suspended for doing the right thing...

Nurses Relations

Published

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:

I was diagnosed type 1 at age 10 back in 1982. I didn't have a school nurse back then. Just my parents and myself. I was mortified when I was singled out all through school. "Are you allowed to eat that?" "You're not allowed to eat that!" ETC, ETC, ETC!!!- especially when going out to eat with the team after sporting events!

Look at me now! I'm 43 years old, a nurse working in a fast paced LTACH! And I'm still a type 1 diabetic with no complications at this time AND I eat whatever I want and I was never-by any means-compliant.

If I end up with complications, I have no one but myself to blame... It seemed like the more people would deny me or treat me differently, the more I would rebel and do what I wanted.

I'm sorry you were suspended for doing what you thought was the right thing to do.

Up Vote Up Vote ×
I don't have advice for you, but I just really want to thank you for doing the right thing and taking care of the child!

It sucks that they want to suspend you over this! It makes me mad! Please keep doing the right thing anyway.

Thank you for your kind words Invitale, they are much appreciated after going through this ordeal.

Up Vote Up Vote ×
Specializes in Psychiatry, Community, Nurse Manager, hospice.

Okay, I'm reading that now. I'm not a nurse yet, so I didn't know.

Up Vote Up Vote ×
Specializes in Oncology.
I was diagnosed type 1 at age 10 back in 1982. I didn't have a school nurse back then. Just my parents and myself. I was mortified when I was singled out all through school. "Are you allowed to eat that?" "You're not allowed to eat that!" ETC, ETC, ETC!!!- especially when going out to eat with the team after sporting events!

And if not that, alternatively, "Are you low? Do you need to eat? You look low!" I'm just tired dammit from staying up late to finish that assignment!

I'm sorry you were suspended for doing what you thought was the right thing to do.

Me too. It truly does seem your intentions were good and your heart was in the right place.

Up Vote Up Vote ×

Me too. It truly does seem your intentions were good and your heart was in the right place.

I agree and I do not think this was suspension worthy.

Up Vote Up Vote ×

I still get lots of "should you be eating that" despite being controlled with no complications. It really dies surprise me how many people do that rather than trusting that I know what I am doing.

Up Vote Up Vote ×

@blondy2061h, thank you. i was just afraid that due to the client having an almost 120g CHO lunch (almost double their MD's recommended meal amount) less than 2 hours before the treat time and this client's tendency for the insulin to "snowball" in their system that the sugary lunch & treats would wear off with all the exercise while the insulin was still working, and also knowing that after my shift ended no one would be rechecking the client's BS for at least another good 3-5 hours while the client stayed with a non-medical care giver. Also, cookies, doughnuts, graham crackers, pancakes, sugary cereals and chocolate milk are daily staples for the client as well, so I was trying to help reduce the carb load on their poor body where I could, and offered a protein snack replacement so the child could at least be a part of the party but the child adamantly refused. The parents weren't contacted regarding the issue b/c as a contracted school employee I am to have no contact with parents-morning reports are done through questionnaire slips as are my ending shift reports, so I was to discuss with the school how to handle the situation.

Up Vote Up Vote ×
Specializes in Critical Care.
@blondy2061h, thank you. i was just afraid that due to the client having an almost 120g CHO lunch (almost double their MD's recommended meal amount) less than 2 hours before the treat time and this client's tendency for the insulin to "snowball" in their system that the sugary lunch & treats would wear off with all the exercise while the insulin was still working, and also knowing that after my shift ended no one would be rechecking the client's BS for at least another good 3-5 hours while the client stayed with a non-medical care giver. Also, cookies, doughnuts, graham crackers, pancakes, sugary cereals and chocolate milk are daily staples for the client as well, so I was trying to help reduce the carb load on their poor body where I could, and offered a protein snack replacement so the child could at least be a part of the party but the child adamantly refused. The parents weren't contacted regarding the issue b/c as a contracted school employee I am to have no contact with parents-morning reports are done through questionnaire slips as are my ending shift reports, so I was to discuss with the school how to handle the situation.

Does the school have legal custody of the child? If not, you are still under the ethical and professional obligation to ensure that the patient or their decision makers (the parents) have their right to refuse aspects of the Physicians recommendations, regardless of who your contract is with.

Above all, the responsibility of the nurse is to advocate for the patient's wishes. A nurse who isn't doing that I would argue is not fulfilling the basic requirements of a nurse.

Up Vote Up Vote ×
Specializes in Oncology.

it does sound like there is room for improvement in the diet, not so much from a diabetes point of view, but even just from a general health and nutrition point of view.

Up Vote Up Vote ×
Does the school have legal custody of the child? If not, you are still under the ethical and professional obligation to ensure that the patient or their decision makers (the parents) have their right to refuse aspects of the Physicians recommendations, regardless of who your contract is with.

Above all, the responsibility of the nurse is to advocate for the patient's wishes. A nurse who isn't doing that I would argue is not fulfilling the basic requirements of a nurse.

I never thought of it from that perspective; I just thought that because the client was in school for x amount of hours/day and because we have documented episodes of altered mental/physical status and impaired cognitive abilities due to elevated blood sugars, that it was my responsibility to follow the MD orders regarding high blood sugars and common sense says not to pour gasoline (aka sugar) on a fire you're trying to subdue (aka high blood sugar). I had no orders to give treats regardless of BS levels, only orders to treat high/low levels and per 15g carb snacks/meals on a s/s basis. I realize that no one is ever going to have perfect numbers, I was just trying to ensure that 1) the client didn't spike too severely and cause damage to small blood vessels/nerves, 2) that the client would not have any adverse reactions once the exercise and insulin caught up to the simple carbs and overtook them, and 3) that the client was still able to function cognitively in order to complete the afternoon lesson which was to happen after the treat but didn't happen b/c of all the ruckus/impromptu mtgs.

Up Vote Up Vote ×

Edited because I'm too crabby tonight to be posting :)

Up Vote Up Vote ×
Specializes in LTC.

Okay, so I'm just going to jump in here: We can eat as we please and cover. That is how it is. I'm a 16 year T1D, I have limbs and eyes and kidneys, I've had good A1C's and bad ones. I currently am at 5.4, eating as I please, and covering. I run marathons. It takes practice to get to that place. This child is still learning. Don't teach them that food=shame and exclusion. That's just sad.

1 in 3 Type 1 diabetic women will experience or suffer from an eating disorder or disordered eating at some point in their lives. Why does this happen? It's complex, but a regimented hyper fixation on "good" and "bad" food is a big piece in this. Check out DWED UK, they have some intresting information on this issue, their founder has published some research as well.

Burnout and depression are also huge issues for us, because it's a tough job and we do it everyday, day in and day out. When you take away celebration and normalcy, you increase our chance for burnout and depression.

It's not neglectful of these parents, who are on a steep learning curve, to feed their child like a normal kid. Yes, that A1C needs to come down but shame and blame aren't going to bring it down. They just wont. Ever. Shame and blame don't work as a treatment method. When you pulled that kid out of class, you did that. You shamed that kid for their disease. A kid that just wants to fit in and be normal. That's hurtful. Forgive me, perhaps I'm overreacting, but I volunteer for a charity that does crisis intervention for diabetics with mental health issues, and I see the end result of this kind of thing. It's not pretty.

Up Vote Up Vote ×
+ Add a Comment