Ridiculous things. This is a new one one me.

SnowyJ, RN · Feb 24, 2016

Out of curiosity, why?

Because adverse effects can be exacerbated by administering doses too close together.

Ask my friend who ended up in the ER with heart palpitations and nausea after fiddling with the timing of her Adderall.

ixchel · Feb 24, 2016

The joys of parenthood. Just when you think you got it - you don't. Good luck on getting this episode turned around; until the next chapter. Having 4 boys (and the GIRL), I think I know to what you reference.

We have one parent who drops off four boys for school in her police cruiser. I joke that you'd have to be packing heat to handle four boys. [emoji23]

Man, your poor daughter.

(I'm not trying to hijack, I promise. Simply expressing ... Sympathy? Condolences? lol I kid!)

Cattz, ADN · Feb 24, 2016

Calling to verify that a order is correct is fine, and often appreciated. I am not sure that's what the initial post was about though. I don't think having concern is a "bad thing", don't get me wrong, I would be happy if someone called and verified it, or if a med was held due to concern for an adverse effect.
I do think there is a lot of bias when dealing with these type of medications, which I don't feel is appropriate from members of the health care team. For example, do you have the same concerns about dosing insulin at breakfast and at lunch? There is a stigma about mental health in general, and IMHO, a stigma on the parents of children with ADHD.

I said I was done with this thread, but since I am the one who started this mess, I have to answer this one.

What my brain is telling (since I have been sitting here working, while I pondered if I was going to jump back in), is this: What I think that you are not understanding Boston, is that what we are working off of- Is a "school nurse mindset". With that brings many facets and possibilities in addressing your questions and concerns (all very thought provoking and worthy of a really good conversation that we all can learn something from. ) I hope you will learn how a school nurses brain works too.

I hope that what you have picked up on, is that we do have to think differently, and outside the box of what nurses in other specialities do. We sit right in between the classroom/education and the medical/emotional/psychological well being of every on of our students/staff and our school families. When we take into account all the aspects of both, we have to use our "nursing brains", to determine what to do (if anything) when we have a concern. I can venture to say, that school nurses would be the last ones to judge a parent with an ADD/ADHD student. We are the voice for the student the parent most of the time. Why? because, that is the essence of what our job is. In my original post, I made it quite clear, that I have spent countless hours helping this family and being this moms "big sister". And, I might add, this is by far, not the first (or last) mom/parent, that will get my "big sister" helpful heart and hands. You may be just saying in general, about being judgmental on these parents....but this is by no means the case...I can say in general that this isn't the case of school nurses.

In my school nurse brain, this is comparing apples and oranges, but....Would I question insulin before breakfast and lunch? Absolutely not. Because, depending on the type of insulin ( I assume you are speaking about something like Humalog). It cannot be ordered any other way. Now, the type of medicine that I originally posted about, yes, it does have some wobble room....especially when scheduling and figuring out what is best for the STUDENTS/THEIR EDUCATION/KEEPING THEM IN THE CLASSROOM with as few interruptions to the day as possible. (which, is the whole point of why we go to bat for these kids/families...all day...everyday)

Also significant -- and I feel like it got lost in this conversation. To those who thought I was irritated and just didn't want to "do my job". I go to 4 different buildings. So, this only effects what I do one day a week. That idea, is irrelevant.

True. Story.

ana010 · Feb 24, 2016

Have had at least 2 kids with this type of order. XL didn't work well on their little skinny selves. Made them not eat and have other symptoms. When you are underweight already, you need every advantage to be nourished.

That said, I had a thought of why am I giving 2pm Ritalin? After history from moms, I got it. It helps when the parent will communicate with you and not on facebook.

SchoolNurseTXstyle · Feb 24, 2016

Cattz,

I am curious, I even looked at your original post to clarify. What is the school hours for the student mentioned? I have a feeling that either that breakfast or afternoon does is outside of school hours? I ask because if school lets out at 2:30 and the student gets in his car at 2:37, well that makes a difference doesn't it? Or does school start at 8:00 and student gets out his car at 7:45 and mom expects you to give it? Either of those scenarios seem to be a parent responsibility and not necessarily the school nurses. Does he ride the bus a long way to and from school because that means something entirely different.

