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.

It's up to the district to make a bus accident policy. If the accident is on the way to school, I just call the entire bus down to my office, and there is usually a police officer there with me Everyone gives me their names and gives the officer their location on the bus. If they don't have an injury, I write "student denies injury" on the report, as does the officer. I make a call home and leave a message to that effect. If there is an injury, I assess it, take appropriate action, the officer includes that in the report, and the parents are notified. If the accident is in the field, an administrator takes a copy of the emergency contacts to the scene, ems is called, and they do their thing. If it's on the way home, and is minor, the kids report to me the next morning and transprotation notifies the parents. The bus driver must always fill out your Worker's Comp Accident Form (even if they deny injury) and the State of New Jersey Employer's First Report of Accidental Injury or Occupational Illness as well. I'm sure that it's more difficult for you because you are in a special needs school. Check your policy manual, I bet that the Transportation Dept. has a policy that nursing can use as a baseline to make a policy that is specific for Nursing.

I do the same as above. I also try and remind them that other kids notice these poor hygiene habits, and that it would hurt me if other kids made fun of them. Don't forget, some girls who are being sexually abused keep themselves dirty on purpose, in hopes of being unattractive and repulsive to their abuser. I've actually had that happen at my middle school once and she finally spilled the beans on the abuser. I'll never forget having to send the police to the house because her little sister was kept home from school by the abuser one day, and my student had finally felt comfortable getting it off of her shoulders.

Behavior Modification Therapist 3 years Developmental Disabilities Nursing 5 years Emergency/Trauma Nursing 15 years School Nursing 7 years Each of the jobs have overlapped, where I worked in both fields for a year or two. Nursing is my 2nd profession after getting a BA in Psych. All have helped me in my school nursing duties. I plan on retiring as a school nurse. It's hard to beat the job, hours, rewards, or benefits.

IF ONLY WE HAD X-RAY VISION!!!! But then we'd all be billionaires and who would take care of the school children?! My own daughter got kicked in the shin in PE, in my school, and complained for days. I finally took her for and x-ray which was inconclusive. Finally a bone scan showed a fracture, exactly where she was c/o the point tenderness! I still get a lot of grief for that one!

They are not talking about hiring a CNA. They hire a lay-person who would be made aware of their duties. I am the nurse on duty, and as I mentioned before, I can't close my office to change an ostomy bag, replace a wafer, straight cath., or directly supervise her care. There is a handicapped accessable rest room right down the hall from me that will be used for those things. Of course, I am there for emergencies, but not for her ADL's. Perhaps it would be a less expensive alternative to hire a CNA though. I would be more comfortable with a CNA than with someone off the street who "likes to work with kids" as their credentials. The school has a lift for wheelchairs, so they can get around. She will be eating food from the cafeteria, chosen by the parents in advance and the parents will supply the Thick-It for the drinks. THANKS FOR YOUR HELP! I feel less like I need an LPN, still not comfortable with a lay-person, but pretty confident about requesting a CNA.

I have a new student coming into 7th grade next year. She was an "average" kid prior to discovering a brain tumor a few years ago. Since then, she has had chemo and radiation, which has destroyed quite a bit of brain tissue. They don't really want to place her in a school for multiple-handicapped students because emotionally, she is still an "average" kid. She is now in a wheelchair, needs thickened liquids and a special diet, and is incontinent of B&B. She will be getting a colostomy soon and will be returning to school in Sept. if all goes well. The special ed dept is interviewing for a one-on-one aide for this student. It is my feeling that they should hire an LPN for her because she has some pretty complicated medical issues. I'm not sure that an aide can do ostomy care, deal with the feeding issues, catheter care, and tend to her other needs. I know that families can do these things at home, but in my past experiences, we've never let ER techs do ostomy care in the ER or CNA's do ostomy care in the nursing home. I am responsible for about 800 students, many with diabetes, arthritis, seizures, etc..., so my day really doesn't include the 20-40 minutes a day that it would take to perform these activities, nor does my office have the space for an aide to perform them (supervised) as I attended to the other students. I'm not sure that I amcomfortable being ultimately responsible for the actions performed by an aide, I'd prefer an LPN who has some medical training. Has anyone dealt with this in the public schools? If so, what have you done? Am I worrying needlessly and I should give an aide a chance? What are your thoughts on this delegation issue? After all, it's my license!!

The student should have been sent to the ER via ambulance. As mentioned before, better to err on the side of caution! Choking is something that I would always send out, even if the object was dislodged/expelled. If the mom gets to the school before the ambulance transports, and wants to sign the release, that's her choice. We should always protect our students and our licenses, and avoid would-have, should-have, could-have situations. That way, there's no regrets.

Middle school kids should be able to carry their own inhaler, we have a dr's form for that & I have them demonstrate proper use. You cannot leave your sick students unattended in your office to get injured kids from outside. Start sending students back to class if there is no fever, vomiting, diarrhea, or other acute problem, and you'll have less requests after a while. I have my middle school students get their own ice, do minor wound care, get band-aids, remove splinters, and other non-acute procedures for themselves (as they would at home). If you don't have time for Diabetes education, purchase a video, make some handouts (we give a folder on allergies, diabetes, seizures, & blood-borne pathogens on the 1st day of school) and be available for specific questions. Accurate record keeping, screenings, medications, emergency care/first aid, and child abuse/neglect are about the only things that you can be effective at right now. Once you make the job and health office your own, it will be easier to pick up additional responsibilities - like CPR, health counseling, etc. - and will feel less overwhelmed. You're only one person, so hang in there, give it some time, and keep your expectations real!

Our day starts at 7:30, ends at 1:51. A student needs to stay until 10:00 to get credit for 1/2 day, 11:30 for a full day. The only true, excused absence is for a religious holiday, not celebrated by the school district (although a death in the family is an unofficial excuse). An MD note helps, but is not an excuse unless they are classfied or have a 504 for a chronic medical problem. The rest go to court after 15 absences, and the judge handles it.

We have a release on every student, signed by the parent. I got about 98%"yes" responses, one or two limiting the information to share, and a few that downright said "no". The release encompasses the school career in our town. The releases are in a binder, by grade, and get passed from school to school. It is part of the papers parents complete when a new student transfers into district as well.