parents won't pick up sick kid!

[nursekoll]

I have never had this happen before, and don't know what to do. The parents and both secondary contacts refuse to come get a sick child from school. They say that none of them can leave work. This child is 8 years old with a 103* fever. I told them they need to find someone to pick up the child, they say they have no one else to call. What else can I do?

[WineRN]

Why would I pick my kid up just for that?

This is why someone asked if you were a school nurse. It's protocol in nearly all districts to send home for a fever, because as you know a fever is just a symptom of else in the body, and most of the time that something else in contagious. We have immunocompromised kids in a lot of our schools that we need to watch out for too and tons of daily meds and treatments and it's not fair to those kids to get exposed to someone else who is sick and in the office simply because their parent doesn't think they are "sick enough" to go home.

[JenTheSchoolRN, BSN, RN]

This is why someone asked if you were a school nurse. It's protocol in nearly all districts to send home for a fever, because as you know a fever is just a symptom of else in the body, and most of the time that something else in contagious. We have immunocompromised kids in a lot of our schools that we need to watch out for too and tons of daily meds and treatments and it's not fair to those kids to get exposed to someone else who is sick and in the office simply because their parent doesn't think they are "sick enough" to go home.

This.

Also, I ask people to pause for a moment and remember how one can feel when your temp hits 100. I got slammed by a bug at the start of school and had a temp of 101. I rarely run temps. I was a miserable mess. The fever broke a few hours later, but man, it was not fun, even after acetaminophen dosing. And I had the luxury of being able to curl up in my bed.

My office cot is lumpy. I don't have a separate room for it, so it is the far corner of my office. The student with a fever is welcome to occupy it, but they will also be privy to my harsh overheard light I can't just shut off because I need it on to properly access other students. This student with a fever could be home in their own bed. Plus, imagine a bus ride home feeling miserable. Sure, we all suffer through it as adults, but even I've called my husband for a ride when I'm sick.

Now do I call CPS for this? Of course not, unless it is repeat thing (and by repeat, I mean happens several times with no response, etc). I'm also not calling an ambulance unless fever progresses to dangerous levels and I still cannot get in touch with a parent or get a parent to pick up their child. But I do use above 100.4 as my absolute for pickup, because I've yet to see a student with a temp of that or above not look miserable.

And the OP had a student with a temp of 103. That is not an insignificant borderline temp.

[LM NY]

I appreciate all your responses and did not take any of them as being snarky. We can learn a lot from each other which is why nurses from other specialties visit the other forums as well. Far, I didn't even think of other students that are immunocompromised until you mentioned it. I hate the internet, because it is so easy to misunderstand someone's comment, but I don't mind clarifying it. When I said I wouldn't pick up my child just for a fever, I mean when the nurse calls me and tells me my child has a fever, I would expect that she already started some nursing interventions to help bring that fever down and is informing me of a high temp that she will recheck again. I have two kids that never show any signs of a fever and then I have my older daughter that turns into a zombie when she has a fever. I guess in my head I am happy my kid's immune system is working and trying to fight something. Not all fevers are severe, but are serious when they are persistently high. This thread has definitely made me want to ask the school nurse what the DOE policy is on fevers.

It's funny how I don't know the policy on fevers, but I know they will send your kid home if they find live lice. Imagine having a district of patients ranging from those on ventilators that require frequent suctioning, the CHF patient that is having cardiac dysrhythmias and your stroke patient that you have to do hourly neuro assessments on and leaving all those patients behind or adding them on to another nurse's load just because you have to take your kid home because of lice.

[OyWithThePoodles, RN]

I think if it were up to us, no child with lice would go home. It's absolutely unnecessary (as stated by the CDC and AAP and NASN) and in most cases, the kids with chronic lice are he ones who need to stay in school the most both for academic reasons, and they likely have a poor home life.

