Immunization issues!

[fireball98]

I started the school year late and came into a mess with the immunizations at my school. The school had a health aid last year. I arrived with about 50 kids with flags on their files marking missing imunizations. I got a 2 week extension from the state to turn in my list of missing immunizations. I stayed after for an hour almost every day working on orginizing my files and sorting out the immunizations. I got an account to the state database and found about 35 missing immunizations reports and brought those kids to compliant status. For every child missing a shot I am checking the date the shots were given. I now have turned in a list to the state of missing immunizations, sent letters home to about 60 families and checked the siblings of those 60 kids. I have also charted all of the prior screenings and put medical alerts into a new computer system. I now have about 28 more kids missing shots to send letters home, and check their siblings files. When all of that is done i need to check the dates of all of the other kids in the school (school has 435 students). After I sent home the first 30 or so letters the secretary told me she just remembered that when there was no nurse the medical info was put in the school records files. those files are stored away from my clinic and I can only look through about 4 before a student needs me at the clinic. So I have no idea how much information I am missing. I asked 2 office staff members for help and they have not helped me yet and even lost the list of students that I gave to them.

I am also seeing about 60 kids a day and had to create every form and system in the office. I also had to learn all of the state laws because I do not have a nursing supervisor this year. I am also aranging blitz screenings and trying to bring in an eye doctor for exams. I am setting ups a staff CPR class etc...

THEN yesterday my intrum principal told me that if I don't have the immunizations done by winter break I will have to come in on my days off to finish!!!!!!!!!!!!

Any advice?? I am thinking about calling finished when I have all of the letters home for mising shots. I don't plan to have all the dates of other kids done until the end of the year. My last school district considered the correct number of shots complint and did not look at the dates they were given. What do you do at your schools? Also if a child does not have a record of the birth hep-B shot but there is a doctors letter stating that their shots are current does that count at your school?

Thank you,

Fireball

[schooldistrictnurse]

My only advice would be to prioritize. The immunization piece is a must. How about the CPR class? Is that absolutely required or just a really good idea. You can't get every system in place in the first year. Do the things you are legally required to do and bring in the other things as you can. You probably are doing better than 90% of the nursing world would do in your shoes, so don't be hard on yourself. If you start working on your time off, it will be expected. I hate to say it, but I do: "I do the best I can within my time limits."

[Jolie, BSN]

Please check with your state Board of Health. In NE, simply having the correct number of doses of a vaccine isn't good enough. The doses must be timed according to state mandates, or we must consider the student to be out of compliance. The only allowable exceptions are religious (notarized statement) or medical (physician certificate).

I was fortunate to have followed a very conscientious school nurse, so my responsibility was to check the immmunization status of my new Kindergarteners, 7th graders (our state requires physical, vision exam and immunizations @ K and 7th grade), and students newly enrolled from outside the district, as well as to update the list of students out of compliance from the previous year. I was able to trust that that list was accurate, so my job was minimal compared to yours.

Perhaps you could contact a Board of Health representative to explain your situation and ask for help in prioritizing your next steps. I suspect that your principal doesn't want to have to explain why the records are such a mess, so he's placing sole responsibility on you.

Don't let him off the hook.

Also, we don't accept letters from physicians stating that immunizations are "up to date." Because immunization requirements change from time to time, we require a specific listing of vaccines and dates given. For example, if a doctor's record shows that the 2nd and 3rd Hepatitis B vaccines were given in the office, I'll accept a letter from the physician stating that the first was given in the hospital, but it must specify the date given.

[fireball98]

Thank you for replying. I am still trying to sort out the doctor letter stating "up to date". I had a student missing 4 shots and no listing for the 1st hep b shot. The doctor gave him the 4 shots I thought he needed. He did not give another hep b shot. He wrote a letter stating that the student is up to date. The parents have contacted the hospital where their son was born and they are not able to get a record of the shot. So if the doctor won't give a shot and the parent can't get a record what do I do? (I even think the mom is a nurse!)

I have had so many complications with this entire process!!!!!

Thanks for your help,

Fireball

[Jolie, BSN]

How old is this child?

Do the parents have anything (discharge papers, card, etc.) from the newborn hospital stay that would indicate whether or not the Hep B shot was given?

If the parents send a written request to the hospital medical records department, I think the hospital would have to provide a record.

I know HIPAA can get in the way sometimes, but I've had parents who gave me permission to contact the hospital directly. When I explained to the med records clerk that a child would have to get another shot unless I had information, they were a little more willing to dig up records for me. These were kindergarteners, so the records weren't that old.

If the pediatrician is convinced that the child is properly immunized, ask him to write and sign a letter indicating that while the exact dates are not known, John Doe received his Hepatitis B series in proper sequence in infancy. I would accept that.

