Student who was refusing epi-pen

[peaceful2100, BSN, RN]

 

Have you all ever had a student refuse and fight you with giving them their epi-pen?

 

That was my kind of day yesterday. By far the most stressful most intense day as a school nurse in my almost 8 years as a school nurse.

 

I have had to give epi-pen a few times since being a school nurse, and never ever had any student fight me. 

 

4th grade girl who is a fairly nice size girl and VERY strong came in stating her throat feels funny and she keeps coughing. I know she is allergic to ALL Nuts. 

 

She said some kid in her class kept “slinging” peanut butter and she kept trying to say stop and moved. It was too late. 

 

I quickly grabbed her epi-pen she said, “what are you doing…no, no, no. Please call my Mom.” I said, I will, but I got to give your Epi first. 

She started yelling, screaming, fighting, hitting my hands. I called Mom. She asked to speak with her she was still refusing. Mom asked,  what do I need from her. I said I need you to come. EMS is on the way regardless if I give the epi-pen or not. 

 

Principal/Vice Principal came running in. They tried to help as I tried to give. She started fighting them too. She kept sliding to the floor.

 

Her Aunt who is a Teacher there, but had just left to go to her other school quickly came back when Mom called her. 

 

She fought her Aunt too. We was all trying to get her to cooperate. She wouldn’t at all. She was extremely combative. Her lips and face was clearly starting to swell. All I could think of is how can I be quick enough/efficient to give her epi-pen. 

 

Mom finally came and saw her resisting and being combative,  and Mom sternly looked at her, and said, “You stop that right now. “She grabbed her, and held her down. I was quickly able to give the Epi-Pen. This girl has a very intense fear of needles. 

 

EMS arrived 30 seconds later and transported her to hospital. 

 

That was scary, super scary. My nerves are still way on edge. 

 

Today we have a snow day and I am so glad even though I despise snow. 

 

This school year has now officially wiped me entirely out. I was contemplating coming back next school year because this has been a very horrific year, but after yesterday I think my mind is now made up. I don’t think I will be back. I just got to figure out what in the world I will do next. I have been a school nurse almost 8 years, a clinic nurse for 4 years prior to that, foster care nurse case manager, and I haven’t step foot in a hospital since 2005. However, I will never ever do inpatient nursing ever again. I can’t do 12 plus hour shifts, and that is not my interest at all. 

 

[NutmeggeRN, BSN]

ugh..what an awful scenario. You have to know that is probably the ONLY time that will ever happen again (unless it is her). This has been a miserable couple of years for us all. Hopefully you  have a Winter or March break coming up soon. Take that time to reflect when you are still not traumatized by this event.

[k1p1ssk, BSN, RN]

This does sound like a nightmare. But I think you did everything you could under the circumstances! How were you supposed to anticipate this was going to be her emotional reaction?

I wonder if it would be worth your time/effort to establish a plan with her - who would be present if she needs another epi-pen at school, how that will look, and what happens if she refuses again.

I wonder, does your school/district special ED dept. offer restraint training? This was a life or death situation in which a temporary hold may have been appropriate - not only could she have died from the allergic reaction without getting this life-saving injection, but she could have seriously harmed herself and others with her fighting. Trained individuals could help to at least restrain her long enough to get the med into her. It is certainly a touchy subject, and you may not be able to do anything of this nature, but what would the ambulance have done, or ED Staff? And I know how hard this can be - I once had a patient who weighed less than 60lbs who was so violent it took 2 security officers and 2 nurses to hold him to receive his (very much needed) Haldol injection. 

Additionally, since she already has a needle phobia and anaphylaxis can heighten anxiety, it may be worth exploring a 504 for her, with a specific intervention for a hold if it becomes necessary to administer her epi-pen and she refuses. 

 

[Flare, ASN, BSN]

I had this happen only one time.  I had a middle school student with an undiagnosed allergy come in with all of the classic signs of anaphylaxis.  As soon as he realized that I was preparing to give him a shot in his leg, he began to panic and run from me.  Fortunately, an administrator came by and together we cornered him and I was able to put the epi in his leg.  After the dust settled, he said he felt silly for overreacting and recognized the gravity of the situation.  

[SandIsMyGlitterRN, BSN, RN]

What an awful experience!  When I started in school nursing I was so happy to tell students that nothing ever hurt when they came to the nurse's clinic (I didn't think about epi pens).  This last couple of years have broken my heart because we now give COVID vaccines in clinics and, of course, we are swabbing for COVID.  I now have students afraid to come to the clinic.  It breaks my heart.