suspended for doing the right thing...

[farmernurse26]

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

[farmernurse26]

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

thank you for sparing me then; i'm very distraught now and feel like I somehow hurt the client's psyche or something, even though they were laughing/playing with me on the playground during the party. I didn't ever want to do that

[vampiregirl, BSN, RN]

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.

Not being able to have contact w/ the parents (responsible party)... that would be frustrating for me in regards to caring for any patient.

It would be difficult to formulate any type of workable care plan (written or otherwise). How are you communicated the expectations of the parents in regards to expectations of education to provide for the patient, offering choices, handling day to day issues?

I can see the OP is very passionate about providing quality care. Part of providing quality care though is understanding that some of quality indicators are set by the patient/ responsible party (along with current standards/ EBP recommendations) - how the patient/ responsible party perceive the quality of care we are providing. That gets really tough if we are not in agreement with how a patient/ responsible party chooses to address a situation.

[blondy2061h, MSN, RN]

Not being able to directly speak with the parents has got to be INCREDIBLY frustrating.

[Alisonisayoshi, LVN]

thank you for sparing me then; i'm very distraught now and feel like I somehow hurt the client's psyche or something, even though they were laughing/playing with me on the playground during the party. I didn't ever want to do that

I didn't mean to make you feel badly, I'm sorry for that. I'm just passionate about this type of thing. You didn't do permanent damage. I really do encourage you to research how to improve this child's A1C without having to take away normalcy. You meant well, you did what you felt was prudent in the situation. Not being able to contact the parents must also be frustrating.

Obviously you care about the pts overall wellbeing and health, and that's the right path. You heard from a lot of diabetics on this thread. I hope it helps to hear the voice of adults who've been doing this a long time, and who've stood in this kids shoes.

[caliotter3]

I have not worked with diabetics for awhile. I like this thread because it has a lot of posts that provide good review/current/useful info, along with the poster's opinions.

[thevez]

I do believe you cross your line there. It was ok to make sure the child's not eating too much sweet but to separate the kid froffrom the class to eat ...there is something wrong there. I do salute you for being passionate about the child's overall blood sugar but please consider not only their blood sugar but also the overall aspect of the child you are treating. Please learn from this and become an even more awesome school nurse.

[13grad71]

I too believe you crossed the line. We educate but ultimately it is up to the client or the client's family to decide, not us. You are not a physician nor the parent and do not have the right to deny that child his snack. You cannot decide what they can or cannot eat. You can recommend. If i was the parent you can bet i will be upset.

[Elle23]

Reading this, I just have to wonder...

Why is the standard reaction these days to overreact?

The nurse in question made an honest mistake that is easily remedied with education.

The child was not harmed. There was no malice intended by the nurse.

And yet (and I see this over and over in the public school where my husband is a teacher), the parents overreact and throw a fit and then the agency overreacts and suspends the nurse without pay (for an easily remedied mistake where no harm was done).

Perhaps this is veering off topic, but we live in such a vicious, reactionary society where grace seems to be a thing of the past.

It really makes me sad.

[jadelpn, LPN, EMT-B]

@Gooselady, I'm starting to realize that even though I had the client's best interests at heart, and only the best intentions, nobody really cares. I truly care for this child and do not want to see them lose limbs like several of my older, non-compliant diabetic friends, and that was my motivation. All anyone cares about is the here and now, instant gratification (oh how different is a cupcake vs a banana), without caring about how that cupcake that *you didn't need* provided no nutritional value then, and contributed to your *now failing* sight and loss of limbs 15-20yrs down the road. Forgive me for having a heart in the nursing field; I guess I forgot to ditch it when I got my license like some others (oh just document, do your best, advocate on paper, blah blah blah).

You may have the child's best interest at heart, however, you are crossing a professional boundary into getting too emotionally invested in this case.

[mmc51264, BSN, MSN, RN]

Perhaps this is veering off topic, but we live in such a vicious, reactionary society where grace seems to be a thing of the past.

It really makes me sad.

Have a child who has a BG of 600 and the people at the school are mandated BY LAW to treat and don't. On regular basis. Or don't check blood sugar or don't realize that a child that you have just treated a low of 60 feels like crap for about an hour and you make him take a test anyway.

Parents are reactionary because many times the school does not follow the law. It is my child's LIFE they are messing with. Like I have said before-live in my shoes for one week and then judge whether I am just being an over-reactive parent.

Oh-farmer-it is called "stacking" of insulin, not snowballing. Insulin administration 101. If you truly wanted to advocare for this child get him.her a pump and a CGMS. It is covered by medicaid if that is relevant

[Elle23]

Have a child who has a BG of 600 and the people at the school are mandated BY LAW to treat and don't. On regular basis. Or don't check blood sugar or don't realize that a child that you have just treated a low of 60 feels like crap for about an hour and you make him take a test anyway.

Parents are reactionary because many times the school does not follow the law. It is my child's LIFE they are messing with. Like I have said before-live in my shoes for one week and then judge whether I am just being an over-reactive parent.

Denying a kid a cupcake once because of an honest mistake is not going to harm the kid in any way. That was what I was talking about.

[tsm007]

Denying a kid a cupcake once because of an honest mistake is not going to harm the kid in any way. That was what I was talking about.

But that is where you are wrong. Go reread the thread and seriously do a search on type 1 diabetes and eating disorders. Nobody is trying to pick on anybody. It is an honest mistake, but saying you're right when you're wrong is going to perpetuate the problem. All of us with diabetes or with children of diabetes are trying to educate. I can just about guarantee this wasn't the first well-minded person to withhold a treat from this child and likely won't be again. Please, please don't mistake disagreeing with being over-reactive.

The OP has come back and I think is starting to see the bigger picture. I think she has very good intentions and has a desire to help. I do think your documented behavioral issues may have nothing to do with diabetes. He could have a secondary mental/behavioral health problem that is not being looked at. I hope others take the time to read the literature on diabetes. I do get a lot of kids eat sugary snacks and have poor diets, but that is kids as a whole right now. I'd just about bet that there are quite a few kids that are overweight and obese in this class. It would be in those kids "health interests" to withhold sugary treats as well. That's just not how it works. We don't get to dictate positive health behaviors. We get to educate, encourage, advocate, and role model. I thought everyone was very polite in this thread and the OP took the feedback graciously.