clockwood

Also, most teachers with whom I discuss salary are shocked when I tell them that nurses are paid on the teacher salary schedule They have no idea.

Thanks for your input! In California, school nurses have to have a "school nurse service credential." (on top of a bachelor's and RN). The program I did was all grad work and allows students to roll the credential into a master's degree (MSN) by taking just 7-8 extra units. The reason I am asking I guess is because nurses in our district do a lot of the work that administrators do, but get paid on the teacher salary schedule.

Question: I want to know if our teacher/nurse union can create a separate salary schedule for nurses. Nurses are sorely under-compensated in our district (okay, the teachers are too!) Does anybody work in a district where nurses are in the teachers' union but also are on a higher salary schedule? Thanks! I would like to bring this idea to the bargaining table... Claire

Does anybody know if there is a law, regulation or nursing code that states we cannot make health lists? I work at two elementary schools. One school has 450 students and one has 600 students. Personally, I am not in favor of sending out health lists identifying multiple students and their health concerns. I don't want to be the person responsible for creating that list in the event it ends up in the wrong hands :) Plus, not all staff need to know all student health concerns. We know that 25% of kids have their first anaphylactic reaction school. Just because a child doesn't have known allergies doesn't mean they shouldn't be assessed for an allergic reaction. I inform (via Emergency care plan, Individual Health Plan, or email if it's a simple FYI) pertinent staff including the secretaries, principal, teacher and PE teacher. I do not notify librarian, computer labs, etc. That's not to say that I wouldn't consider notifying them if the need arose.

What law/regulation specifies that we cannot distribute health lists with multiple student's names on it? I'm trying to find it in writing to give to my supervisor. Is it FERPA? Ed Code? Where specifically? Thanks.

Thank you for the resource!

Once it's in a container, pull up with a 60 cc syringe? I guess that's kind of cumbersome.

I have encountered parents who are hesitant to discuss their child's health history with me (or anyone) on the IEP team. They might defensively remark, "Why do you need to know the number of pregnancies I've had?" Or "What does the number of hours I spent in labor have to do with my child's IEP eligibility?" It is hard to perfectly defend every question that we ask, but the sum of the questions paint a picture of a child who may be at risk (or not). How do you respond to parents when they ask you the purpose of the Health History when determining IEP eligibility services?

Thank you all for your input. Our area administrator said she thought the letter from the doctor was ridiculous and asked me to discuss it with him...??? I thought that was pretty funny. I agree that this is a behavior/OT issue. My goal is always to advocate for the child...with that said, I do believe that weaning the child off of the chewy and integrating a behavioral plan that emphasizes "appropriate" coping strategies is 100% within this child's abilities. That is my "team" input, however it may not bear much weight as I am not a behaviorist, nor and OT :) Does anybody know if the school district legally has to comply with the note? I'm just curious.

Legally speaking, if a doctor writes a note saying a child needs a "chew toy" for oral/sensory purposes, to reduce agitation, to keep his hands out of his mouth, etc. does the school/school district have to comply with this? The child is in kindergarten and has what amounts to a teething ring pinned to his shirt. It gets slimy and is a hygiene issue and distraction to the other 18 students. The student has an IEP but is in a regular Kinder class for the majority of the day. The "chew toy" is not written into his IEP. I live in California...so anything pertinent to California law/ California Ed Code would be helpful to me. This is my 6th year as an RN...but only my 2nd year as an RN in the school setting...and I am bamboozled as to how to approach doctors orders when Ed Code seems to dictate. Help!

AED, never

Absolutely. Best to leave with a positive attitude. No matter where you work, you will always be given way more than you can possibly do, so triaging is the key. Leaving a job you love is always hard, but a new adventure awaits you!

I would take a different job. Your boss will be sorry. The APA recently recommended that every school in the US employ a full time nurse. There is good reason for that. Your boss will soon find that it would have been much cheaper to keep you in the long run. Good luck!

Oh, and the oil diffusion would not be for the "treatment" of anything, or to "create a calming environment" ...no claims of this sort on the permission slip...just because the teacher thinks it is nice.

