So annoyed/offended right now

[MHDNURSE]

As you all know, I have been dealing with a very difficult, non-compliant mother of a Type 1 diabetic. He was finally able to start school yesterday, but there are a lot of issues going on. Mom is determined he come to our school vs. his neighborhood school. Our school hours are 7:30-4. No nurse after 1:30. His old school is 8:15-1:45, 2 blocks from home. Mom wants him to take the bus to and from school, so he would be getting ON the bus at 6:30 am and get OFF at 5:15 pm. There is no bus monitor so if he got into trouble, things would go downhill quickly. His grandmother who has been significantly involved confided to us yesterday that she has almost called CPS on her daughter (the kid's mother) a few times b/c she has not done what she is supposed to do for him. She also said she has lied on several occasions to the doctors and nurses. Based on the several failed meetings last week, I am pretty sure there will be some non-compliance issues. He also showed up for his first day of school having not eaten breakfast!!!! So grandma runs out and buys him DUNKIN DONUTS!!! Of course his mid-morning BS was 316!

Mom agreed that she would bring him in the morning and pick him up when we spoke, but then went behind my back to try to make bus arrangements. Luckily the bus coordinator came and asked me what the deal was. We are not denying him the right to ride the bus, but he just started yesterday and we need to make sure he is safe and also make sure that we have a plan in place for the bus. Right now we have no monitor and we are working on that.

So now for why I am annoyed/offended...mom told me to call the nurse at the diabetes clinic to discuss any issues/questions I had about his care and that she was happy to talk with me. So I just called to essentially get a feeling for their experience dealing with the family (compliance, etc.) and also to make sure they were aware that there is no one to administer glucagon in an emergency for the last 3 hours of school, or on the bus. I want to know if they really think a 9 1/2 hour school day plus an extra hour on either end of that is safe and ok for him b/c mom doesn't seem to think it is an issue. I told her about the last week and a half I have spent running around trying to plan/coordinate and mom failing all the meeting and appointments, not bringing in the paperwork I needed, not providing the keytone meter, etc. and asked if she had a similar experience since they have known them for a year. So the nurse sort of hufs and says "I don;t think you seem to appreciate the fact that this mother is parenting a child with a chronic illness and will be doing so for the rest of his life. So you questioning how she is managing him and his illness is not your place". I was shocked! Isn't our job during the school day to make sure our kids are safe? Isn't it my responsibility to make sure that he is being protected from bad outcomes from his diabetes if they are preventable? Maybe it was her tone, which was extremely condescending, like I am "just the school nurse and who do I think I am". I calmly told her "Yes, I absolutely can agree that this mother has a long struggle ahead of her, but I am concerned for her son if he is arriving having not been fed, eating grapes, fruit gummies and chips for lunch and being put on a bus for 45 minutes after a 9 1/2 hour school day. If you have advice that would be helpful in dealing with this family to put the safety needs of the child first I would greatly appreciate it". She then just hufed again and said she would have the "other" nurse call me later.

Am I wrong to be offended? I have seriously invested hours of my time over the last two weeks training staff, preparing the school and classroom and setting up meetings with this mom which she has failed all but one.

Anyway, thanks for reading if you made it this far. I am just exhausted and feeling like no one gets how much we as school nurses do for our chronic kids.

[Emergent, RN]

It's basically pointless to be offended. It's understandable though. But, it accomplishes nothing.

Just do your your job the best you can. Try to cultivate a detached attitude. This will save you a lot of grief.

[WineRN]

That does sting. That nurse obviously has NO IDEA how much work you need to put in to make sure he is safe at school. Hopefully whoever calls you back is more understanding on what a huge role you are going to play in the care of this child.

[GdBSN, RN]

Stay strong!!! You are definitely putting the health and safety of this child first.

[caliotter3]

You are not wrong to be offended, but your energies are better placed in putting yourself into a calm mental state to deal with the upcoming challenges. That nurse is just another one of the many one meets who have a problem with how THEY approach everyone else on the planet. Her problem, don't make it your problem.

[OyWithThePoodles, RN]

I understand your frustration. This person would be the same one blaming you for not notifying them sooner if kiddo ended up hospitalized in DKA because of Mom's negligence, I mean, you are with him most of the day, you should've noticed.

No one is saying Mom doesn't have a long, stressful, and expensive road ahead, but even the grandmother (her own family) is questioning her parenting. Keep watching the kiddo and if need be report her for medical negligence. If you find that she is having trouble affording his supplies or that her food stamps will only cover certain foods (I'm not familiar with food stamps, do they offer pretty healthy/sugar free/low carb options?) then that is something you can talk with your family resource officer about. And with the food stamps, is there anything that they can do if low carb options aren't available? Like getting a note from the doctor to allow certain foods?

