Jeanine

HELP! I have 7th and 8th grade students with IDDM, who are having some adolescent related diabetes management problems. Some of the kids have been diagnosed for a long time, others within the last year, and some in-between. Even though we are in metropolitan NJ, there are no outside support groups that I can find. The kids have such busy schedules, that when groups start, no one shows up or continues attending when it's in the evening. I have decided to start a support group in school (with a guidance counselor) and need some help with ideas and activities that are pertinent to middle schoolers. I have some activities from an old camp nursing book (1994), but the changes in diabetes management have come so far since then. If you have any resources or can give me some ideas where to go, I would be greatful!

We stopped using H2O2 in the ED over 10 years ago because of the tissue damage. The hospital used ShurClense, which is too expensive for me to order in school. I use plain soap and H2O. If it is a wound that they can't clean at the sink, I use Bactine.

Under the Allergies section, a parent wrote: HOMEWORK Not really a blooper, but gave me a chuckle anyway!

The NASN puts out a book "Ouality Nursing Interventions in the School Setting: Procedures, Models, and Guidelines". It contains a 5 page model for procedure development (based on Oregon Law), for "Delegating to and teaching unlicensed persons". It also contains a Diabetic Action Plan and Evaluation Tool, which is another 8 pages. My version is from 6/96, but if you want, I can mail or fax a copy to you.

Check with the Public Health Nurse in your area. She/he probably knows who's gotten what they're supposed to, and who is due for what by just looking. They may know of a specific program. I also think that you can purchase just the immunization part of SNAP's program. The problem is that the requirements are continually changing, the combinations within a single immunization keep changing, the drug comapnies use different names, etc... The Public Health Nurse will probably have to audit your charts at some time, so I would get friendly with her/him. They are an invaluable resource!

Would I be operating outside of the NJ Nurse Practice Act by giving a prescribed medication for a use not approved by the FDA? A doctor has prescribed Wellbutrin for a 13 year old student of mine. This student is non-compliant with taking his meds at home for his mother. He has been suspended X3 already this year, and as a condition for his return, he must come to my office every am to take his medication (per our Superintendent of Schools). "Wellbutrin XL is not FDA approved for use in treating any indications in the pediatric population." The prescribing information goes on to quote the BOX WARNING for Clinical Worsening and Suicide Risk. I have the necessary signatures (PMD and Parent) for medication administration. I personally have no problem helping out in this situation, but am unsure where I stand professionally. I realize that there are many times that medications are used for off-label reasons, but I have never done so at school. Wellbutrin is a drug that requires a consistent blood-level, and if he's not taking it for his mom, then he will only be taking it 5 days/week. I also don't want to be the one responsible if this student suffers from one of the adverse reactions or events.

If I have a question about whether I am seeing nits or not, I ask the student to pull out a strand that looks like it has an egg, (that I have separated) and I look at it under a microscope. The science lab has been kind enough to leave me one on loaner (one with a plug-in light, not a mirror) along with a few slides/covers. A nit will look exactly like the photos on the internet. This will help with an initial identification, but not necessarily after treatment. Once treated, dead nits should easily slide off the hair shaft. It's actually pretty cool to look at a louse under magnification as well! I always share the view under the microscope with the student in question, using it as my "teaching moment". It seems to increase their motivation to comply with every aspect of treatment.

I Love It! It's technically part of the job to keep kids in school, but also to keep them healthy! The kids on our retention list are usually the ones with the most absences/tardies. It truly is a conflict because you don't want them getting everyone else sick. I always give everyone the benefit of the doubt the first time they ask to go home. I tell them that this is their one freebee. After that, they need to have a fever, be actively vomiting, bleeding, have a broken bone, severed limb, or any other such emergency in order to go home. Some choose to save thier "freebee" for another time, some go home. I don't think that strategy will work with elementary students though. I often call a parent every time the kid comes down if they have become a frequent flyer. Make it their problem too. Let us know if your new policy of sending everyone home works!

my worst was cardiac arrest, cpr, revived, ambulance to the hospital, discharged with a dx of hypoglycemia (b/s of 112?). i insisted on a follow-up with peds. cardio., & he was placed on an event monitor. next week, cardiac arrest again, hit monitor, rescue breathing, ambulance to hospital. monitor showed v-tach, v-fib, toursades, and echo showed hypertropic cardiomyopathy. the student was taken to nyc, had a defibrillator/pacemaker implanted, and is now a healthy college junior.

