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If you provide PDN services at school?

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by nursenmom3 nursenmom3 (Member) Nurse

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If you provide 1:1 nursing services to a child at school, can you tell me if you also provide educational accommodations?  My husband and I are thinking about transitioning our 9 year old to school next year.  He is a kid with lots of medical complexities and technology, moderate physical disabilities, and no cognitive or behavioral issues. 

He currently receives home/hospital instruction, and on his IEP it specifies that he is able to dictate to a scribe for all written work.  Of course, in home/hospital where he's working 1:1 with a teacher, the teacher provides it, but I'm wondering how it would be provided in a regular classroom.  Is this a reasonable thing to ask the nurse to do?  Or does the school need to provide a nurse and an aide?  

 

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Kitiger has 40 years experience as a RN and specializes in Pediatrics.

1 Follower; 18,535 Visitors; 904 Posts

Since my only focus would be on your child, I would work with him in the classroom as a scribe. The only reason to do otherwise would be if I had to do something else for him. Charting counts here, because if I don't chart specifically why he needs a nurse at school, his insurance can say he doesn't need a nurse.

You don't want that.

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158 Visitors; 85 Posts

No, definitely don't want you not to chart!  

I asked this in the other forum, but do you ever see the same child both at school and at home?  For example, if my kid goes to school for 3 hours, can the same person ride the bus with him, attend school, and then care for him at home for the rest of a shift?

 

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Kitiger has 40 years experience as a RN and specializes in Pediatrics.

1 Follower; 18,535 Visitors; 904 Posts

I would typically go to the home first, get him ready for school, ride the bus with him to school, attend him at school, and ride the bus home. I might then stay to do his afternoon care, respiratory treatments, etc..

It depends on his insurance, how many hours/day he is allowed a nurse. Sometimes, parents have to cut back on nighttime hours in order to have enough hours available to have a nurse at school. But you probably know all about that. 😐

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Thank you!  

We definitely know about juggling schedules.  My biggest concern isn't that we'll use up the hours, but that we won't be able to find people, or that the people we find won't meet my standards.  So far, that's the issue we've had and so most of his care is provided by family.  I'd love to have a couple consistent people providing coverage at school, and home, but so far that has eluded us.  I worry that we'll set him up for school, and then he won't actually be able to go.  
 

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Kitiger has 40 years experience as a RN and specializes in Pediatrics.

1 Follower; 18,535 Visitors; 904 Posts

I know some families that use 2 or even 3 different nursing agencies. It's a lot of juggling, but it can work.

It's usually not too hard to add another agency. What's hard is completely switching agencies. And it's getting to where the only way a nurse can switch agencies to stay with a client is to actually go 6 months without caring for that client.

I really don't like these no-compete rules.

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I will try the multiple agency strategy, thank you for that. 

I wonder if there's something I can do to make the job more appealing.  I'd really like to find a few consistent people who want to take shifts with him.  I think it would be much easier to support him at school if whoever is with him is there regularly to form relationships, and learn the routines.  Plus, I'll worry less!

Do you have any ideas of things someone could do to make a job more appealing to you?

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Kitiger has 40 years experience as a RN and specializes in Pediatrics.

1 Follower; 18,535 Visitors; 904 Posts

Discipline issues with a child can be a problem, especially when the parent does not help the child set limits. I always try to work with the parents to understand their mindset, their goals. But if the parent's goal is to keep Johnny happy no matter what while my main goals are safety and health, we may have a problem.

Do you discuss goals and back-up plans with the nurse ahead of time?

In what ways do the nurses not meet your standards? Safety? Basic knowledge of the different therapies? Lack of experience? Infection control? Interacting with your child?

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To be clear, we haven't looked for daytime nursing services.  Up until this point, we've preferred to cover those hours ourself, but we're at the point where my husband and I need to work more hours to support the family.  There is a certain irony to the fact that I need to leave my kid with a nurse to go be a nurse to someone else, when I'd rather be home, but that's the way the funding stream works.  Plus, if he's going to attend school this fall, then we'll need someone to go with him.  

When looking for night care, the biggest issue we've found is that there's a shortage.  We're in a high cost of living area, and reimbursement rates aren't anywhere close to what they should be, so while we have plenty of hours that we can technically fill, the agency tells us they don't have anyone for us.  Everyone I know in the area with a medically fragile kid has that experience.  But some things that I suspect might make the position harder to fill are that we want night hours, that I'm a nurse which might be intimidating, and that we make limited use of cameras.  

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On 6/26/2019 at 5:57 PM, nursenmom3 said:

Thank you!  

