Rosie67

Hi Everyone! Last week a parent called stating her daughter had a rash looking like chicken pox to face and trunk. Student had a fever several days prior. Has had one Varicella. Parent is not very reliable and really couldn't describe lesions to me. Stated doctor diagnosed her over the phone and refused to give her appt to confirm. She is in 8th grade. Today, I had another parent call. He is in 6th grade. Had both Varicella vacs. In school all last week, I see him often for every little thing not related to illness! Mother reports he had no complaints until he broke out in rash this weekend, "all over, looks like chicken pox". Called them red but not blistering. She is calling doctor, will let me know what they say. I don't know where to go from here. It is unlikely they had any contact at school. We keep the upper lever grades separate from 5th and 6th. They don't live by each other and I have never seen them together. Unfortunately, they are both from odd families with less than attentive mothers. I don't want to let something get out of hand but really not interested in mass hysteria. Any thoughts???

I have 2 diabetics in 5th grade this year and several others in the school. One year is a fairly new diagnosis. It seems strange mom wouldn't want and need your support. I have an 8th grader diagnosed 4 yrs ago, now with a pump and just recently identified independent by his MD. I have his current care plan to reference for questions and emergency orders. It clearly states independent daily routine diabetic care. I would insist on such documentation from MD. Diabetes requires a health plan and usually a 504. He needs to have emergency interventions in place even though he may be deemed independent. Don't feel alone about this- get your principal and social worker involved. Can you contact the diabetes educator that works with the student? I haven't had a 10 yr old yet who doesn't need supervision of some sort. It's ok to feel uncomfortable and challenge the appropriateness of this situation.

I have 3- 1 inch binders divided up alphabetically. Each student has a sheet with 6 visit comment sections on each side of paper. I note the date and time, C/O, brief assessment,interventions, a check box for parent contact and whether student returned to class or went home. It is very time efficient, privacy compliant and easy to locate each record. A card system would be good too, except I would get behind on filing the cards after each visit. My corporation is broke, so not sure if we will ever have electronic charting.

Oh my!! After reading that post re cramps and all- I sure needed this laugh. My police officer heard me laugh in the next office. I can't wait to share that request and the responses. Hee Hee!!! I thought I have had everything come through these doors. No other area knows what we deal with everyday- Keep up the good work.

Ohhh, This happens so often! Sometimes the odor is so pungent that I know there isn't any hugging and kissing going on in that family let alone washing. The way some of these youngsters are raised is disgusting. Several times, when it comes to girls especially, I will acquire a piece of clothing, socks or new underpants. I can get them from our Social Worker or Goodwill. I call the student down and tell them I was thinking of them when I saw .... and thought "I know who would like these..." Then I talk to them about caring for the new item and switch to how to keep our bodies clean. When the child is young it's easier to gain some trust and get a conversation going. I call them down after wards for a few days in row. See if anything changes. Get the Social Worker involved. There are success stories and those make everything worth it. Some of those girls will just beam a smile when they start to feel better about themselves. Don't forget about CPS to get those medical concerns taken care of. Hygiene may not be her only issue. Good Luck!

http://www2.ed.gov/policy/gen/guid/fpco/doc/ferpa-hipaa-guidance.pdf-- This is the address- I'm not good at links and fancy computer functions, so you'll have to copy and paste the link. If it doesn't work then search US Department of Education FERPA HIPAA. That should get you there.

I am sure Martha would have plenty to say. We have had discussions on a listserv recently. Most issues in schools are FERPA and not HIPAA. These discussions prompted me to download the US Department of Education -Joint Guidance on the Application of the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996(HIPAA) To Student Records- Published in November 2008-- Whew! Still red tape and some gray areas but has specific answers that apply to school health issues.

I think the point is lost. We are not talking about that poor child who doesn't have food and misses breakfast from circumstances out of his control. I ask several questions when a student comes looking for breakfast. Many CHOOSE to skip breakfast so they can socialize in the gym. Some students turn up their noses "That food is nasty!" Some come late at 1000-if it takes them an hour to get hungry, then they can wait for lunch. My cafeteria staff works hard. They are not running a restaurant. If a pattern develops, then we look deeper and perhaps get the Social Worker involved. Not a single student in my school is starving. Your research based point is respected, but I do believe that on a day to day basis, responsibility and accountability are great lifelong lessons.