The only fever reducing interventions I could use in my district would be cool compresses. And of course we don't want to induce shivering as that would make the temp shoot right back up. We are unable to give OTC's without an individual form for each student and signed by the parent. I've suggested to the boss lady adding a policy where we could give fever reducers if a temp is so high and he parent is so far away. She had a good point when she said "Unfortunately, some parents in this district would just wait until their the medicine had time to take affect, then when the fever went down, say they never had a fever to begin with and now they can stay."

I do understand some parents can't leave work. We're nurses. Not many of us can leave work without it putting our patients/co-workers in a serious bind. But this is where the village takes over. Whether it be another family member or close friend. We need to have someone we can trust to pick up our child in the event they cannot stay at school.

*Forgive typos, on the iPhone and now car sick from typing.

[moreoreo]

Just like SullyRN said, when I call a parent, I am not hoping the parent will be able to pick up. I ask if they are able, but if not, is there someone else? With a parent's permission, we can dismiss to another adult. If not grandma, grandpa, uncle, or aunt, I have had parents call other parents to see if they could come because at least the child could go and rest somewhere comfortable.

In my office, just like in other offices, a feverish child will lie on an uncomfortable cold rubbery cot and sometimes have to get up because I have a child I have to catheterize (for others, maybe suction or tube feed or what have you). Sometimes we fill up and have 7 or more children in there requiring attention and it is admittedly distracting to have one more person you are responsible for. In the elementary school setting especially, these little ones just feel awful and don't understand why. I have had children be very calm, patient, enduring of my cool cloths/more sips of water/etc. for over an hour and then just burst into tears when their parent finally arrives because they're so relieved.

As school nurses we have no reason to inconvenience parents except that the wellbeing of the child is our first priority. Sometimes parents tell me, "there is no one else who can come, so I will leave work but I work in the city so it will take me an hour to get there," and I am grateful for them, but this is one reason why I think parents need support systems so much. No one should have to feel they are jeopardizing their work (and most of us have worked in hospitals so we know what it means to have to leave in the middle of a shift. Honestly, while my little patients are 99% entirely stable, I cannot leave my job mid-day either--can't leave 900 little ones without a nurse) to be decent parents. But just because children can wait in the health office all day doesn't mean they should, and as their champions and as the health professional of the school it would be wrong of us not to make our best effort to get them on their way home.

[Farawyn]

I appreciate all your responses and did not take any of them as being snarky. We can learn a lot from each other which is why nurses from other specialties visit the other forums as well. Far, I didn't even think of other students that are immunocompromised until you mentioned it. I hate the internet, because it is so easy to misunderstand someone's comment, but I don't mind clarifying it. When I said I wouldn't pick up my child just for a fever, I mean when the nurse calls me and tells me my child has a fever, I would expect that she already started some nursing interventions to help bring that fever down and is informing me of a high temp that she will recheck again. I have two kids that never show any signs of a fever and then I have my older daughter that turns into a zombie when she has a fever. I guess in my head I am happy my kid's immune system is working and trying to fight something. Not all fevers are severe, but are serious when they are persistently high. This thread has definitely made me want to ask the school nurse what the DOE policy is on fevers.

It's funny how I don't know the policy on fevers, but I know they will send your kid home if they find live lice. Imagine having a district of patients ranging from those on ventilators that require frequent suctioning, the CHF patient that is having cardiac dysrhythmias and your stroke patient that you have to do hourly neuro assessments on and leaving all those patients behind or adding them on to another nurse's load just because you have to take your kid home because of lice.

Yes, but this is your kid, and this is OUR policy. You have to respect both.

Are you saying that us taking care of a school full of your kids is not as important as your job?

I'm sure I'm misunderstanding you.

And no, we don't start interventions to bring the fever down, outside of making the kids comfortable. Why? because the parents never fill out the paperwork properly so their child can get Tylenol.

[WineRN]

Yes, but this is your kid, and this is OUR policy. You have to respect both.

Are you saying that us taking care of a school full of your kids is not as important as your job?

I'm sure I'm misunderstanding you.

