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No raises. Not even a small, yearly cost-of-living raise.

Do the children with inhalers have doctor's orders for their use? If a child at my school needs to have an inhaler at school, then I must have doctor's orders telling me when/how often/how many puffs, etc. Without orders from the doctor, the parent must come up to school for the inhaler administration.

I made copies of our district's health guidelines and keep them next to the book where the parents sign their children out. I'll usually hand one to the parent when they pick them up. (Before I made copies, I also put stars next to the part about fevers and vomiting since those are the most common violations.)

Thermofocus 1500 I just got this at my school this year and it's fantastic! It's very quick and doesn't touch the student's skin, so you don't have to clean it after each use. https://static1.squarespace.com/static/50fc9d45e4b0dcfb3cb51002/t/54de17bae4b03b0d7a926e0e/1423841210512/Thermofocus01500A_H1N1_ENG_150206.pdf

What kind of doctor's orders does the student have regarding the Dexcom? I do think it is a fantastic tool, but I have a student (middle school age) who uses one and the mother calls constantly because she is seeing the readings on her phone. She also texts and calls her child if she doesn't see the number going up/down, or just to see if he treated. I can not run down to the student each time the mother sees a reading she doesn't like, and I have made this clear. I have also declined to put this on my personal phone. I can get email notifications, but I do not check my email frequently through the day because I am too busy! The student can check his sugar in class and has snacks in each class if he is low. Unless there is a problem after that intervention, I do not intervene. This is a capable child who is very used to mom doing everything for him. I am not being insensitive, as I do understand the severity of T1D and the rise and fall of blood sugar. I want this student to learn to listen to his alerts and react to them himself instead of relying on mom to text (during class) and say "You are 75, you need to eat four peanut butter crackers." And if he doesn't respond to the text, then mom repeatedly starts calling his phone (in class) and then calling the office to get me to go check on him. The doctor's orders state that he should check before lunch, before and after gym, before getting on the bus, or anytime he is feeling symptomatic. These are the times that I assess the student, unless there is a problem. So, I guess my point is, has anyone else had issues with parents seeing the numbers all day long? What kind of boundaries did you set? (My administration is scared to put restrictions on the diabetic students.)

Instead of listing what exceptions are acceptable, maybe you should say, "The only exceptions to this policy will be made by the school nurse." If you give examples of what is considered ok to remain at school, the parents have their ammo right there to keep them at school. "Oh, Susie isn't sick, she has a test." And Susie is sitting in your office pale and looking like she is about to pass out.

My school (6-8th grade) only allows 10 doses to be brought in at a time. The parents generally know that every other Monday they need to bring in a refill. I will call when there are about 2 pills left and call again the first day that the student is without meds. After that I don't track them down. Our school system considers it a service to the parents that we give their child medication instead of them having to come up here and do it.

Our district's guidelines state that if a child vomits at school (and I consider this vomiting that has been seen by an adult), they must go home and can not return until free of vomiting episodes for 24 hours. Unfortunately there are cases where I know the child has only vomited because of menstruation, sinus drainage, test anxiety, etc. However, the staff and other students know this is a policy, so I can't get away with making exceptions. Sometimes I will keep the student in the clinic until dismissal if I know that their family situation warrants it. I'd rather them be with me and monitored than have an 11 year old alone and vomiting at home. If the parent is playing the "I can't pick them up" game, I play the 911 card. If they don't answer, I will leave a voicemail letting them know that I will have to call 911 if nobody calls me back with arrangements. I also call all emergency contacts and let them know the same thing. I have a very no-nonsense district. It's a double edge sword.

Keep your head held high and a smile on your face! The kids can sense fear! I came into school nursing with a few years of hospital experience, but it didn't matter, school nursing is a whole new ballgame. My advice with... *Lice...after looking at pictures online, I knew it when I saw it. Nits don't come right off like dandruff. If you can flick the tiny white spot off the hair, it's dandruff. Look first at the roots of the hair behind the ear and neck because they love to live there. If you aren't sure that what you are seeing are nits, have handouts/letter that you send home with the student saying that you checked their child for lice and they should do the same at home. *The students who come in with "major" complaints (chest pain, trouble breathing) but are not symptomatic of a major health issue...do a full assessment on them (temp, BP, O2, respiratory & heart rate) and then call home. You are a nurse, you are not there to diagnose their child. "M'am, your son is complaining of chest pain. His BP, O2, heart rate, and respiratory rate are all normal. He is not showing any signs of distress. I am planning on sending him back to class but I wanted to make you aware first." *The students that come in all the time...I am also in a middle school and they students have a different teacher each period. They don't know that each of the other teachers have sent the student down. I will first email all of the student's teachers and let them know the issue. (This usually solves it.) If that doesn't work, I will start calling the parent every time the student comes in and have them talk to their child. The parents eventually tell their child to quit going to the nurse unless they are throwing up. *Diabetics (specifically noncompliant)...follow the doctor's school plan to the letter. If the student is not coming to check their blood sugar, track them down and pull them out of class to do it. If their blood sugar is high or low, the orders should tell you what to do. Follow it, follow it, follow it! That is the only way to cover yourself. The kid might be annoyed because at home they don't do it that way, but you just let them know that YOU are in charge them at school, and they must follow what the doctor says. If they are high and don't have any insulin, they go home. If you can not get in touch with anyone to pick them up, they get a free ride to the hospital. It's that simple. You are there to make sure the doctor's orders are followed, and if the student is putting you in a position where you can not do that, then they must leave because you can not be responsible for that. *Head injuries...I fill out the CDC checklist on each student. No matter how minor, a parent is always notified and I let them talk to me and their child. I also let them know that I am sending a copy of the checklist home. HEADS UP to Schools: School Nurses | HEADS UP | CDC Injury Center *When in doubt, call the parent and document! The parent knows their child and can make a judgement call on whether the student should go back to class or be picked up.