We definitely know about juggling schedules.  My biggest concern isn't that we'll use up the hours, but that we won't be able to find people, or that the people we find won't meet my standards.  So far, that's the issue we've had and so most of his care is provided by family.  I'd love to have a couple consistent people providing coverage at school, and home, but so far that has eluded us.  I worry that we'll set him up for school, and then he won't actually be able to go.  
 

Is it your choice to have a PDN nurse attend school with your child because the school is using trained medical 1:1 aides and you are uncomfortable with this? Have you explored requesting/ requiring the school to employ an LVN to accommodate your son’s medical needs while on campus as part of his IEP? Since it can be difficult to find a nurse, guarantee their ongoing devotion to an assignment, and replace a nurse should it becomes necessary... often parents leaving the school district to be responsible for providing a free and accessible education by meeting the child’s medical and academic needs (with a 1:1 aide, 1:1 nurse, 1:1 aide and specific times the LVN attends to the child in an appropriate and dignified manner) is the best solution to guarantee the child’s unencumbered attendance.

Not that it should matter but from a particular standpoint- State funding is student census based here, so home/hospital is usually a much more costly solution for the district and accordingly they may be motivated to properly staff a child at school so they can attend. If you have good input from the child’s physicians and a detailed overview of accommodations during the formation of the IEP - it’s certainly worth exploring if you can have the school accommodate with their own staff and then should a PDN nurse become available through your agency maintain the right to send the PDN nurse with your child instead. 

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2 minutes ago, kaliRN said:

Is it your choice to have a PDN nurse attend school with your child because the school is using trained medical 1:1 aides and you are uncomfortable with this? Have you explored requesting/ requiring the school to employ an LVN to accommodate your son’s medical needs while on campus as part of his IEP? Since it can be difficult to find a nurse, guarantee their ongoing devotion to an assignment, and replace a nurse should it becomes necessary... often parents leaving the school district to be responsible for providing a free and accessible education by meeting the child’s medical and academic needs (with a 1:1 aide, 1:1 nurse, 1:1 aide and specific times the LVN attends to the child in an appropriate and dignified manner) is the best solution to guarantee the child’s unencumbered attendance.

Not that it should matter but from a particular standpoint- State funding is student census based here, so home/hospital is usually a much more costly solution for the district and accordingly they may be motivated to properly staff a child at school so they can attend. If you have good input from the child’s physicians and a detailed overview of accommodations during the formation of the IEP - it’s certainly worth exploring if you can have the school accommodate with their own staff and then should a PDN nurse become available through your agency maintain the right to send the PDN nurse with your child instead. 

We are still in the very beginning phases of figuring out school.  My son's diagnosis and needs have changed pretty substantially, so the last time he attended school he didn't receive much medical support at school.  Plus, he's aged out of the school he did attend, and we don't have even know what school he would attend. 

I can't imagine that a "medical aide" would be able to support him. Do they suction and problem solve trachs and support kids with fluctuating O2 needs?  To me that's skilled nursing.  If the proposal was to have him supported by anyone other than a 1:1 nurse, we'd probably refuse and keep him home.  But I would be open to a 1:1 nurse who was a school employee.  

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Kitiger has 40 years experience as a RN and specializes in Pediatrics.

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6 hours ago, kaliRN said:

Is it your choice to have a PDN nurse attend school with your child because the school is using trained medical 1:1 aides and you are uncomfortable with this? Have you explored requesting/ requiring the school to employ an LVN to accommodate your son’s medical needs while on campus as part of his IEP? Since it can be difficult to find a nurse, guarantee their ongoing devotion to an assignment, and replace a nurse should it becomes necessary... often parents leaving the school district to be responsible for providing a free and accessible education by meeting the child’s medical and academic needs (with a 1:1 aide, 1:1 nurse, 1:1 aide and specific times the LVN attends to the child in an appropriate and dignified manner) is the best solution to guarantee the child’s unencumbered attendance.

Not that it should matter but from a particular standpoint- State funding is student census based here, so home/hospital is usually a much more costly solution for the district and accordingly they may be motivated to properly staff a child at school so they can attend. If you have good input from the child’s physicians and a detailed overview of accommodations during the formation of the IEP - it’s certainly worth exploring if you can have the school accommodate with their own staff and then should a PDN nurse become available through your agency maintain the right to send the PDN nurse with your child instead. 

One problem with using a school nurse is transportation, since the private duty nurse would ride the bus with him. The school 1:1 nurse would need to meet him at his house to ride the bus with him. And the parents would have to see him off and be there when he gets home; this can be hard to do when both parents must work.

I'm not sure what is meant by, "specific times the LVN attends to the child in an appropriate and dignified manner)". That wouldn't be needed with a 1:1 nurse, and it wouldn't be enough with a 1:1 aide.

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