ARN

I received my booster in october. no side effects other than a sore arm with my first two doses or my third. both my kids age 6&9 got their first covid vaccine last Thursday and they only had sore arms.

we start Spring break tomorrow. all of our students are taking their chromebooks home today if they have a signed agreement by parent that they can take them home. something that happens at the beginning of the year I'm sure. I apparently signed one for my first grader because per his teacher he is "good to go". I have asked my director what will the nurses role be in case of an e-learning day and so far the response is they are working on a plan for us. She put out a Google doc to see who has a laptop/chromebook and who still only has a PC. So I am guessing we may have some education etc they might have us do? but as far as real workable time for 2 weeks I have my doubts they will figure something out. I can still work at the hospital because I am PRN there. (do I really want to? IDK because then that puts me at risk for further quarantines and unable to work my school job when we open). so much still up in the air.

I have not. I should reach out to them. This is my second year here. we are a unique school and our kids travel to two other schools for certain classes and we don't have sports at our school but they can choose to play for one of the other schools. probably just going to take some work on my part to open up communication.

just had a kid come in and ask me for a qtip to clean out his airpod...come on now! I frequently get asked for qtips for various reasons. the answer is always no you may not use my qtips for that. nor may you use it for your ear! I am not going to be responsible if you bust your ear drum putting it in too far. clean your ears out at home!

thank you. we have a protocol but its just a flow sheet that doesn't really outline anything. so hopefully the trainer will refer him to an md. baffles me that I get no communication from the trainers at all. he is supposed to follow up with the trainer after school today. as far as my psuedoseizure gal her concussion happened at home. her md order isn't very specific and just related to limiting assignments on the screen. I frequently send her home due to her episodes and not wanting to return to class. previous nurses have allowed her to hang out in the nurses office and I have had a hard time limiting her time in my office but I am trying to keep a boundary with her.

what do you do for the kids who have had concussions recently (not that day)? evaluated by md and given instruction to take rest breaks. I had one yesterday I had to have her go to a conference room that the secretaries could keep an eye on her because I had so many kids coming in. I only have two cots and a chair next to my desk. 359 students. she also has psuedo seizures so I had to make sure that someone had line of sight with her. she just wanted a quiet space with dimmed lights to rest. I have another kiddo who just had a head injury during practice last night seen by athletic trainer but of course nothing communicated to me. thankfully today has been better and I was able to let him rest for a bit. I usually only let kids stay for 15-20 minutes then back to class unless waiting on pick up or something else is going on I need to monitor longer.

this is so hard. we have several students who are on my radar right now as potential suicide risks. they have expressed thoughts in the past. self harm. are in counseling and have multiple supports in place. some even have good family support. they are still struggling. I also had a student take more of her antidepressant than prescribed last year but thankfully not enough to do any damage. mom was able to pick up and take for evaluation and VS were stable. thanfully she ended up in class crying on the floor in regret so the teacher alerted me. coming from the hospital setting as my background I have cared for a young teen who OD'd on ibuprofen I believe it was and had to have emergency dialysis. I don't know what his outcome was but he was very ill. I have never really sought EAP for anything work related but I did after my sons type 1 dx. When really its all the burdens that we as nurses carry that add up and affect us in other parts of our lives as well. the scale was tipped enough for me that I needed to release something. It was very helpful. I agree, seek out your EAP person. It is good to talk to someone and have that time to process.

every meeting with the mom that we had last year resulted in similar things. she demands. we meet demands. she demands it in a different way. rinse and repeat.

oh lord help my mother. this could be my brother in 30 years. my 4 year old asked me the other day "can I always be in your family even when i'm a mom". yes but you have to live somewhere else with your family ?.

even if she hates being pushed on right now (it needs to be done)....hopefully one day she will see the benefit of helping her child become more independent. personally i don't want my type 1 diabetic kid to live with me forever (or my other kid who is 4 and wakes up and climbs into my bed often at night). one day i'll miss them but also one day i will enjoy being an empty nester and not reminding my children to wash their hands, dose for food, don't leave your toys in the living room or the dog will eat them etc etc. ? my 23 year old brother still lives with my mother, doesn't have his drivers license, and I am not sure if he will ever move out. thank goodness he at least works but guess who takes him to and from everywhere...yup my mom. he was born with multiple health issues. was on ECMO and didn't come home until he was 3 months old I believe. when he did come home it was with a feeding tube, oxygen, heart monitor. his diaphragm didn't form completely and his organs were in the wrong places, lungs full of fluid, not fully developed, heart murmur, and his soft palate didn't form, bowel issues ( I can't remember all the technical terms for what happened it was just a random thing that happened to him and they knew when he was still in the womb so they were prepared when he was born to intervene). he is perfectly healthy now aside from asthma flare ups and he eats like garbage and has zero physical activity. anyway my point in sharing this story is, i have seen what it looks like to not push your chronically ill child to be independent and to coddle them. while it sucked he had to go through all that as a baby and had multiple surgeries as a child he could be totally independent of my mother now. fingers crossed one day she will push him to move out!

