Lice Policies/Help Please!

[dta815]

Hello Everyone,

First time poster, long time lurker. I currently work in a private school in MA, we have 368 kids and K-8. Also important to note is that I am fairly new to School Nursing (started 10/11). In any case, I need some help from RN's who have been doing School Nursing for a while!

My School is currently having an issue with Lice, this started yesterday and has became a major issue (teacher hysteria) over the past 24 hours. A parent reported to me that their child has lice yesterday morning and asked me if it would be possible for me to check the child's friends and some fellow classmates. I found 3 cases of active infestation within the classroom. I researched the school policy regarding lice and did not find one, the principal was out at a meeting, so I called the City Health Coordinator who is the person I am supposed to contact with any health issues, considering she is an NP. I researched the current NASN guidelines and found a great position statement from them about head lice. I spoke with the Coordinator about keeping the kids in school, but alerting their parents. She advised me that currently the standards for lice are that the child stays in school and I should follow the guidelines accordingly.

To make a long story short, a few of the teachers went into a mass panic. Telling me that I am going to be the cause for lice "epidemic" if I do not send these kids home. I attempted to educate them on the myths about lice and I tried to explain that these kids could have had lice for a month or more. They said I had no idea what I was talking about and ended up calling the principal out of her meeting. She came and essentially told me that I need to adhere to a no-nit policy and immediately dismiss the children who have lice.

I tried to explain to her that this was not necessary. I even printed out the current CDC, NASN and AAP guidelines for dealing with head lice. She said that the teachers were very worried that they would get lice and did not want these kids in their room. I tried again to explain that dismissing the kids in the older grades was not necessary, but she will not even listen to me.

I am torn because I know that I should be following the guidelines put forth by the state and the recommendation of our Health Coordinator, but the Principal and the teachers who know nothing about nursing or head lice for that matter are blowing this out of the water and refusing to listen to my explanations and suggestions about how we should handle head lice. I emailed the Principal today and explained the rationale for not sending kids home with lice and also suggested that she speak with the Health Coordinator. Work is extremely volatile right now and I do not feel that my nursing skills and judgment calls, which are grounded in evidence-based practice, are being respected or even heard. What should I do??

[Jolie, BSN]

I'll start by encourging you to do a search of this site. This topic has been discussed at length in other threads. In a nutshell:

Both the AAP and well-recognized public health agencies now regard head lice as a nuisance, and not a communicable condition (in the sense that there is no real harm that comes from head lice.) For this reason, excluding a child from school due to head lice is no longer recommended. The only justifiable reason for sending a child home is that s/he is so bothered by itching as to be unable to concentrate and participate in class. Even then, the child should receive treatment at home over night and return the next day, regardless of whether the condition appears to be completely resolved or not.

Printed materials on identifying head lice, providing treatment and prevention of transmission can be provided to teachers, parents and administrators without identifying the involved students, or disclosing their classrooms or grades.

On a side note, one of the biggest laughs I got as a school nurse was trying to talk the principal "off the ledge", so to speak, when she was fearful of NOT disclosing head lice to the parents in her school. She wanted to send out an emergency e-mail and phone tree alert, on the order of what would have been done for a natural disaster. In her defence, the parents at this school were highly privileged and absolutely nuts, but I still found her response funny. She was far more reasonable when measles and whooping cough were the concern. Go figure.

[Wave Watcher]

We have a "no-nit" policy (420 students, grades K-6) which I do not believe should be followed in all cases. Although, we have a "no-nit" policy we are allowed to use our own judgment as to when a child should be sent home. This is what we do. Every Monday we have a school wide "head check". The teachers check for lice. If needed I can go and do certain grades if there is an issue. If I see nits or any signs of lice then I call the parent the 1st time. They have to come pick their child up. As long as they treat their child that day (they have to bring me the box and receipt) then the child can return back the next day. I will continue to check their child each day before they go into the class room to make sure there is progress being made with the nits. As long as I see an improvement each time then they can return to class. Any type of bean bags or pillows in the classroom need to be put into garbage bags for 2 weeks. The janitorial staff are made aware which room(s) need to be vacuumed really good.

If I were to keep a child out of school due to a nit then there would be some children who would fail due to absences. It just doesn't make sense to me BUT I know many schools who will follow the "no-nit" policy every time without fail.

