankful for the input. Better yet, have the *parent* take the note to the clinic to discuss at the next visit. Often the kid is in the psych clinic alone and is not a great historian, or he kid looks quite different at home than at school, or the parent knows he's struggling at school but doesn't have the detailed language to describe it (does it look like a concentration problem, with struggles in math? Is the student looking extremely anxious when asked to work in groups of peers? Is the student so slowed down that he's not processing long paragraphs of information, and it takes him a long time to answer simple questions?).

And then you're not wrangling about dosage - you're coordinating care, so the parent and doctor can make informed decisions.

The teachers who are just trying to dump behavior problems on you will quietly disappear when asked to contribute.

The diabetic kid - to me, that's a smile-and-shrug. Smile, "well, neither of us is an endocrinologist, so I have to work with the orders and policies I've got," shrug. Steady gaze. Don't apologize. Repeat as necessary.

The hygiene thing, meh. I'm tired of that one too.