The glucagon...are you not allowed to delegate this to other staff members if you are not there? In our district we can delegate anything besides insulin as long as they are trained by an RN. If so, this could help alleviate some stress for you. There is still the issue of no bus monitor and him being on a bus for so long. You could always train the driver (if your district allows) and give the kiddo a "big brother", an older kid to help keep an eye on him and alert the driver if he starts showing symptoms of his glucose dropping.

There is also the option of him checking his glucose 10-15 minutes prior to getting on the bus, if it is below a certain number, he gets a snack to help keep it up for the duration of the bus ride. Then check again 10-15 minutes later, if his glucose is still low, Mom picks him up. Have your administrator back you on this one. And this is all stuff that can be discussed in his 504 meeting.

I understand your frustration. This person would be the same one blaming you for not notifying them sooner if kiddo ended up hospitalized in DKA because of Mom's negligence, I mean, you are with him most of the day, you should've noticed.

No one is saying Mom doesn't have a long, stressful, and expensive road ahead, but even the grandmother (her own family) is questioning her parenting. Keep watching the kiddo and if need be report her for medical negligence. If you find that she is having trouble affording his supplies or that her food stamps will only cover certain foods (I'm not familiar with food stamps, do they offer pretty healthy/sugar free/low carb options?) then that is something you can talk with your family resource officer about. And with the food stamps, is there anything that they can do if low carb options aren't available? Like getting a note from the doctor to allow certain foods?

The glucagon...are you not allowed to delegate this to other staff members if you are not there? In our district we can delegate anything besides insulin as long as they are trained by an RN. If so, this could help alleviate some stress for you. There is still the issue of no bus monitor and him being on a bus for so long. You could always train the driver (if your district allows) and give the kiddo a "big brother", an older kid to help keep an eye on him and alert the driver if he starts showing symptoms of his glucose dropping.

There is also the option of him checking his glucose 10-15 minutes prior to getting on the bus, if it is below a certain number, he gets a snack to help keep it up for the duration of the bus ride. Then check again 10-15 minutes later, if his glucose is still low, Mom picks him up. Have your administrator back you on this one. And this is all stuff that can be discussed in his 504 meeting.

Lots of helpful suggestions, thanks. In MA, I cannot delegate the glucagon, unfortunately. We are definitely working on a 504 and hoping to include someone trained to ride the bus with him as one of his accommodations. The previous 504 from his old school was a JOKE- looks like it was scribbled out in 5 minutes and didn't actually provide any accommodations. What is hard is that our school will literally bend over backwards to provide everything he needs, but mom has to be willing to do her part as well. Will definitely keep you posted.

[Farawyn]

Vent here all you want, productive or not.That's what we are here for! We get it.

Just keep doing what you're doing. Document. Get your Principal on your side. Consult your state laws; what constitutes having medical staff present during the school day? etc.

Good luck.

[kidzcare]

I would feel put off as well. Feelings are never wrong- we all feel things different ways.

Is this child on continuous monitoring?

[JenTheSchoolRN, BSN, RN]

Lots of helpful suggestions, thanks. In MA, I cannot delegate the glucagon, unfortunately. We are definitely working on a 504 and hoping to include someone trained to ride the bus with him as one of his accommodations. The previous 504 from his old school was a JOKE- looks like it was scribbled out in 5 minutes and didn't actually provide any accommodations. What is hard is that our school will literally bend over backwards to provide everything he needs, but mom has to be willing to do her part as well. Will definitely keep you posted.

This is a tough one. Technically, a nurse or the parent needs to accompany this student on the bus and a nurse should be at the school for the entire school day in case glucagon is needed since it cannot be delegated.

I have parents that don't want me to send glucagon on a field trip (which is awesome because I can't); even a trained teacher can get stuck with the fact that stuff has to be mixed, etc. If I go on the trip, I'll bring it. They support a 911 call if student is unconscious due to fast response time for ambulance in my area. But again older students that I've worked with for years and recognize their lows and advocate for themselves. I brief all teachers on the procedures. Student's providers are on board. Usually this action plan is a transition plan for 7th grade, however, as that is the grade where in my district, busing is no longer provided for students and students often take public transit to school. I'd love to say every diabetic teen I've worked carries glucagon with them, but that would be a total lie.

[OldDude]

Forget about it...I've worked in a lot of specialty clinics and that's a typical evolution you see in some of the nurses. They become so self righteous, thinking they have become the all knowing expert about the field, they ultimately entertain themselves by being critical of everything that doesn't fit their, sterilized from reality, clinic visit environment and narrative. They can recite the entire owner's manual but forget how to get out on the highway and drive the car!

Try to get an email address from them and communicate that way.

Forget about it...

I would feel put off as well. Feelings are never wrong- we all feel things different ways.

Is this child on continuous monitoring?

No, he gets checked before meals and if he is symptomatic