suspended for doing the right thing...

toomuchbaloney · May 28, 2015

How odd our world is.

If you were a police officer who had just shot and killed the child, you would be sent home WITH FULL PAY while they investigated and most likely exonerated you.

But because you are an RN, and because you were advocating for the best health interests of the child you will lose a days pay to appease the employer.

In both cases the parents will be upset and will complain.

Both individuals are just "doing their jobs".

Isn't that special?

MunoRN, RN · May 28, 2015

It's possible that it might have been reasonable to let the kid have the snack. One myth about diabetes is that it's better to avoid snacking in order to keep blood sugars normal rather than appropriate snacking with insulin coverage as needed. These is what can lead to ketosis (even with a fairly normal BG level), and more importantly this often backfires, leading to binge snacking behaviors which are far more damaging. Ideally the kid gets a reasonably diabetic-friendly snack, but without knowing more specifics it's hard to say the situation really warranted isolating the kid from the group while everyone else had a snack.

Purple_roses · May 28, 2015

These are the parents that are ruining school for everyone else. Now this school is going to basically outlaw sugar for everyone because one parent gets upset that their child cannot have it while everyone else can. Most parents who have diabetic children make homemade treats so that the child won't feel left out. It's a shame that you're taking the hit for this.

meanmaryjean, DNP, RN · May 28, 2015

I think you have a distorted view of 'doing the right thing' for your patient. Do you have a specific MD order limiting this child's intake? Because most diabetics now do NOT have diet restrictions and simply count carbs and take the required amount of insulin for correction.

I believe the parents were right to be upset, and you were wrong to remove the child from a classroom celebration.

jadelpn, LPN, EMT-B · May 28, 2015

I am not sure I would be monitoring the food intake of the child. You can only educate the parents, and go by the FBS information that you are presented with. Unless you are 1:1 with the child, in order to monitor food.

Seems to me like you are stuck between a rock and a hard place. However, it is not up to us to do anything other than educate and then follow the treatment plan/sliding scale for what we are presented with. If the sugars are out of control, then the child needs to be seen by the PCP.

There are many, many food rules at school these days. No peanuts, nuts, gluten....lots of things. Also a lot of rules regarding childhood obesity and sugar. Maybe something to take to the principal regarding no more home made foods. I don't know what the answer is. But if the child makes their own choice at lunch time, again, you are in a thing with sugar control. If the child decides to have breakfast at school, again with the muffins, pastries, that type of stuff.

Maybe the answer is to have this child consume only the food that the parents send that is ADA....

And kids are funny, they like the idea of cupcakes for birthdays, but really, many don't have that stuff at home a whole lot---not like when we were kids. Alternate ideas are fruit salad...trail mix without the nuts, goldfish in a bowl (and they have 999 flavors of goldfish now a days) If other parents are aware of a diabetic in the class, then I don't know one of them who would send their kid to school with sugar snacks. This is akin to bringing peanut butter cookies in a class that has a child allergic to peanuts...

Food issues are huge issues in a lot of schools. I would have conversation with the school dietician (as every school is to have one now) about how to change things.

Meanwhile, I would get CLEAR direction on what you role is in having to be a food monitor. I get that the concern is real, however, it should not fall on you if your role there is to take FBS and cover child with insulin. And next time, the supervising RN needs to have the conversation regarding this exclusion of this child--and take the fall for it when the parents balk.

LadyFree28, BSN, LPN, RN · May 28, 2015

I think you have a distorted view of 'doing the right thing' for your patient. Do you have a specific MD order limiting this child's intake? Because most diabetics now do NOT have diet restrictions and simply count carbs and take the required amount of insulin for correction.
I believe the parents were right to be upset, and you were wrong to remove the child from a classroom celebration.

THIS.

As long as the carb ratio is in play, one can eat whatever they choose.

There seems to be a misnomer out there about correction-carb counting, and unfortunately, this was the end result.

Did you confer with the provider on what the pt is supposed to have?

Just because you believe that the pt needs more "healthy" foods doesn't mean you take it upon yourself to do "what is right"; meaning; you should have allowed the kid to have the snack and have the correction insulin accordingly, THEN start having a conversation or more complex-carb snack ideas, and start the education process from there, and allow the right for the parents to self determine whether your ideas are helpful, otherwise let it be; unless you have instructions from the pt's endocrinologist on the specifics, then yo have made huge misstep; including denying the pt a right to a snack and appropriate coverage, altering the POC.

farmernurse26 · May 28, 2015

@meanmaryjean-so you would not take into account that the blood sugar was already elevated, and that, per MD orders, insulin is only to be given after the client eats, which would cause a severe spike in blood sugar before the insulin had a chance to kick in? Furthermore, because of extenuating circumstances around client's mental status, had I caved and said yes to said sugary treat the client would not have been satisfied with a smaller portion in order to help keep the spike down, but would have "razed cane" until they had the same amount (approx 30g cho) as everyone else. Isn't that considered to be neglect at best, and abuse by-proxy at worst?

Jules A, MSN · May 28, 2015

Although I appreciate your concern for this patient I think you going way out of your job description especially to the point of taking him somewhere else while the class had a snack. As others have written it is not for you to decide his intake. Your job is to give the medication ordered as indicated and thats all, imo. You can educate the patient and his family but can't force them to adhere to your recommendations.

farmernurse26 · May 28, 2015

I am the one-on-one nurse for this client; I monitor their every bite, record, check blood sugars, and treat accordingly for both as, due to their impaired mental function, they cannot do it themselves. That is why I am in a conundrum over this whole situation.

Jules A, MSN · May 28, 2015

I am the one-on-one nurse for this client; I monitor their every bite, record, check blood sugars, and treat accordingly for both as, due to their impaired mental function, they cannot do it themselves. That is why I am in a conundrum over this whole situation.

You are with the child in school 1:1?

mmc51264, BSN, MSN, RN · May 28, 2015

As a parent of type 1 child, it not abusive behavior to let a child have a snack that the other children are having. You CAN cover BG and carbs at the same time. Most times the "diabetic" alternative is usually loaded with sugar alcohols that have the same effect on BG as sugar does.

How old is the child? what were the #s? You said "high" what does that mean to you? in a young child, high is at different parameters that an older child. My child was dx at 2. He is now 11. Things change DAILY with metabolism changes over the years, activity and hormones, it is more of an art than a science. Does the child have a pump? a CGMS?

School nutritionists know NOTHING. Food is usually provided by lowest bidder and schools are on the same tier as prisons. We pack our child's lunch when the carb counts that the school was giving us were whack. (65 grams for a hot dog and then 30 more for the bun. If we had bolused for that-child would have been in a coma.)

Until you have lived the life of a parent of a T1 child 24/7/365, do not judge them. They more than likely know more about their child's disease and rights than you ever will. I am not criticizing you, but it just something you will never understand until you live it.