My Encounter With A Health Room Sub

[bleemadden]

I'm the health aide at 500 student K-2 school. I have a few children with ADHD, too many to count with asthma, a little one with cystic fibrosis, and a kinder diabetic. I run a very busy health room, so when my 13 month old started getting a fever a Friday evening 3 weeks into the school year, I immediately started my sub planning. In the event that I'm absent, one of the two secretaries in the office take over. In the morning, my daughter was up at 4 with a 102 fever. I went into my office at 5 to finalize my istructions, print them and place them strategically through my office and on the secretary's desk, and send out emails to teachers explaining that we were using the "emergencies only' rule that day. In the notes for the secretary were very detailed step-by-step instructions on how/what time meds were given. My cystic fibrosis child needed his capsules opened and mixed with applesauce and my diabetic was newly diagnosed and had very frequent peaks and dips. I was close with the mom of the diabetic and talked to her the night before and she asked that if I was indeed staying home the next day, to have the secretary call her and she would come in and monitor her son's blood sugar (I wish all parents were like this!)..that tid-bit was also in the note..first bullet actually. Well a couple hours into the day I recieve a phone call. The district RN who usually does our screanings was in my office as a sub because the secretary was overwhelmed. She was calling to find out where the MAR was (3rd bullet down on my note, she would read it's right by the computer at the desk she was sitting at). 15 minutes later I recieve another call this time asking if the cystic fibrosis student in the office got meds at that time (because my instructions that at 10:00 he has 2 capsules opened, emptied, and mixed into two spoonfulls of applesauce in a Dixie cup and fed to him in four small bites, w/o letting him chew it wasn't clear enough!) I continued to recieve numerous calls throughout the day asking questions that could have been answered by reading the note that I left. (Can the diabetic check his sugar at the time? Yes, in my note it says he comes in frequently as he feels it's needed plus 3 scheduled visits at 9:45, 11:30 and 2:00. It reads 64, what is his protocol? As the note says, if a reading is below 80, he gets an apple juice, sits for 15 minutes, then another check needs to be performed to assure it is above 80.) Smoke had to have been flowing from my ears..Not only was I dealing with my daughter's pharmacy that was taking hours to fill her antibiotic because it had a low priority due to it being faxed over, I was dealing with the most absent minded woman as a sub that would always end the phone conversations with, "Oops, I suppose I should have read the note more carefully!"...Once Monday rolled around I was very happy to be able to take over my office once again. My great mood was instantly shattered when I found new, undocumented meds in my desk drawers and a MAR that wasn't filled out! While trying to sort those things out, in storms the diabetic's mom wondering why she was never called to come in and why her son's sugar was only checked once. I showed her the instructions that I left the secretary and RN and she was understandably livid, as was I! Checking a diabetics sugar only once?! Meds in a desk drawer?! Undocumented medication administration?!

Needless to say, I had many complaints and the district hired a new sub that has been doing a much better job for the other schools...I'm still too terrified to take another day off!!

[mustlovepoodles, RN]

Yike! That makes my hair stand on end! makes me doubly appreciate my front office . Do you have anyone else in the school who has been trained in diabetes care? I have one newly diagnosed 5th grade diabetic. I made it a requirement that all 6 of his teachers watch a Diabetes Awareness video, as well as a principal and one of the front office staff. The child's main teacher has been an unwilling participant from the word go, so i tapped one of our 1st grade teachers to be trained in the specifics of diabetes care. She had a diabetic child last year who was very labile and I have a lot of confidence in her ability to be on top of things.

Sheesh, i would be mad has heck if a sub came into my clinic and didn't do a better job than your sub did:yawn:

[OnlybyHisgraceRN, ASN, RN]

I understand your fustration. I worked as a health aide for a couple of years before working as a sub school nurse. First of all, the RN should have had a resource person to contact. Such as the health specialist or another RN covering another district. She should NOT have been calling you at home for instructions. You were off and your priority should have been taking care of your daughter.

Secondly, the RN should have been more diligent with reading your instructions, orders, and the manual to know what the protocols are. I hope this was a teaching moment for her, however I'm sad it had to happen at the kids' expense.

When I was a health assistant, I was the same way so I can't even blame you. When I did need a day off, I would leave my number too, and very detailed instructions. I was also grateful that the school district RN knew her job well, and never had to call me.

Hopefully you will get a better sub!

[bleemadden]

He has two teachers that I've had meetings with to teach them about his diabetes. I tried to get monitors placed in both classrooms to be on the safe side but the principal denied my request because she didn't feel comfortable with needles (the lancets) being in a classroom. Even after showing her the lancet and the mechanisms of the prick and how the needle retracts, she still denied the request. It's hard to be an advocate for a student's health when others aren't 100% on board or don't correctly understand the disease.

[Jolie, BSN]

It's time for a professional conference. The principal needs to be reminded of the child's right to an education in the least restrictive environment possible. Blood glucose testing in the classroom is perfectly safe and is the norm for many children in many schools. I don't believe s/he can legally prevent it, if the parents and healthcare provider request it.

And frankly, "safety" of lancets is a silly reason to interfere with a method of blood sugar testing that is convenient, timely and minimizes the child's absence from class. There are other common objects found in every classroom that are far more dangerous than properly stored lancets.

Time for some research on the REhabilitation Act of 1973 (which outlines 504 plans), IDEA (Individuals with Disabilities Education Act), and ADA.

You may also want to look at the American Diabetes Association website for information on diabetes at school.

Safe at School - American Diabetes Association

[BettyGirard, BSN]

Being also the mother of a diabetic, you need to enlist mom's help to the point of even having her start a 504 action to allow the testing supplies to go with the student. I fought this long and hard with our own district. This is not something that a lay principal should have a say in.

[mustlovepoodles, RN]

You may also want to look at the American Diabetes Association website for information on diabetes at school.

Safe at School - American Diabetes Association

This is where I got my diabetes training video. Look at "Diabetes Care Tasks at School: What Key Personnel Need to Know." It comes with a power point and a DVD. I dispensed with teh power point because the DVD is so good. There are 13 segments and it only takes about 35-40 min to see the entire video(if you skip the credits.) I have had very good response from the teachers who viewed the DVD, lots of good questions too.

[HazelLPN, LPN]

Forgive my ingorance, but I'm not sure what a "health aid" is. In the district I work in, we have a certified school nurse in every high school who has a BSN and a license from the state department of education to practice as a school nurse. We also have "assistant school nurses" who are either LPNs or RNs who do not possess the license from the department of ed who mainly work with special needs students.

[bleemadden]

Our district has an RN that works at the district and Health Aides at the schools. We have a K-2, 2 K-5s, a 3-5, and a 6-8 school. They don't require the health aide position to hold any license, but we undergo medication administration training, CPR/First Aide, and numerous classes and workshops. I'm actually a CNA though, but they don't use my certification.

[HazelLPN, LPN]

Our district has an RN that works at the district and Health Aides at the schools. We have a K-2, 2 K-5s, a 3-5, and a 6-8 school. They don't require the health aide position to hold any license, but we undergo medication administration training, CPR/First Aide, and numerous classes and workshops. I'm actually a CNA though, but they don't use my certification.

My goodness. I sure wouldn't want to have that RNs job!