Ok, so I'm a school contract nurse through a home health agency working with a very young diabetic patient. The school is great, couldn't be more supportive of my role and continuously praise my efforts at keeping the client's blood sugar levels within range. That being said, the parents are much less than cooperative, downright non-compliant mostly. They have the "feed whatever whenever and cover with insulin" mentality, and cannot seem to understand why I won't jump on board with their dangerous, and if I'm honest, abusive behavior. After a particular incident occurred recently in which the client's blood sugar was well above the MD's range for the client, I refused to give the client a sugary, carb-filled treat with the client's classmates. I discussed the situation with my supervising RN as well as the school principal and we all agreed that adding fuel to the fire was a big no-no for BS levels, regardless of the fact that everyone else was going to have the treat. The client's parents were informed well ahead of the event that the class would have said sugary treat and could have brought in a diabetic-friendly alternative but did not do so. Furthermore, the parents called my employer after I clocked out to inform them that they were furious with me denying their child the sugary treat since everyone else had it (I took my client onto the playground so nobody ate in front of client) and since BS was high and I had to treat with insulin anyways why couldn't I just give the kid the treat?! Well, after much griping, my RN mgr decided to call me and determined it would be best if I were to take the next day off-without pay!!!- to let everyone cool down. So, what can I do about this whole situation? Keep my mouth shut and poison the kid next time like they wanted me to do so I don't get suspended without pay? ~feeling like a flamin' bag o' poo after being stomped on a few times right now
I agree with others who thought the situation was handled poorly.
It reminds me a bit of my first clinical where one of my classmates was outraged a nursing home resident with diabetes was allowed to have a danish for a snack.
I was wondering if this was a true suspension or more a matter of request for a different nurse and OP not re-scheduled as of yet. I can't imagine being actually suspended over a complaint like this. Disccusion on how to handle differently but not suspension.
suspended for 1 day without pay and without the option to work with another client, then removed from the case at my request.
Specializes in Complex pedi to LTC/SA & now a manager.
suspended for 1 day without pay and without the option to work with another client, then removed from the case at my request.
Probably a good thing that you asked to be pulled. If the parents have an issue now they may look for other issues to complain about going forward so it's better to walk away at your own accord. You now have experience to help you move forward and clearly are learning from this experience.
I never pried anything from the client's hand or whatever simile you'd like to insert, and the school/my supervisor made the decision to send the child to the playground then the teacher could give out the treat to the other kids. Yes my client knew it was ice cream day, but nobody had it in front of them, nor did I remove the treat from their possession. I'm not an evil witch stealing treats from children for ***** and giggles here!
I'm sorry - my comment was not intended to criticize you at all.
Again, I was merely responding to a comment about parents calling the shots about physician's orders. I tossed the cupcake comment in because people were associating the cupcake with the actual orders.
So hard on the internet sometimes to get a point across.
My diabetic student on the insulin pump has parents who are strict about what they want. No snacks, period, at snack time. If the snack is store bought and the carbs are listed, then the snack is saved for lunch or taken home. This goes for parties as well. He doesn't really mind. As I mentioned, he picked out two cookies (25 carbs apiece) and had one after eating his lunch so I could add those carbs in with the lunch carbs. The other one he took home.
There is nothing in the orders about snacks or how to handle parties at school.
My comment about physician orders pertained to insulin, carb-counting ratio, emergency care, etc. Not cupcakes.
I think I'm lucky in that my student is really mature and knowledgeable for a 3rd grader and has no problems with being patient about getting a treat. He knows how to use his pump as well and we are working towards total independence for him - when the physician says it is ok. Not the parents. His parents do let him take his own blood sugar and run the pump while supervised. I do too, with parent's permission.
Please don't take what I'm trying to say as a criticism of you. I really haven't commented on that . . .yet.