It takes a lot of practice, but you can give the appearance of being academically oriented while maintaining Nursing as your priority. Try to appreciate the fact that you will always be misunderstood by people whether you work in a school, hospital (HELLO!...can you say "handmaiden"), MD office, etc... It can bring you down, but only if you let it! Keep a positive attitude, smile, celebrate your successes (including the small ones), and order flowers for yourself to celebrate Nurse's Day if you didn't receive any from your PTA or administration. I agree that we have to advocate for ourselves. Don't just sit in that little closet that they call the Nurse's Office. If that means killing yourself to plan a Health Fair or getting the school community involved in a fundraiser for defibrillators and mass CPR training, than do it! You have to show them how invaluable you are. The teachers and staff that I work with at school have become better friends to me than the nurses that I used to work with in the ER. They know how much I do! They marvel at how many hats I wear during the school day - nurse, educator, mom, seamstress, eyeglass repairer, braces fixer, mental health resource, friend, secretary, food supplier, custodian, spy, nutrition resource, confidant, medical dictionary, time-out room, and the list goes on... By being positive, you feel better about yourself and others feel better about you! That makes it easier to be the only medical professional in a world of educators. It's up to us to change the old stereotype of "band-aid pusher". That may be the reputation that the nurse before you had. Old stereotypes of nurses in every field are being changed, and we need to work on that as well.

Laws of supervision in schools vary by state. Some states don't even hire nurses in any form to work in the schools! I would make sure you know what your license allows you to do, and never practice beyond that or else you are opening yourself up to a lawsuit (you could lose your job, license, and even your house and posessions). Start with the National Association for School Nurses (Search NASN) for resources to help you network in your area. LVN's work under the supervision of RN's (Certified School Nurses) in NJ, although they don't necessarily need to be in the same building all of the time, only the same "complex".

New Jersey state law requires a written MD order and parent signature for all medications, including otc's. This order needs to be renewed every year, and parents are required to supply the student's medications in our district. To diagnose/prescribe medications is outside the standards of the nurse practice act. The school physician has written standing orders for oxygen and epi-pen in an emergency situation, and Mantoux as required by the state law. We are also not allowed to dispense otc's to staff. I do have a locked box with a stock supply of apap, asa, ibuprofen, antihistamines, tums, and mylanta that the staff have access to and may help themselves as needed. I'd rather have a locked, stock supply than have teachers keep their own in their desks. I don't know how the law appllies to students in residential facilities though. I think that there are certain differences when your facility is considered the guardian/caretaker of the child. You need to search your state laws in that regard because you don't want to risk your license.

Sometimes I do. I often find that a teacher knows the student better than I do, so I will give them the initial benefit of the doubt. If this is a frequent problem, I ask a staff member to watch my sick students for a few minutes (or close the door if I have none at the time) while I walk the "sick" child back to the classroom and interrupt the teacher for their "valuable, medical opinion". Hopefully, they will get the hint. I always invite them to see me for a friendly discussion at the end of the day, but if you don't let the teacher know how you feel, then they won't know, will they? If you don't get anywhere with that, ask for a meeting with that teacher and the principal. You can explain that your job is to keep these kids healthy and in school. So... unless they have a fever, rash, are bleeding profusely, or are vomiting, you would like them to return to the classroom to get the most of the valuable education that this talented teacher is providing for them.

If you have brought it to their attention in the past, I would press the button on the mini recorder or cell phone in my pocket. If not, you should tell them that it makes you feel uncomfortable when they speak to the students in that manner. I don't care who they are, they have no right to treat anyone like that. They are abusing their authority and they need to be stopped before they push a student over the edge, possibly harming themselves or others. Don't let administration cover this up, but that's who you should go to first. Don't give up your original recording either. These teachers need to be suspended and go to some kind of sensitivity training before they are allowed to return to the classroom! If it doesn't stop, I would let the parents hear how their children are being treated!

My mother is an RN, and tried to discourage me from going into Nursing. That was 30 years ago! She did a good job, because I got my BA in Psychology. After working in that field for 4 years, and getting married, I went back to school to become, of all things, a NURSE! I got my RN license, and have been working in many different fields of nursing ever since. I have a daughter in college now, and I tried, and tried to convince her that nursing was the way to go! Where else can you continue to work in your field, and still be a "stay-at-home mom"? No day-care costs, you can work only weekends or nights, you can work as much or a little as you wish, and the benefits and rewards go on and on. If your daughter or son wants to go into nursing, they will eventually, whether you think they should, or not. Please support them in their decision so they don't spend time and money unnecessarily.