How Do You Handle the Student Who Wants Last Year's School Nurse Back?

[MotherRN]

Hi!

In general, the kids are working with me well in the Health Office. I am having trouble with one of my diabetic kids. I think he might have a crush on the former nurse. He's in high school and she looks like she is too, even though she is in over thirty.

Basically, everything I say is wrong and he doesn't want to take his insulin coverage for lunch time meals or snacks. He tells me things like, "I'm not eating today." Then I discover him with a plate of about 100 carbs!!! worth of food!!! Or, he will tell me he is only getting a snack- Gatorade and Doritos- and his doctor says to not cover these. And, when 30 days had passed and it was time for a new bottle of novolog to be dropped off, he told me last year the nurse let him keep the same bottle month after month, because he barely uses it! More than three weeks went by before I could convince mom to drop off another bottle. During this time, he did not get any coverage because I would not give him expired insulin.

I feel like Ms. X put me in this position by mismanaging his treatment last year. She basically took him telling her he was not eating and gave him no coverage (when he was surely eating the whole time or else he would have dropped at least a pound or two!!!) Plus, the not requiring him to drop off insulin monthly is crap! He doesn't believe the stuff expires.

I have told the principal when I first found out he does eat (and lies to take no coverage), she talked to him. It was fixed for about two days. This Monday, he came in like a loaded gun looking to go off! So, I had to tell the principal again. And, this time I had to put him in his place because he was tossing things around and being really disrespectful. I refused to let him storm out after that behavior and told him he would stay put and behave respectfully in my office. He is a junior in high school. He will also speak loud enough to be hear and stop this game he is playing where he mutters and refuses to make eye contact like a spoiled child!

I called mom as well. I requested she call his doctors to see if they want to change his orders in any way. I explained I have to follow the orders given to me in the health office in order to be compliant.

This kid does not run high. He is below 100 when he comes in. I don't want him to refuse to eat, then drop, because he is often at 72-82 and his lunch is early. He is still on campus for another 3.5 hours after lunch.

I'm rambling. I'm just so frustrated. Here I am, actually following the rules of diabetic management and his orders safely, and I'm the bad guy! Today, he told me, "I can't work with you! I want Ms. X!"

Suggestion?

[morte, LPN, LVN]

My biggest concern is that this student, as you noted, is not being taught to be a man. shortly he will have no over sight, and may well kill himself and possibly someone else when he gets his lic to drive. He has been failed by his family, very much failed. And the principal is being no help. Is there a dad in the picture? if not, do you have any sort of mentoring program that he could be recommended to? I understand your lead nurse's attitude to some degree, but that still leaves society at risk from this young man.

[MotherRN]

No mentoring program. Single parent household, no dad.

[BuckyBadgerRN, ASN, RN]

You're going to drive yourself bat-sheet crazy over this kid. He's non-compliant. His mother contributes to his non-compliance. School administrators contribute to his non-compliance. Honestly what do they expect you to do, more importantly, what do YOU expect you to do?

You can't spend your entire day chasing down ONE kid with an attitude. I know you don't like the advice that the lead nurse gave you, but your options are rapidly running out. I'm not sure how they'd find you liable for delay of care, the kid straight up lies to you, he's delaying his own care. I understand that he's a minor, but he's not YOUR minor child, know what I mean? If the district thinks that it should be your personal mission to try to educate this one kid about his disease process, then THEY need educating as well.

I agree with a previous poster that this child is being failed in many ways, but he's at the age where its time to man up and start being somewhat accountable for his own health.

[NutmeggeRN, BSN]

Here is another thought...has he ever been tested for a learning disability? I had a kiddo who was low average IQ/state testing scores in elementary school. She was dx with Type 1 diabetes in her last year of elementary and REALLY struggled with complience and blood sugars in MS ...by the time I had her in HS her test scores were so low she was coded MR!!!!

Maybe some academic testing including a social emotional would be in order and then he might be coded under other health impaired. Not having any odea wha tthis kid is capable of I only toss that out there as a possibility!

Good Luck

[MotherRN]

Thank you all for the advice. I have managed to come to terms with my own concerns over this kid. My husband (long time manager) told me to do my job, even if it means the end of my job. I appreciated this so much because part of my concern has been financial. I really need this job!! Basically, I think the lesson I learned from the whole issue is to not involve the administration in my health office affairs-not until it's absolutely necessary. I involved them too early in this issue. I hoped they could keep him out of trouble because they all seem so involved with him. It didn't really help. They don't really understand the medical end of things. I think what helped the most was calling mom and having her give me permission to call grandma (never underestimate the power of grandma in an African-American, fatherless household!!!). Because he knows I will call her, I haven't had anymore trouble, lately. Doesn't mean he won't regress, but for now, I'm catching a break.

Plus, he hated it when I took him upfront for his meds. He hated that more than me! So, he is towing the line with his emotional outburst so we don't end up there again. And, I am not rubbing it in. I am very matter of fact. I talk with respect and I expect respect in return. I'm also having him fill out his own form after he checks everything. I do verify, though, for obvious reasons. At this point, I would love for him to do the right thing, but I will settle for keeping his blood sugar in a safe range so he stays off the floor.

Apparently, his diet has consisted of Fruity Pebbles for breakfast only (no wonder his BS is about 70 three hours later!) and Gatorade/Doritos for lunch (until the cafeteria cut him off).

The other day, he ate a real lunch and was at a safe blood sugar before dismissal. He was actually cheerful. He had energy. He even smiled!!! You'd think he'd get a clue!

[jodil77]

Maybe a bit off topic....but maybe just slip into conversation how African American people tend to have hypertension, which kills the kidneys and blah blah blah. Unregulated blood sugars would totally kill this too. Make sure you also mention dialysis too. I am all for the in your face education

[MotherRN]

Update:

Things have calmed down with this student. I haven't had any trouble in two weeks. By sticking to the plan, he knows what is expected and seems to have come around. He still doesn't like me much, personally, but he does make eye contact and I can hear him when he speaks!!

I recently went to a state convention. Boy was I disappointed to find that no one at the state level wants to give any specific advice when we have difficult issues in the schools. The universal theme seems to be "Don't quote me on that" and a general unwillingness to respond in writing, lest there be a record of the advice given. Interesting!