https://www.doe.in.gov/sites/default/files/news/sea-52-low-thc-hemp-extract-guidance.pdf

Is your office in line of sight of any other adult who can help police the door? ie send kids back if they don't go back on their own? or have a puker wait with a trash can until you get back? call you for a legit emergency that can't wait? my office is in line of sight of the secretaries so they can catch kids and grab a bandaid or let a kid lay down that legit looks sick until i get back in the rare instances I take a quick break to run an errand. there is literally no room in my building that doesn't have a window (no blinds or curtains). so if i were pumping in this job i would probably opt to use my office and a cot with curtain drawn. either that or i would have to ask to transform a supply closet and make a spot in it for myself. note on door and let my secretaries/principal/and counselor know i am unavailable unless its a real emergency. I think an email is in order once you know your general break times but of course those times could get messed up because you could have a situation come up that makes you run late. but I still think a general email to let people know that this is the best laid plan so they can avoid sending kids certain times of the day. this time is important. pumping is hard work. it won't be for forever.

similar situation last year. it is so sad.

I edited my response above. it makes more sense to me to add both together and then round. but i am pretty sure we were taught when we came home from the hospital to round each then add. but I will have to look for that info when I get home. i am 100% sure i now add both and then round once. but thats for my own kid. now you've got me curious how we were originally taught so im going home and digging out papers lol.

round each number then add together is what my sons orders say...I think....now that we pump and don't calculate as much I am really not 100% sure. we do have a rounding rule that i put in my phone. 00.-.24 round down to whole unit. 0.25-.74 round to 1/2 unit .75-.99 round up to next whole unit. since im in the high school setting my students are independent and there isn't anything on their orders about rounding or adding doses together.

https://www.sugarsurfing.com/single-post/2016/07/22/Gaming-Your-CGM-ala-Pokémon-GO a fun idea to get kids to engage in their care more. maybe make up a guessing game with him based on something he likes to try to get him to come up with some answers on his own. maybe start by getting him to tell you how many carbs are in one food item in his lunch. he has no interest so I feel like you might need something to get him started. we already guess at what the glucometer is going to say vs what the cgm says. I have my kiddo tell me what number he feels like he is. Sometimes he is super close. he might say im like way low, like urgent in the 50's. or im in the 60's. sometimes he is wrong and he feels low because he just had a big drop so we talk about that and why its important to double check and wait before treating.

my 7 year old type 1 knows he needs to eat a starburst if he feels low or some other fast form of carb and at home he knows where they are, although we decide how many grams of fast carbs and help him do that still. he can read labels for total carbohydrate count. he can check his dexcom and put his blood sugar into his pump for a correction, and can put carbs into his pump. he frequently doses himself with his pump with us double checking that he did it correctly. he can also check his blood sugar with his glucometer himself with a little supervision to make sure he doesn't forget to clean his finger first. he still forgets to wash his hands after going to the bathroom so ?. he doesn't always want to do those things but I try to give him the opportunities so he knows how. I am hoping by the time he is in 5th grade he will be mostly independent with adult backup for most everything. I expect I will be helping him put his dexcom sensors and omnipods on for a while though. he already knows a lot of carb counts for his regular foods. like he can go to the pantry and get a prepackaged snack that he eats frequently and will yell out how many carbs in this mom? and before I answer he will tell me what he thinks and he is usually correct. we have some foods we don't dose fully for that are high in fiber etc that tank him if we do and he has figured that out. we are always talking numbers and he loves math. I hope you can get mom on board with giving him more small responsibilities at home and building his Independence.

even if you can't pump at those exact times just shoot for pumping as many times as your baby would feed and squeeze it in however you can. breastfed my babes when I worked med surg and I would pump before my shift started and 2-3 during a 12hr shift and then sometimes if baby couldn't wait to feed until i got home i would pump again to make up for that feeding as well. my first babe i worked nights so it was a bit easier to manage since he didn't feed as much at night. second babe I worked dayshift and I had a much harder time but somehow it all worked. hopefully you have someone who is understanding and can cover non emergencies and non scheduled things while you are taking your pump breaks. having a freezer stash helped reduce my stress about not pumping enough a little. I knew I had backup if things got crazy busy but I still made it a priority to take my breaks. like you if it came to formula my baby being fed was most important but it was also very important to me to try to make it work. have you seen the freemie? seems super discreet and might make life easier. no idea about cost. Good Luck!