I had to take a personal/family ill day Friday. My grandfather had Mitral and CABG open heart. A student was throwing cheetos in the air and catching them in his mouth at lunch in the cafeteria. He lodged one and lost color. I was told the security and lunch aides kept calling for the nurse on the radio. Most everyone knew I was gone. Everyone ran to his assistance. The security guard dislodged the cheeto. The student never lost consciousness, thank God, and thank the staff efforts. I returned to school today. Many have come by my office to tell me what happened "when you were gone". My secretary came in to ask for a donation for the Hero Luncheon today. They are having a potluck to honor the security guard. He came to my office a few minutes ago, laughing, and states "did you hear what I did? We don't even need you anymore, you could just go home". (!!!!!) I gruffed back, "OK, sit down right here, I'll leave." Now-- I am so shocked by my reaction to this whole thing. Don't get me wrong, I couldn't live with the alternative outcome of this situation. We as school nurses, do so many things that prevent catastrophe. It is expected: it's why I'm a nurse: it's what we do: it's why we are here. I guess some of the feelings I'm having is because I don't even get a card on Nurse's day. No thank you, no good job. I go unnoticed until a someone needs me, or a parent calls. I was worried about not being here in the first place. In my building we have a SW a couple days a week. When she isn't here the jobs falls on me. Many days I don't even get out of my office. Have any of you ever felt like this? I have contradicting reactions and I can't put my finger on it. Thank you!!

I keep a running log on a clip board. This lets me know how many kids I see everyday and it's a quick reference if I get too busy to chart details immediately. I have a record for every student in a binder separated with alphabetical letter tabs. They fill three binders. It is very useful to track student visits and concerns all on one sheet. Without use of computers, I find it to be the next best thing.

Past two weeks I sent home average 20 kids a day w/ fever over 101. Slowing down now. I don't know what to do with myself, only sent home 2 so fartoday. I got used to a line out my door at 800 am. Fires me up that parents don't keep obviously ill children at home. They look so sick and uncomfortable.

I'm sure that all of us reading your post have had similar situations. Even after six years in schools, I learn new things about myself and parents. Sometimes parents who haven't been doing all THEY should do for their child at home, feel the need to blame someone. That someone is the school nurse. You can only make decisions with the data available to you at the time. Not with what might happen later at home! You are not an extension of the parent. My corporation doesn't even supply peakflows or oximeters. My basic assessment involves lung sounds, respirations, distress, color and duration of symptoms. Calling the parent in this instance is appropriate. You did fine. Sometimes you can't please parents, no matter what you do. You won't be able to reason this one out. It won't be the last. It just comes with the type of work we do. You did fine.

I thought I should give an update- Some of you are making leaping assumptions- "power play", no, just doing what is right and prudent under my license. I did have communication with the MD, she was to have ice for the first 3 days and then return for PT. Well past the date on her Work Restrictions Form. Nothing in the orders pertain to any care from me at school. This wasn't an issue of giving a bandaid or taking a temperature. Non of that was even mentioned in my post. This was about providing care without orders. Please read my original message again. I'm glad my corporation makes the distinction between first-aid and treatment. I made the best decision with the information I had available. Sometimes "going above and beyond" means doing what's right but not always popular.

Hello Everyone- I almost made it to the end of the year without more issues-- THEN... A teacher aide sent a student to me for ice. I have her Return to Work Restrictions on file for a non-work related injury but I have no history and don't know what procedure she had if any. She is to have "non weight bearing and elevate leg throughout the day". No ice orders on the form. She actually rented her own w/c. I usually have to tangle about that too. I called my supervisor downtown who said we are here for first aid for teachers that's it, we "shouldn't" treat teachers, especially without orders. I sent a little note back with the student stating that I don't have orders for ice and an apology (to be nice). I didn't get into the whole "nurses are at school for the students" thing. I She then called my principal to complain about me. I touched base with my principal. Explained ice is a treatment. How long? How often? Duration? Location? He said to follow policy and write a narrative description of the events. First of all, I can't stand it when they send students down to take care of their personal business. Then she calls to complain about ME!!! Geez!!

I am on the Student Assistant Team here in my very inner-city school. We never have a 504 without the psych or social worker. Most importantly- he may not qualify for a 504. You don't want to make one unless he neets it!! We often start with a behavior plan. Your psychologist or social worker along with your administrator evaluate that need. You are vital in that decision as well. This is a health issue, that is you! If mom won't agree then you need to seek advice from your district. The issue stays the same even with a behavior plan or a 504. He can't stay in soiled clothing. You call mom and send him home or have her change his clothes if he won't change himself. It's really quite simple. No ultimatum. This happens and this is the consequence. I wouldn't let a child stay here during an asthma attack without an inhaler. Skin breakdown and hygiene are huge parts of the Nursing Process. You have all the knowlege you need! Again, let us know.