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.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Are you sure you were even talking to a nurse at the clinic? The red flag is "the other nurse" will call you. One of our MAs has used that one on the phone. When the "other nurse" does call you, you will hopefully be able to have a professional conversation with her.
Are you sure you were even talking to a nurse at the clinic? The red flag is "the other nurse" will call you. One of our MAs has used that one on the phone. When the "other nurse" does call you, you will hopefully be able to have a professional conversation with her.
Yep, I'll probably call again on Monday at a slightly different time.
It is obvious that you have the child's best interest at heart and are doing your best to keep him stable. However, let me throw a few thoughts out for consideration if you would?
Noncompliance will not change because you believe it should. It appears you are looking at things from your perspective, not the family view.
What is the biggest barrier to forward progress? There appears there may be generational conflicts, diet history issues, and willingness to try alternate ideas involving Mom and Grandmother.
Are you allowing Mom to be "in control" of her child? Is this a sign she is over-whelmed and doesn't know how to deal with those emotions. For some asking for help is difficult or seen as a sign of weakness.
Who is setting goals for the child? Are you asking what mom wants? Are you willing to let her fail so she learns to trust you and recognize you may have information to a better way?
Failure may facilitate learning or may show Mom indeed has neither skills or interest that supports not only a protective service's call but will facilitate action. In the real world you have to show harm and intent or inability to manage.
EDUCATE - DOCUMENT - OFFER SUPPORT - DOCUMENT - GOALS/PLAN/SUCCESS OR FAILURE - DOCUMENT!
Nurses have an extensive amount of knowledge. We know what will happen when our patients or those caring for them fail or make less than optimal choices. We want them to avoid those. However, the reality is nurses can't change choices, only influence them when and if people are willing to listen, consider and then change actions. This is tough on our hearts especially when children are involved. In the end, we need to: Foster trust without judgement; Be willing to let our patients/caregivers fail; Be open to allowing them to progress and learn at their pace; Evaluate and cooperatively plan how to make their reality better on their terms; and while knowing the potential negative outcomes, revel in the improvements, no matter how small, when they occur.
Okay so hear me out- please know I am not in any way defending the mom here. From your description, she is not appropriately engaging in her child's school and medical needs. And that is unfair to her child and to the school.
But. I have to say, the response you got from the clinic nurse really did warm my heart. It is rare to hear someone come to our defense so readily. We all love to praise the shining superhero parents who devote their lives to their disabled/ill children. But what about the rest of us? Those of us who can't (like this mom maybe?) or choose not (like me!) to take that path. I've got a kid with a progressive disorder. It's called ataxia telangiectasia if you want to google and bum yourself out. Do you have ANY idea how many MD appointments I've cancelled last minute, for terrible reasons like I just don't wanna go? Or how many medical forms I have failed to give the school nurse because it doesn't even make it on my to-do list? How many times I've chosen beer and netflix over an enriching activity with my kid? I go to the school meetings, but I have to phone in from work and cut the quarterly ones super short. And sometimes I don't even pay attention. I am just telling the truth here.
It is possible that she doesn't care about her kid. But is more likely that she loves her kid, and that there are medical/educational/socioeconomic factors that are contributing to this situation. I certainly don't have any sage advice beyond trying to reach out to the mom in a nonthreatening way, to establish a human connection with her.
Leaving aside any concerns you have for the child, just try to figure out who she is and how any identified barriers can be addressed. This is your role as a nurse- you have to fit the medical problem into a holistic context. The problem is lack of engagement from mom. What is it related to, and what evidence do you have to support your assessment? What interventions and outcomes will you plan and how will you measure your progress?
Maybe the response from the clinic nurse is a cue that you might want to re-examine your approach. Because regardless of your intentions, the RN must have picked up on your feelings for this mom. So probably mom is getting that vibe as well. Again, your intentions are good. But when we aren't meeting our desired outcomes, it is time to re-evaluate our nursing care plan.
It does sounds like he needs help learning to manage his disorder autonomously; mom doesn't seem to be helping him with that. You could make such a huge difference in his life there. But the clinic nurse is right, at least in sentiment. I never thought this is how parenting would be. I did not think this was what my life would look like. I wouldn't trade my kids for the world, but I also won't pretend it isn't terribly burdensome. And very lonely. It's nice when people stick up for us.
I am really confused as to why you didn't plan for things like the bus and who could provide glucagon when you aren't here. Even if you had trouble tracking down mom for details, you still had notice a child with type 1 was coming under your care, right?
As you noted, your job is to keep him safe and healthy while he is under your care. So why in the world didn't that get set up when you found out he was coming?! I must be missing something here, so i'll just give the benefit of the doubt.
It is not selfish or weird in any way for mom to want a more convenient school schedule, and to take advantage of the bus service like every other family.
I am really confused as to why you didn't plan for things like the bus and who could provide glucagon when you aren't here.
She said there is no one who can do glucagon because it can't be delegated in her state. The school district would have to hire another nurse or pay her overtime. I have several diabetics in my school who have glucagon ordered, but didn't bring it to school (ditto with epipens, inhalers, benedryl, etc). In my district, the plan is to call 911 in an emergency and let EMS take over for students who don't being medications. Ideally, every student would bring their medication to school and every school would have a nurse to give it, but we don't live in an ideal world.
Part of me wonders if that nurse was, in fact, a nurse. I also imagine that this time of year the clinic has been dealing with a lot of phone calls from school nurses, health staff, and parents. She was definitely condescending, but I would just brush it off. If it happens again, talk to their supervisor. Anyone can have a bad day, but consistent rudeness is another matter entirely.
I have a child with a chronic health problem and another who carries and Epi-pen to school, so I guess I can see both sides. I'm surprised a new 504 hasn't been formulated by now.
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!
I assume she bought him a doughnut or a muffin. DD breakfast wraps look pretty diabetes-friendly. The Egg and cheese wrap has 13 grams of carbs. Does the school serve breakfast?
I have worked in a special needs camp (MH/MR as the basic dx) and of course have several diabetics each session. It amazes me that they would send a nearly empty bottle of test strips, barely enough syringes (if they send any at all) and parent/caregivers who act like I am asking them to swim to the UK to bring me what is missing (at most it is usually a 2 hour drive). These parent/caregivers are ones whose vacationer has been coming there for MANY years. And the paperwork??? Don't even get me started on the lack there of...
I am really confused as to why you didn't plan for things like the bus and who could provide glucagon when you aren't here. Even if you had trouble tracking down mom for details, you still had notice a child with type 1 was coming under your care, right?
As you noted, your job is to keep him safe and healthy while he is under your care. So why in the world didn't that get set up when you found out he was coming?! I must be missing something here, so i'll just give the benefit of the doubt.
It is not selfish or weird in any way for mom to want a more convenient school schedule, and to take advantage of the bus service like every other family.
We found out he was coming after the school year had already started and we can't just "hire a nurse" . My district has a nurse shortage. We have been looking, trust me. And part of the issue of getting everything "set up" before he actually started was mom's failure to show up to all of the meetings, or bring in any type of paperwork (see my other posts about that). While it is part of the school nurse's job to help coordinate care for these kids, it is definitely my job to jet "set up" another nurse, "set up" the bus for him, etc. Mom definitely needs to do her part so that the coordination can actually happen (again, see my previous posts about that).
kidzcare
3,393 Posts
Ug. Is he aware enough to know what to be on the look out for?