FWIW my client's teacher once excluded her from the class for a certain situation after explaining to me the reason why. It had nothing to do with having, or not having, a sugary snack, but it was exclusion nonetheless, and based upon her reasoning, justified. Her classroom, her call to make.
OP, I am very sorry that you had to ask to be removed from this child's school nurse. You seemed to really cared for this child.
I'm sorry if you have felt attacked in this thread. I have learned so much from this thread. I thought I had a pretty good understanding of DM. Boy was I wrong.
Thank you for starting this thread. I, and I'm sure many others learned a lot from this thread.
People die from hypoglycemia. Long term hyperglycemia is what causes the problems, and one cupcake isn't going to put their sugar high enough for long enough because you'll end up correcting it with the next dose anyway.
Let the kid be a kid. I have a close friend who I went to nursing school with how said that the biggest misconception about diabetes is that having the occasional sugary treat would kill him.
@Spidey's Mom, no offense taken, the comment wasn't intended towards you, moreso towards some of the comments basically equating me to a sugar nazi afraid of giving insulin to the client or not letting the client be a kid. I have no problem whatsoever with the occasional treat but, as I mentioned in a previous post, every single meal for this client is laced with tons of sugar from sugary cereals and choc milk for breakfast to a packed lunch full of graham crackers, cookies, chips and more choc milk, to then these snacks after lunch. Avg BS every single day for this client is 245+ on avg, according to their meter's 30, 60, 90 day averages. In this scenario, they have sugar coming out their ears almost, so i don't see how I'm not letting the kid be a kid b/c I advocate for a healthy breakfast/lunch/snack EVERY SINGLE DAY to no avail, and just could not make myself feel comfortable giving a BS 250+ more sugar when 45 mins heavy cardio + insulin couldn't even get the BS from lunch down. Normally, when the BS is that high after recess and lunch insulin, the client doesn't have a carby snack in the afternoon and the parents didn't care then b/c they know it is not good for the client and affects the afternoon lessons.
@Spidey's Mom, no offense taken, the comment wasn't intended towards you, moreso towards some of the comments basically equating me to a sugar nazi afraid of giving insulin to the client or not letting the client be a kid. I have no problem whatsoever with the occasional treat but, as I mentioned in a previous post, every single meal for this client is laced with tons of sugar from sugary cereals and choc milk for breakfast to a packed lunch full of graham crackers, cookies, chips and more choc milk, to then these snacks after lunch. Avg BS every single day for this client is 245+ on avg, according to their meter's 30, 60, 90 day averages. In this scenario, they have sugar coming out their ears almost, so i don't see how I'm not letting the kid be a kid b/c I advocate for a healthy breakfast/lunch/snack EVERY SINGLE DAY to no avail, and just could not make myself feel comfortable giving a BS 250+ more sugar when 45 mins heavy cardio + insulin couldn't even get the BS from lunch down. Normally, when the BS is that high after recess and lunch insulin, the client doesn't have a carby snack in the afternoon and the parents didn't care then b/c they know it is not good for the client and affects the afternoon lessons.
If this is every single meal and a consistent pattern then the endo should be called and his insulin dose needs to be adjusted. Fix the insulin dosage first to get his numbers in range and then gradually start working on improving the diet. This to me would be the best way to advocate for this patient. I'm just curious if he was eating crap every day and had fantastic numbers would you be as concerned? Obesity is an epidemic and kids are eating crap everywhere. I get that! I totally do, but in this case you know the kid is eating junk and the parents are not changing this. That's likely not something you will fix easy, but you can suggest adjusting his insulin dose and at the very least improve his glucose readings.
Maybe those parents need a field trip to the local dialysis clinic to see what hyperglycemia does to the kidneys, lifestyle, eyesight, amputations, etc!!!!
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ArtClassRN, ADN, RN
630 Posts
I agree with others who thought the situation was handled poorly.
It reminds me a bit of my first clinical where one of my classmates was outraged a nursing home resident with diabetes was allowed to have a danish for a snack.
The resident was over 100 years old.