Maine17

We actually has an incident 2 years ago when a K+ student drank some instant sanitizer-fortunately it was only a small amount. After checking with Poison Control (and notifying parents), we just monitored the student all morning. I agree with the previous post-it should be someplace that it can be monitored. The problem that may arise is with students who have their own little bottles of sanitizer in their backpacks/lunchboxes. With H1N1, good luck to any district that tries to tell parents that they cannot send their children to school with their own sanitizer.

Hi! I am in southern Maine. I started out working at Children's in Boston, lots of VNA and now 14 years of school nursing. Two years ago I moved from elementary to middle school. I am lucky to be able to work fulltime in one school with 550 students.

We have no audit ability or any way to know who is looking at our logs. The rationale the district uses to allow our logs to be read by the principal/secretary is that the principal needs to be aware of what is going on in their school, esp. if there is not a nurse in the building. Four of our schools have full time nurses and two have half-time nurses. We keep our principals up to date on all serious situations. Rarely does a school not have a nurse in the building or availble if needed.

This is kind of a followup question -something that has been bothering me. My school district (and many others) use a medical record system where the nurses log in each student visit. My concern is this system allows the principal, his secretary and the guidance counselors all access to this log when they pull up the student. I feel this is a breech of confidentiality-what do you think? Thanks.

I am a school nurse in Maine-550 middle school kids. School nurses across the country have been told to use fever as the primary symptom (for H1N1 screening), usually with cough, sore throat etc. The directive comes from the CDC-repeated attempts to address the findings of up to 40% of cases have been afebrile (initially) have been ignored by the CDC. Until the vaccine is available, the school setting is going to be a zoo! Even with an optimistic estimate of 40% of students that will recieve the vaccine, by the time they recieve two doses, separated by 3-4 weeks, add two weeks for antibody development-we are looking at mid-December.

The rapidly evolving situation in Australia is pretty amazing.

Thanks Indigo Girl for clarifying that info. It seems that we probably will have no choice but to go with adjuvants due to the need to make as much vaccine as possible (assuming the virus does not mutate). Wonder if this is something that the US should have been looking into to prepare for a pandemic. Makes me think that we are woefully unprepared to handle a significant event.

First I would like to thank Indigo Girl for the incredible amount of factual info that she has gathered and posted regarding influenza. Awesome job! The more I read about bird flu/swine flu, the more convinced I become that we are overdue for a world pandemic which we are totally unprepared for. For all the advances we have made in science, we have lost more in plain common sense. The significant cuts in public health, hospitals, staff, equipment etc. will come back to haunt us. Still, I find myself feeling like an alarmist. I am surrounded by smart, well educated people-none who are very concerned about a 'true' pandemic. I cant figure out if they are just too busy to think about it or they really dont believe it will happen.

I read the link about adjuvants, but it did not state why the FDA has not approved the use of adjuvants with the influenza vaccines in the past. Does anyone know why?

Maine gets out June 17th. Cant wait for summer.

I am very lucky to be in a district that has a nurse in every building every day. I cant imagine having to be responsible for more than the 530 students I already have. God love all you nurses running from building to building!

The 504 eligibility requirements have become so broad that almost anyone who has a health problem will now be eligible for 504 protection. The emphasis will switch from eligibility to the need for accommodations. Each nurse will need to look at her list of students with health problems and determine which ones (without meds) have a condition that substantially limits a major life activity-walking, talking, breathing, learning, concentrating, listening. That list will most likely include all of your kids with ADHD, some asthmatics etc. These kids are all eliglble for 504 and need a plan. Your principal will need to know who has 504 protection because if there is a disciplinary issue with a 504 student, certain protoccol may need to be followed.

Has anyone out there started to look at what the new 504 eligibility regs will mean as far as volume of paperwork?

I agree completely with Artistyc1-we do the same thing. Cowgirl-Part of your job is not only educating your students/staff, but your administration also. Send them copies of what AMA, NASN, Harvard School of Public Health etc. all say about No nit policies-they are all against them.

I guess I am not clear about "providing treatment to staff" aspect. If a teacher asks for Tylenol/Ibuprofen because their back is sore, would you say that you are 'treating' that teacher? If a teacher comes into my office and asks for some ice or asks to borrow a heating pad, I have never thought of that as treating them. Now, if a teacher asks for my advice, I am very careful about what I say and how I say it. What do you all think?

Great idea-I think I will try that!

I agree with the last two posts. Students come first, but I am happy to assist a staff member if I can. The nursing role in a school is usually an individual position-the nurse needs to build her own 'team' within her school. Every encounter with another staff member is important-instead of "power" plays, try to figure out a solution that is a win-win for both of you-it will benefit you in the long run.

I think that any school that are using lay people (including nonlicensed nursing students) to assess student health problems runs a significant liability risk. I would recommend that if a nurse is not available, parents make the final decision on their child. Anyone who takes on this responsibilty without training,a license and insurance is foolish-I say that after 13 years as a school nurse!

I just read Purple Scrubs reply. She is right-if there is any drainage, then send her home and to the doc.

If the student was at the elementary level and had those sx, I would send them home. At the high school level, hopefully they know enough to wash their hands if they touch their eyes(???). If dad is planning on taking the student to physician after school-I would let her stay thru the day. I would not feel bad about having the other student go to MD's only to find out it was allergies-it could have been an eye infection or scratch from makeup etc.

I agree with you regarding the student just coming in to the HR for a nap-not an appropriate use of the Nurses Room. What would happen if you had to leave the nurses office to go to a student who had fallen/had a seizure etc? Who would watch that student? I disagree with you about the third grade student with bowel problems-obviously this child has some issues. I assume that you have already investigated all potential problems that this behavior is associated with-physical, mental, abuse issues etc and that you have provided input as well as a school toileting plan. When I have a student who (for whatever the reason) is incontinent of bodily fluids/solids, the bathroom in the nurses office is always used. This is not only for the protection of other students,but also to protect this student's privacy. Hang in there-summer is coming.

Nurses just by their training/experience know how to prioritize. If a nurse has dependents (young children, elderly) at home who need care (and spouse cannot provide), then the nurse will most likely stay with his/her family, otherwise I believe most nurses will try to provide nursing care where it is needed. Nursing is not a vocation (although there obviously are still who think it is), but a profession-people go into this field for many different reasons, come from various different walks of life and have a variety of home situations. In a pandemic, hospitals will do whatever they can to have adequate nursing staff-Unfortunately, possibly even with job/license threats. Before there is a pandemic, is the time that the hospitals should be planning how to meet high patient numbers/limited nurses-this should be part of their Pandemic Planning. They can predict that a certain percentage of their staff will not show up or will have family needs-they already should have plans in place to work with nurses in other fields.(Most do not). Hospital nurses should be demanding that these plans be in place-They are the ones who will bear the brunt of poor planning by the hospitals.

Hippy.... If you left patients during a crises-it would be called "abandoning" and I believe you would lose your license.

Many of the school nurses in my state have been expressing concern that students that have been sent home ill from school with symptoms that could possibly be swine flu are not being seen by their physicians and not staying out for 7 days. The result is (probable) lots of spreading of this virus, with most of the cases being mild. Concern is for students/staff that are immunosuppressed etc. I believe we will see an increase in more severe cases due to this lack of surveillance.

If you are providing home care service to Medicare patients (for whatever company) who you KNOW are not homebound, then YOU are participating in fraud. Get out now and report them.