I felt like this at my hospital job. family/and patients sometimes were so extremely rude. cursing/demanding. a whole culture of entitlement.

I feel very lucky ?. I get some behavior kids in my office as well but I feel like its probably not near as much as some other schools. our principal has really set the bar high for behavior and he follows through and holds them accountable. as well as their teachers. there are of course things that happen. we have kids bringing vape stuff to school/truancy/occasional fights but I know that its not as much as what others deal with. counting my blessings.

My school doesn't do passes. Hs level and our three pillars are trust respect and responsibility. That being said...There are certain students that need follow up. A lot of times they will stop by my office if they are about to be late to try to get out of a tardy. Nope. You would have been late even if you hadn't stopped in my office so you are tardy. I have a few that I have had to remind often...Do not stop in here during passing period unless you are bleeding. Go check in with your teacher first and get permission to come. Sometimes I will get a phone call asking if its ok if a student comes down. Which is nice because then I know to expect them. Or I'll get a heads up so and so is coming down for this. I def get a lot of kids that don't need to come down and the teacher is just trying to appease them so hopefully they will move on from whatever they claim is ailing them and get back to work once I send them back. We are small. 359 students. Our building is small. If someone isn't where they are supposed to be we figure it out pretty fast. We don't even have all of them here at once because they travel to and from three other high schools to take c4 classes or other electives that we don't offer. If we were larger I feel like we would have to have a pass system.

when i am out and i can't get a sub my admin team have to cover for me. I will document meds they passed while I am out and make a note of who passed the med. if i get a sub they are able to login using a sub login and document themselves. I try to document parent phone calls. sometimes I'll add a note to the students visit about it. or if it was a stand alone call without a visit from student I will chart it as its own occurrence. especially if i want to make sure and have a record of how many times I have requested a parent bring in more meds/supplies/or return paperwork needed.

when i got my first nursing job it was in med surg. for the first year I was so nervous that i wouldn't know how to care for my patient load. that there would be a patient that i didn't know how to care for. I find myself having that same feeling again 11 years later as a school nurse at times. I have a lot of what if thoughts. what if there is a severe injury what if a kid has a severe asthma attack what if my diabetic student needs glucagon (i have given it in the hospital setting when a patient was low and didn't have iv access, and refused to eat, but they were conscious). what if i have a student with a seizure that needs diastat or intranasal versed ( I have yet to give either of those, have given ativan for a seizure a handful of times iv in the hospital setting). what if i need to use epi (my own child has life threatening food allergies but thankfully i have not needed to use epi). one of these days if i continue in this school nurse role one of these scenarios will likely happen. I keep reviewing things when i am not busy. I try to remember that I was once a nervous new nurse in med surg and I have now responded to codes and performed cpr on real life people. i will do what needs to be done. my instincts will kick in. ems will come and help. I will do what I can until they get there. I have to put the what ifs out of my brain sometimes. its hard but if anything happens i will critically think. i will learn from whatever I do and figure out how to do it better next time. the hardest transition for me is feeling like i am mostly alone. being the only medical person in a building with over 350 kids. I am used to having a full code team to respond to an emergency.

we can't be 100% sure. we are instructed to report suspicion and not to do our own investigation. that is CPS's place. we are mandatory first reporters.

nope. I am down to one diabetic who does not have a 504 and overall hasn't needed any special accommodations.. he had a dexcom for a little bit so I did have to shoot out an email letting teachers know his reciever was not a cell phone so no one would give him a hard time about alarms or looking at it if he needed to. I have his orders from endo but he mostly self manages. seizure disorder with an action plan but no 504. two students who self carry epi with action plans but no 504's. a third with a new unknown allergy i am waiting on orders for. they qualify for them but just don't have them. not having any issues with classes so guess parents haven't requested? I have some kiddos with asthma that self carry inhalers but haven't had any issues last year or this year so far...knock on wood! overall our teachers are pretty accommodating and our principal. This year we don't have anyone making outrageous demands. last year we did, but thankfully that student transferred. the counselor is pretty good at handling 504 and shooting out emails of accommodations. I feel like the last nurses just didn't have involvement which is why I haven't really been involved but I know that is not the case at all schools. I just feel like I should know more about 504's, and am surprised that I don't have a bigger role. maybe I should just count my lucky stars.