Although I have never accepted this, our state actually allows parents to provide immunization records of their own. They don't have to come from a physician's office or clinic. My problem with this is that few parents actually keep such accurate records, and many are confused as to which shot is which. But in my state, you could use the parent's copy of the immunization record that comes in a baby book or the little booklet that the formula companies give at discharge.

[mustlovepoodles, RN]

I don't know about your district, but in mine the penalty for non-compliance with immunizations (or a notarized letter of religious objection) is the child is barred from attending until the immunizations are completed. If the parent chooses to just keep the kid out(and not legally homeschooling) they will be taken to truancy court. Schools in my area take immunizations very seriously. My last school was pretty lax about it and it cost them AYP. After that, they got VERY serious about it.

I sympathize with you. I had to look through every one of our 430 student cumulative folders to find out who is in need up updateds. I sent home letters last week and they have a Dec 15 deadline. After that, it will up to administration as to how they handle it. But parents have been put on notice that their children will not be allowed to attend if the immunizations are not current. In the spring I'll have to do it again with the 5th grade--the middle school won't even allow them to attend ONE DAY if their immunizations aren't up to date. Seriously.

[Flare, ASN, BSN]

i'm similar to mustlovepoodles. Students that aren't compliant are not permitted to be in school until they are compliant. In some ways i'm dealing with the same thing as you. Started in a new school in my same district this autumn and the vaccine recoreds were atrouious to say the least. Over half of my 830 students were no in compliance. Of course I only learned this after my clerk and I went through each file by hand. I compiled a list and letters have been sent out. A deadline has been established and any student not in compliance after the deadline will be excluded.

They need to get a sub nurse to cover your office for a day of two so you can go through their main files for the records and they certainly should not penalize you to come in on your own time (unpaid, i assume) to correct what should have been done by their last nurse.

[fireball98]

Thank you all for your advice. I stayed after work on tuesday and got a bunch of letters done. I have 14 children left who are missing shots to go through as well as their siblings. After those 14 every child missing a shot has a deadline to have them or the bus will not pick them up in the morning on that date. I will then start in on the kids not mising shots but need the dates checked. I am going to refuse to come in to do that part on my time off. My last school district didn't even check the dates!! I think on my last count I had 78 kids missing a shot!!

I really hope I am at this school next year because I don't want to go through this at someonelses school next year!!

Happy Thanksgiving!!

[SchoolNurseBSN]

You are doing a great job! It is going to take time to straighten out a mess like that ESPECIALLY seeing 60 kids a day. I agree with another poster about continuing to work late and come in on days off........they will start to expect it of you all of the time. Don't do it!!!! If you do, you (or the nurse that follows you) will never get any help. Also, those 60 kids you are seeing a day, are they valid OR trivial??

[fireball98]

25 inhalers, 6 daily meds, 2 epi pins, 1 diabetic, 3 to 11 kids who wet themselves daily, 1 who soils himself daily, 2 to 6 kids a day who are injured in some type of fight and about 2 to 4 who throw up a day. I have about 4 frequent flyers who do not have significant reasons to see me. The rest are your average visits. Ring worm is about 1 a week. I am on my 3rd wave of lice.

8 letters home to go. I will be holding about 11 kids out of school tomorow and the parents are going to be ******! Then each week it will be another 15 to 25 kids if they don't get their act together! I am not staying late to check dates of kids who are not missing shots. I will just work on that all year.

Thank you all so much for your support, this can be a lonly job!

Fireball

[SchoolNurseBSN]

3-11 peepee pants a day in a school of 435???I am soooo sorry!!!Do those teachers need some education on scheduling potty breaks?

[fireball98]

One day I was out of pants and I had 6 kids in my office for a combined 9 hours. That is a lot lost instruction time not to mention crowding up my office! I have to wait for parents but many have no transportation or I have them wait an hour and hope they dry out. I have continually been bringing in clothes and today I am almost out again. If I go to a thrift shop that is $4 a pair of pants. I have almost used up all of my places where I can get donations. The kids get a note home to return the schools pants but I think many kids are too poor to buy clothes so they keep them and use them. The note also asks for donations but so far only one family has donated. I may try to get a grant from wallmart/sams or go on donors choose.com.

My ethical delema is do I get colored sweatpants that the famillys will return because they are ugly. But this would single out and embarrass the children. Or do I get things that will blend in but never be returned.

Most of the accidents are not the teachers fault (they call me and tell me if it is their fault). These kids pee in their seats before raising their hands. They pee in the hall because there is a line. 3 have peed in my office 6 inches from an open bathroom. It is an epidemic. It is usually not the same kids I see new ones all of the time. I get 2 most fire drills! There have been three that I believe did it to get better clothes!

Any advice?

Fireball