PDN role at school

LadyFree28, BSN, LPN, RN · Dec 3, 2013

I went to school with children in elementary and middle school.

The teachers usually don't get involved in the medical aspect at least in my experience. I always had a place to sit, do notes, draw up meds, etc.

My middle school kiddo was blind and in a wheelchair, and had sensory adapted tools so when an activity was started, I assisted with setting up the sensory communicators; other sensory activities she couldn't handle with her hands (my kiddo had two strokes and seizure disorder) I would handle so they experience could occur.

It may occur the same way in elementary school as well; it really depends on what class the kiddo is in; I had a kiddo with a trach only; so being present to be able to suction or replace a trach was my only goal; if the kiddo has a feeding tube, seizures, developmental delay; it's going to be a different classroom plan; at least in my experience. :yes:

caliotter3 · Dec 3, 2013

I am responsible for the medical aspect of my child, but school personnel do not hesitate to enforce school rules, i.e. fever- child goes home.

PerfectlyPlump, ADN, RN · Dec 3, 2013

OK, I need to be more specific. My question is not about the healthcare needs, which I, of course, will handle. It is about lifting and transfer from one activity to another, and all-over use of time, for a child who, left to himself, just plays on the floor. This is pre-school, but it is school!

If you have experience in this role, tell me: Is the child "mine" or "theirs", during school time??

Not_A_Hat_Person, RN · Dec 3, 2013

I attended school with a high school student with multiple, profound disabilities for 2 years. He attended a few classes, and a half-day regional program 3 days a week. I was responsible for medical care, personal care, feeding, ROM, getting him on and off the bus. I also did some instruction, primarily reading to him and using the computer. We spent most of our time in a classroom with a changing area and hoyer lifts.

My only advice would be to get to know the special educator and school nurses. Familiarize yourself with procedures for things like fire drills, evacuations, and lockdowns (we had 2 drills per year).

systoly · Dec 3, 2013

The pt. safety is my responsibility. While i gladly accept help with transfers, im always present and if you will,

in charge. The pt. is always "mine". but it is my responsibility to work with the teachers to get the most out of

classroom time. During one on one between the teacher and pt., i'll step in the background

to not distract from the activity, but im never far. Depending on what else is going on in the classroom, i might

assist my pt. with that activity, or we may do something else if the classroom activity is not appropriate.

i have several meds and boluses during school so the teachers and i let each other know what our agendas are

caliotter3 · Dec 3, 2013

This is something you work out with the school personnel. They expect you to do the moving around, one on one 'encouragement' etc. for your client, but they will help if you ask, and vice versa. However there are some nurses who sit in the back of the classroom and do not lift a finger to help, even if needed for their client. This is frowned upon and will make the nurse an unwelcome person in the class.

CloudySue · Dec 4, 2013

I know exactly what you're talking about. One case I was to sit in another room across the hall with other nurses, waiting to be called for a medical task, like suctioning or finishing up a tube feed. But on another case, the aides (and I think the teacher too) saw me as an "extra aide" and just assumed I'd sit and do all the educational tasks in addition to feeding, changing, meds, PT (stander), etc. and it sort of bothered me a bit. It really wasn't supposed to be me assembling her craft, helping her paint, going over the lesson and eliciting answers from her, etc. I did feel taken advantage of while I was there. I was a fill-in nurse so I was stuck in a position where if the regular nurse was doing all those things, I didn't want to be seen as the "lazy" or "difficult" nurse.

PerfectlyPlump, ADN, RN · Dec 4, 2013

Thanks, Sue, you hit it......I just need to construct ways to set boundaries that won't negatively affect their view of my patient.

SDALPN · Dec 6, 2013

Each classroom environment is different. I work with the teachers to create a routine that works. We are there to be the nurse and nothing more. I try to treat the classroom as a setting where the child is there to do what they are supposed to do and the teacher is there to do what thru normally would do if we weren't there. We are only there for nursing. Some teachers want us to do part of their job because they see us "just sitting there" vs monitoring. Some teachers want us out of the classroom and view us as a disruption. I have even been told by a teacher that they will let me know when the child needs nursing care....problem is the teacher wasn't a nurse and can't assess my patient. I stay out of the way in the back of the room. I an friendly with other kids in the class, but I maintain boundaries.

I'm on a case now where I go to daycare with a child. The teachers complain about one nurse that won't let the patient roam the classroom playing like the others do. I let the patient act as the other kids do and I only interrupt his play for nursing care. The teachers and I both change his diapers based in who notices it. They would be doing it without me there anyway. But if I notice it, I pull him away to change the diaper.

Some teachers feel that we are there watching them and judging them. I personally don't care what they do. What happens in the classroom, stays in the classroom. I will however, report abuse if I see it. Luckily that has never happened! On the flip side, the teachers can call our supervisors with complaints or compliments.

Most schools and daycare have a fairly set schedule. So it's easy to learn the schedule and adapt nursing work to the schedule.

I've had good and bad class environments. It is almost always based on how the teacher in the room is.

I hope that helps!

CloudySue · Dec 6, 2013

I just remembered a very temporary case several years ago where I accompanied a first grader to a week-long summer "class" at a municipal recreation center. She was alert and oriented, just a bit fragile. She was in a themed 3-hour/4-day class based on Harry Potter, and it was clear that she was too young for this class. They had kids up to 6th grade, there were over 15 kids in the class, and it was run poorly by several high school students. The activities were inappropriate and too advanced for my girl, so she ended up sitting with me and playing with me the whole morning. I knew the parents were paying over $100 for this class, so after two days of entertaining this child, I asked the high schoolers directly to please include her in some of the activities, adapt something that she could do. Well, this really backfired on me. The director pulled me out and was nasty to me for "telling her people how to do their job", and she called the girl's parents complaining that I was criticizing and telling them how to do their job. The parents asked me what happened and I explained what was going on. Fortunately the parents sided with me and was appreciative that I cared about her having a meaningful experience, but I was kicking myself for saying anything. It wasn't my business and I knew it, but as former elementary school teacher, the incompetence was unbearable to me. They still sent her and it was horribly uncomfortable being there the last two days of the program.

Not_A_Hat_Person, RN · Dec 7, 2013

I briefly had a peds case where I attended preschool with an active, trached, nonverbal child. The program had a lot of nonverbal and hearing-impaired students, so all of the staff knew ASL. My job was to be there for emergencies like trach changes, give meds (an inhaler before gym and emergency O2), and toileting. Otherwise I sat in the background and the teachers did their thing.