Sorry you are having such a hard time right now.

[mariebailey, MSN, RN]

In my experience, private schools shy away from us, but health departments in your jurisdiction are probably eager and able to provide support and education. Don't be afraid to call your local health dept. & enlist the aid of an epi or communicable disease nurse. You'll then have more people supporting your statements. "Children should be able to return to their usual activities and school or daycare after the first treatment". This is directly from my state's guidelines. Also, an infestation may not be active, so isolation after finding eggs/lice in a child's hair isn't necessary. Educating parents to check their children and learn how it is spread may be helpful. I attached some literature from my state's Disease Control Manual. P.7 is most applicable.

Fact Sheet on Pediculosis - Management.pdf

[sfajctxnurse]

At my school district, we also have a no nit policy. I do not agree with it, but I follow it because it's policy. I do not believe these kids transfer lice here at school & if there are just nits present then I do not see the reason for them missing school. I seem to have the same kids over & over who are sent home for lice & then the are usually out 3-4 days each time. If I am doing school wide checks, & find kids with nits, they are supposed to be sent home.

[bleemadden]

In my district, we send students home for live lice and give the parent the option of picking their child up for nits. I don't agree with it because it's unneccesary to keep students from learning, but it was a policy put in place to keep teachers happy. Like your teachers, ours freak out if just one nit is found.

[misty_dawn]

Our policy is to only send them home with live lice, they can stay in school with nits but their parents must be contacted and they "must" be treated that night and rechecked the next morning. It is often difficult to know whether or not they were really treated though. I have one kiddo in particular who comes to me 3-4 times a week because her mom wants me to check her head for lice. I don't understand why her mom cannot do it, I told her that while I dont mind doing it once in a while I cannot do it everyday. Her teacher freaks out the minute she scratches her head and sends her to me. I have educated and educated the mother about this to no avail. She has already had nits 3-4 times and we have only been in school a month, it is going to be a long school year with the lice stuff.

[Artistyc1]

Every Monday head check? That alone is pretty humiliating for any child that MAY be found to have any evidence of lice. That is an outrageous misuse of time and resources for an educational facility, in my opinion. Lice are frequently misdiagnosed in the first place.

[Artistyc1]

It is pretty ridiculous to have "no nit" policies in this day and age. Nits don't go from head to head. They also may never hatch. If they are old, the child is going home for no good reason, and missing educational opportunity. Sad that parents and teacher choose to remain ignorant, instead of bothering to read the evidence based information that is out there. This sort of hysteria is what keeps a multibillion dollar lice treatment industry wealthy.

[100kids, BSN, RN]

We have a no nit policy and I could present evdience til I'm blue in the face and they wont change it. Right now I'll fight other battles. :)

[Supernrse01, BSN]

We also have a no-nit policy and agree with 100kids- I could present and argue until I am blue in the face and there will be no budging with this policy.

[Nurse ABC]

We finally were able to get rid of our no nit policy and go to a no lice policy! They tried to go for the kids can be in school with lice policy due to the new recommendations of the NASN but the teachers threw a fit. The teachers weren't happy with this new policy but have now accepted it and it has made the school nurses' job so much easier and made it much better for the poor kid that was constantly being asked to leave because someone found a few nits all the time.

If there is no official policy than the principal can do whatever she wants. The principal is ultimately in charge of her school and as an employee working in her school she is your first supervisor meaning it's best to do what she asks as long as it's not putting your license on the line. She has to answer to several hundred parents so even though she might believe some of what you're saying all those parents might not. She's trying to keep the peace.

In order to make changes there needs to be an official policy and education. I don't know who creates those policies in your school but you would have to have someone higher up than you agree or enough people vote on it to make it a policy.

Until that can happen, for now you need to go along with what your principal wants. You are creating strife with people you have to work with all the time. You say you don't feel your nursing skills and judgement calls are being respected. That happens a lot in school nursing because it's an educational setting and not a medical one. It's basically you against them and there's a lot more of them so if they all want the kids with lice out of there that's what's going to happen at least until you have some sort of backing like an official policy in place. The official policy can become a no-nit policy if that's what enough people want even though it goes against NASN guidelines. Those are only "guidelines" after all. This is one battle all school nurses would like to win but we rarely do.