I have a TLC (therapeutic learning class) aka emotionally disturbed at one of my schools. There are currently 6 kids in the class grades 3-6. The teacher asked me if she can diffuse essential oils in the classroom. I of course, see where she is coming from. I told her that because there is a risk that a child and/or staff member could be adversely affected, she should not do it. Now I'd just like to throw an idea to the wind. (why not?) what if...the teacher sent a letter home saying that she would like to diffuse lavender oil every now and then, then had parents sign a permission slip? Also an advisory would have to be posted on the door. There are only six students in the class. My concern is that the parents of these children are not of the highest character...might be asking for trouble. Probably a dumb idea but I want some open-minded opinions. Thanks.

Here are a few things for review: 1) anaphylaxis 2) seizures 3) asthma 4) food allergies 5) Type 1 diabetes 6) ADD/ADHD. Schools nurses often have to train staff in the use of Epi Pens and Glucagon. Many students don't use their rescue inhalers correctly, so it's a good nursing intervention to teach them the correct way. Management of student with diabetes/insulin administration. That's a start. Working in a pediatrician's office is a great background :)

Great resource! Thanks!

Thanks Jen! In hindsight, I think the more appropriate course of action would have been to allow the student to stay at school. The student did not have any ketones in his urine and while I didn't have an order for correction, lunch was only an hour away and he would have received correction then. It's hard to make judgment calls when you are not there to assess the student. It's also easy to get blind-sighted by such large numbers!

I had a similar situation...a student on the spectrum with "food aversions" who was also on a stimulant medication. Mom was actually blaming school for his weight loss. Ha! The lunches she packed him were not healthy or calorie dense. I emailed mom (so that there was hard evidence of my action) that I too was concerned and recommended a f/u with pediatrician and/or nutritionist and/or behaviorist/psychologist.

If not outlined by an order, at what upper limit of (blood glucose) do you request that a diabetic's parent pick them up? Kids with Type 1 are very resilient to both highs and lows so how do you judge an unsafe level for school- especially if you are not there at the school to make an assessment? My example: a Kinder student tested at 488 (highest he's been all year) so secretary called me. Secretary said student was acting "fine" but that student said he was "tired." I consider fatigue/brain fog to be a safety issue so I asked parent to pick him up. Parent was not happy. Input?

Thank you so much, Spidey!

I think you have a good point about assessing first. I went to the classroom to observe, and one of the "offenders" kept pulling, tugging, and lifting his shirt. I noticed that his shirt looked uncomfortable (buttons, collar, stiff material) and he said the tag was bothering him. I also read online that "lack of communication" is another reason kids may take off their clothes at inappropriate times. For example, if they are hot they might not have the skills yet to raise their hand and ask that the door be opened, or ask if they can get a drink of water.

I live in the state of California. I am confused because our state legislation says that school staff needs to be trained in CPR before they are trained in any emergency medication (is Epi-Pen the exception?). However, my boss says that all of our district employees are legally protected with or without CPR in the event that they administer an Epi-Pen. My boss said that it is only volunteers who must have CPR training before the nurse trains them in CPR. She also mentioned that if a student has an existing Epi-Pen Rx, and a teacher administers this pen but is not CPR or Epi-Pen trained, they are still covered by the Good Samaritan Law. I am having a hard time straightening this all out Does any of this sound correct? I would appreciate any clarity or insight! Links to California legislation are good too. Thank you!

Management and clinical leads already know how incredibly stressful nursing is/can be. It's their job to gauge how their employees are doing, and be supportive. It will not surprise or phase them if you discuss your anxiety, especially as a new grad. I can't possibly imagine that they will use it to bite you in the butt. I find that the people who are always sincere and speak from their heart are heard. Listen, they've gone through all this work to hire you, so they definitely won't fire you because you said you were experiencing anxiety as a new grad. It is not high maintenance to say that you need more time, or a more mellow shift to continue your orientation process as a new nurse. It is high maintenance for a veteran nurse of 15 years to wine and moan because she got 4 patients and the other nurses only got 3. Huge difference. Reminder: your instinct is correct 99/100 times, so go with your gut.

Making a med error takes your breath away, it makes your heart stop for a second. But guess what? To error is human. Here is a fantastic Ted Talk about errors in medicine Brian Goldman: Doctors make mistakes. Can we talk about that? | TED Talk | TED.com