suspended for doing the right thing...

Nurses Relations

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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 :no:

Specializes in nursing education.
I take it you're British? I haven't heard that term in ages, since I used to be on message boards with diabetics from all over the world that would talk about their DAFNE courses. I had forgotten all about that term. That being said, I believe it stands for "dose adjustment for normal eating."

Yes, I did mean Dose Adjustment for Normal Eating. You are correct and I am smacking my own forehead.

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I am a home health care nurse in Canada and I have an Type 1 diabetic school child as part of my regular patient caseload. I communicate often with the child's mom, and we work together (with the Dr of course) for the best care of the child. The limitation of not having the ability (at your discretion) to speak to the parents does not contribute to developing a therapeutic nurse/clt/family relationship. I would be advocating a change within your agency of that policy!

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I get a sense of a bit of a cultural misunderstanding between the nurse and family regarding food issues. I might be wrong, but I sense the nurse comes from a viewpoint of eating for good health, and saying no to food sometimes for the sake of better health in the future. I suspect the boy and his family regard food and eating in a different way.

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Specializes in critical care.
Sorry, but as a parent I would have been livid if you'd overridden my decision and isolated my child from a class party.

Agreed. As a parent with a child who has a condition that makes him different from his friends, one of the MOST important things is making sure he is not isolated or made out to be different from his classmates. It is not your right or responsibility to do what you did. I'm not sure how I feel about your suspension being unpaid but disciplinary action was reasonable.

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This can't be the nursing supervisor's and principal's first kid with DM, I wonder why they didn't point out the social/psych aspect?

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Apparently you can. It's called a "nursing dose"

Ha!!!

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Specializes in School nursing.

This thread is very informative - I am better for reading it all the way through!

OP, I'd be so frustrated if I could not talk to the parents. I feel like that is an essential part of any diabetic student's care. I would have called about the blood glucose and the snack option. Since food isn't in the guidelines, if the parent wanted the child to eat the cupcake, sure he can eat the cupcake. I'd just document that and talking with/educating the parents, and move on with my day.

I remember growing up I read The Babysitter's Club series (probably giving my age range away here, lol) and was fascinated by Stacey, the character who was a Type 1 diabetic. This was back when sugar was considered a "no-no" and the term brittle diabetic was used by her and others throughout the series.

Flash forward 20+ years, now I'm working as a school nurse and lovingly laugh at what was in those books. I help a few Type 1 diabetics manage at my school, a couple with pumps and one non-compliant (though I really dislike that word) teen that is on a sliding slide after the student was often inconsistent with carb counting. The sliding scale helped and now I am trying to help this teen transition back into a sliding scale with some carb counting per the doctor's order. I don't dose insulin outside of the order, but I have reached out to a student's physician and parent together when I need an order clarified and/or when a student's BG exhibits a noted change. Students eat normally and give insulin as directed. I have had one student worry about dosing during our international food festival day - lots of homemade food. We are a peanut free school that generally discourages homemade snacks unless for a specific festival day; ingredients of the dish must be carefully listed, however. He and I weighed the food options to try and get a accurate count to dose insulin per his orders. He is generally well controlled, so his parents were not worried about his participation and food consumption and I support that, them, and the student. I'd personally rather deal with a student that is in the 200s vs 70 or under, but that is just me. A BG of 70 means the student was likely low for awhile and it could have affected his/her learning. I've had student feels low when their sugar dips below 100 and the classwork can sometimes show it.

I know there is so much I need to learn! Puberty can really throw a student's BG and insulin needs for a loop. (I have seen a 1:9 carb ratio in orders this year.) I'm planning to complete some more CEU's myself this summer to further help my student transition from high school to college someday.

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Trying to deal with insufficient insulin coverage by reducing intake is actually what's most likely to result in ketone production, and the altered mental state that goes along with it.

munro,she has clearly stated that even covering the added carbs has not worked, and she did not state that withholding the extra carbs was the only treatment being given.

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reread, the recess was a substitute reward, not punishment.

I think it was a little much for you to be suspended...

But at the same time I don't agree with taking the kid outside while the rest of the kids were having an ice cream party.

Let the kid be a kid and have some dang ice cream with his/her classmates.

I think sometimes as nurses we need to think about the little things and appreciate the morale of the child. You can argue this child should or should not have had the ice cream...

But at the end of the day would the ice cream have killed him or her? No.

Let the kid be a kid.

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I don't understand how nurses can be so misinformed about this. A patient's, or their POA's, refusal of a physician's order is what we are legally required to abide by. Continue to implement a Physician's order that has been refused is grounds for loss of license and potentially criminal charges.

she specifically stated that the parent could do would they wanted, READ.

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reread, the recess was a substitute reward, not punishment.

Just like that school in New York rewarded kids to poor to pay for a school carnival ticket by separating them from their peers to watch a fun movie? Kids still know that they've been separated from their peers and are being treated differently.

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this dec. was not made only by nurse, the extra recess was given as an alternate reward, because the kid likes recess.

Agreed. As a parent with a child who has a condition that makes him different from his friends, one of the MOST important things is making sure he is not isolated or made out to be different from his classmates. It is not your right or responsibility to do what you did. I'm not sure how I feel about your suspension being unpaid but disciplinary action was reasonable.
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