I think her point (correct me if I'm wrong LM) is that it's hard to dump a case load of high needs patients to another nurse and leave the unit short because of something like a low grade fever, or lice, or undiagnosed rash, etc. She isn't saying her job is more important at all.

And depending on the unit/hospital culture, the nurse managers and coworkers may get aggressive and angry with someone who needs to leave suddenly because they might not be able to find coverage to fill that gap. We were alllwaaayyyss short or at bare bones coverage when I was inpatient, so when someone had to leave for an emergency it simply sucked for everyone.

[Farawyn]

I think her point (correct me if I'm wrong LM) is that it's hard to dump a case load of high needs patients to another nurse and leave the unit short because of something like a low grade fever, or lice, or undiagnosed rash, etc. She isn't saying her job is more important at all.

And depending on the unit/hospital culture, the nurse managers and coworkers may get aggressive and angry with someone who needs to leave suddenly because they might not be able to find coverage to fill that gap. We were alllwaaayyyss short or at bare bones coverage when I was inpatient, so when someone had to leave for an emergency it simply sucked for everyone.

*hands you my spoon*

You know I love to stir the pot.

[NurseBeans, BSN, RN, EMT-B]

I'm not trying to get all up in the middle of this but I think the point is being missed here; the school nurse's role is getting confused and parents need to understand that it does not matter where you work, if you are a parent you have responsibilities. If your child is too sick to be in school (per policy and the school nurse's nursing judgement), you need to remove them from the school. A fever indicates an illness that might not even warrant a doctor's visit BUT WARRANTS ABSENCE FROM SCHOOL. I don't care who you are or what kind of job you have, take care of your parental responsibilities. If your job isn't great for leaving suddenly for a sick kid, find another way to get your kid home or get another job.

Yes, I have worked in hospital settings. I left those settings because my kids were starting school and I knew leaving work for them might be an issue. I work a job that earns less money so I can take care of my responsibilities as a parent.

No, you cannot just leave your sick child in my office all day because you "can't leave work". The school is not a daycare and the nurse's office is not a hospital room.

[OldDude]

*hands you my spoon*

You know I love to stir the pot.

I haven't noticed that...

[LM NY]

Oh Far, I thought your pot stirring days were behind you. All jokes aside, yes WineRN you are right in what I meant. I totally went in another direction with my example. I was mentioning the crazy irony of leaving unstable patients to take your kid home just for having lice.

Far, there's paperwork? Other than the emergency contact forms and the annual physical form filled out by the doctor, I have never encountered any additional forms. Also, I never said my job was more important. I went off topic, but it's too late now. I have upset too many school nurses.

Things have definitely changed. I remember growing up and feeling so much better just being in the nurse's office. You guys rock and I have never felt any different. However, I never said you guys were babysitters and I am not sure how any of what I said may have indicated that's how I felt. I apologize if you perceived it that way.

Back to the thread. I wouldn't do anything different if my kid was at home with me with a fever. Medication is always a last resort for me. Rest, hydration and cooling methods are first while I keep checking the temperature.

[Amethya]

I hate the phone numbers that are out of service or their voicemail isn't set up. It's barely the first week of school for us and they put these on the contact list for some reason. I do call them a lot of times but it seems like I can't do a thing. The good thing is that lately I had no child with a horrible fever but just small problems that can wait until the end of the day, but I always put that I tried to call them in our system.

To the topic:

I'm just a CMA but I'm a medical aid in my school and the only one here, so there's a lot I can't do to the students. Even if I was a nurse, it depends on the school district on the policies on what we can do to students.

My policy in my school is if the student has a fever, we can't give any medication because we need a doctor's order. I tell this to parents too and they come get them, but a lot of them think if I'm here then that means they are in good hands but that's not the case.

My job is to make sure they stay in class, not babysit them for hours in my office, where I only got 3 chairs and one bed and have a queue of 5 kids waiting for me. If they can't stay in class because they are sick, they must go home. That's the policy in my school.