Not off to a good start

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Specializes in Coronary Care, School Nurse.

I tried something new this year. I have never done head checks at the beginning of the school year and I don't do class or school-wide head checks. This year I compromised and during the first week of school, I checked the heads of the students that were known (as in I actually saw lice or nits, no rumors) to have head lice last year. I was hoping to nip in the bud the comments like "They didn't have it before, my kids always get it at school".

I was pleasantly surprised in a few cases when I didn't find anything. I was not at all surprised when some chronic infestations were still present.

One mother (of a chronic infestation) sent a nasty letter to the administration stating that I was inappropriate in checking her children. She claims that her students are afraid of me and that I am "a bully" and on a power trip. She is refusing to allow me to do head checks ever again or to have anything to do with her kids.

The sad thing is that 2 of her kids are diabetics and are supposed to be under my care. Of course I have to force her hand each year to get her to provide Medication Authorization Forms for the insulin and Glucagon kits. The elementary aged child is on an insulin pump and does not come to me for routine/daily things. The Jr high student is in another building (without a nurse). Her insulin pump was discontinued by the Doctor due to inappropriate use. She was supposed to go to the office to have her insulin injections supervised by administration but rarely showed up.

So far my administration is supporting me. It is just very frustrating that this family cuts corners everywhere and blames others for their children's problems.

Any advise? Do you see the students with an insulin pump on a daily basis?

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Head checks are not the standard of practice. They are not supported by American Academy of Pediatrics, the National Association of School Nurses, nor the Harvard School of Public Health.

The CDC says that the first communications with kids and parents in a school year should not be negative. http://www.cdc.gov/healthyyouth/adolescenthealth/pdf/connectedness.pdf

"The sad thing is that 2 of her kids are diabetics ..She was supposed to go to the office to have her insulin injections supervised by administration but rarely showed up.... Do you see the students with an insulin pump on a daily basis? "

An adolescent should be independent in their care - so no, would not be unusual to not see an adolescent on a pump daily.

There is an evidence based program offered HANDS that provides materials and instruction on the standard of practice for kids with Diabetes. There might be one in your area scheduled or you can arrange for one to be offered: http://www.nasn.org/Default.aspx?tabid=411

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Specializes in Coronary Care, School Nurse.

Unfortunately, my district is holding fast to their no-nit policy. I have provided the research and advocated for a change of policy without success. I will continue to try to educate and update the policy. For now, I can only follow what is in place.

The student on the pump is in 5th grade and is independent.

The student in Jr High was instructed by her endocrinologist to have supervised injections to ensure compliance while at school. Since I am not able to be in that building during that time, the administration is responsible for this. They do not follow through either.

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What is our responsiblity as professionals?

What if the administration insisted that nurses use hydrogen peroxide on wounds because it was a pre-exisiting policy?

What if they insisted nurses put saline in trachs?

That we conduct Scared Straight Programs even though it leads to increased juvenile deliquency?

If the parents take the district to court for denying their children their rights to Free Appropiate Public Education (FAPE), and provide the evidence that nits are not grounds for excluding kids, what is the likely outcome?

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Specializes in School Nursing, Ambulatory Care, etc..

Kids,

I just want to say that I'm sorry you got off to a tough start this year. Sending big hugs and good thoughts your way!

Sara

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Specializes in School Nursing.

hang in there kidsnurse ! i see things like this all the time too. you are doing your job....so hold your head high !

praiser :heartbeat

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NASN Radio interview: Handling head lice and no nit policies (August 2009)

http://www.nasn.org/Default.aspx?tabid=597

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Regarding the headlice situation...nipping it in the bud so parents can't say they got it at school. With my past experience proving them wrong only makes them more angry and complain more. I never go looking for it anymore. You are fighting a losing battle. Just take it as it comes..realize that you will never cure some of these families that keep it. I am now seeing the 2nd generation and they also have lice and when I first came here I made home visits, helped clean house and heads, supplied the shampoo, and treated them at school to no avail. I came to realize I have more important health concerns to take care of. :banghead:

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Specializes in School Nursing.
If the parents take the district to court for denying their children their rights to Free Appropiate Public Education (FAPE), and provide the evidence that nits are not grounds for excluding kids, what is the likely outcome?

That is a great point! Some of us in my district are trying to bring ours out of the stone ages with the no-nit policy and this will be a great point to bring up when we present our arguments. It kills me that NO ONE recommends no-nit policies anymore but the districts cling to them and are so protective of them. Maybe if some parent did push the issue it would promote change, because so far they are not listening to us. As far as professional responsibility, I fear for my job if I do not at least "appear" to be following policy, but I will let a kid back in with a few nits left and have her come in to my office each morning for a few days for a check and combing. I do not let them miss more than one day if I can help it.

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Specializes in Coronary Care, School Nurse.

I advocate for the policy to be changed. I have supplied the appropriate research based information trying to get the policy changed. I am "on record" disagreeing with the no-nit policy. That said, I feel I have to be careful in this economic time. If I am uncooperative with the policy/decisions of the school then I can too easily be cut from the budget. I am sorry to say that I compromise on this issue so that I can make a difference in the lives of other students in the bigger picture.

Does anyone else feel like they are playing "give and take" for the greater good?

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"Does anyone else feel like they are playing "give and take" for the greater good? "

I think that is part of the job. And you can win the battle and lose the war. I also agree with the above comment about "not going looking for it". And by making good decisions like letting "a kid back in with a few nits left and have her come in to my office each morning for a few days for a check and combing".

I think the FAPE argument "If the parents take the district to court for denying their children their rights to Free Appropiate Public Education (FAPE), and provide the evidence that nits are not grounds for excluding kids" is a real one and the districts who exclude for nits are becoming few and far between, which makes them much more at risk for being taken to court.

You have to partner with administration while advocating for the kids and families. I was reading about Senator Kennedy today about being idealistic and yet a compromiser, pragmatic, of celebrating gradual and incremental change, and that is how things get done. On no nits, the tipping point has past and the momentum is to eliminate this out of date policy universally.

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