I think non-school nurses think in terms of the 24 hour hospital time and we work on a different schedule. If the doctor orders a 6:00am med in the hospital, it has to be given by a nurse. If he orders it for a student at same time, well hello - the reason I took a job as a school nurse is so I don't have to be to work at 6:00AM or 6:00PM.

Yes, yes and yes on us having to also balance missed class time and disruption to the learning environment. These are specific to our specialty and nowhere else!! 15 minutes possibly of missed class time for each medication administration x 3 = 45 minutes. That is like missing an entire class everyday.

Our medication policy strictly states "only medication that can not be given at home be given at school." Do we make exceptions for kids that get themselves ready because their single mom has to be at work early, you bet we do!! Do we maybe stand strong and not give in to the mom who is there daily, feeds him breakfast at home, drives him to school then loiters in the front office for 4 hours to make sure her darling is ok? You bet we do because due to all of those circumstances , it is more appropriate to be given at home.

Every student that comes in my clinic has a physical assessment but I also look at their attendance, their grades, what class they are coming from, time of day, what their parents said and did. Heck, what teacher said and did too (only a school nurse will understand my meaning on that one.) That times 12 because they are walking in 10 deep at a time while someone is calling you on the radio saying someone is hurt in the gym, a parent in waiting to yell at you about not treating their kid that the PE teacher never sent down and the teacher waiting for you to hand her the field trip bag in which 2 diabetics, 3 peanut allergies and 4 asthmatics are going on and you only found out 12 minutes prior and the bus is waiting to pull away.

That was a giant run on sentence but school nursing in a nutshell. So, forgive us if we want to get her and leave here at our contracted time so that a parent is relieved of their resposibilty.

Cattz, ADN · Feb 24, 2016

Great words, Tx.

To answer your question. These 2 students ride the bus 2 blocks to get to school. They are at school from 7:45 to 3:30.

Happy Wednesday evening Friends.

allnurses Guide · Feb 24, 2016

What I think that you are not understanding Boston, is that what we are working off of- Is a "school nurse mindset". I hope you will learn how a school nurses brain works too. I hope that what you have picked up on, is that we do have to think differently, and outside the box of what nurses in other specialities do.
I can venture to say, that school nurses would be the last ones to judge a parent with an ADD/ADHD student. We are the voice for the student the parent most of the time.
In my school nurse brain, this is comparing apples and oranges, but....Would I question insulin before breakfast and lunch? Absolutely not.

First off Cattz, don't think for a second that I (or anyone else here) is judging you. I'm not. I am asking some questions to help provoke some thought from everyone in general but it's not a judgement on you personally/professionally. You obviously know the intricacies of this case much better than we do.

I am trying to understand the mindset, it's not my are of expertise. At the same time, as I think is reasonable to do every once in awhile, I am also challenging it slightly. For example, I could imagine it is easy in the school nurse mindset to forget about life once that child leaves school.

Students are lucky to have school nurses to be their advocates, and I would assume that means you need to be their advocate against prescribers and parents at times, and that's great.

The reason I asked about insulin aspart (obviously a much different medication) but also a medication with little stigma and a lot of potential side effects if dosed incorrectly and has a similar duration of action as methylphenidate. Again, just to provoke thought.

SirNurse312 · Feb 24, 2016

I too shake my head with you.

SirNurse312 · Feb 24, 2016

eieiyo · Feb 25, 2016

I was a school nurse for awhile. The kids took a dose before coming to school. Then we gave the noon dose, parents gave the third dose. Sounds like the parents aren't coping well. Maybe the kids need something physical to do after school rather than be expected to be calm?

eieiyo · Feb 25, 2016

Also, I was the nurse for three different schools in my district. It was busy and every second was busy.

ixchel · Feb 25, 2016

Cattz, as a mom of an ADHD boy, thank you for advocating for this child. By your description, you do a great job.