Trying to avoid a confrontation...

[LACA, BSN, LPN, RN]

i work at a small elementary school. there is a k student here who misses an unbelieveable amount of school. there are things that just don't add up with his mom and his family. last week, his teacher brought him to me because of his finger. when i looked at the student's finger, it was swollen, and part of it was black as could be. it appeared that he had an infection under his fingernail and that the nail was going to come off at some point. i didn't touch his finger at that time, i told the teacher to keep an eye on him and see how he did. the student said that his mom knew about his finger. a couple of days later, the guidance counselor of the school came into the clinic. she asked if i had seen his finger and i said yes, and told her how concerned i was about it. she said that we needed to call mom and tell her to come get him and take him to the doctor. i called the mom and she made up a bunch of excuses and said that she would make him an appointment for the next day. never happened. the guidance counselor, teacher, and i were very concerned over the student's finger. the guidance counselor called the system's family intervention people and was put in contact with social services. ss contacted the mother and told her that she would have to take the child to the doctor to have the finger examined. she had previously said that she called the doctor and he told her over the phone to "cut it open and drain out the infection." this is doubtful, because i can't think of one doctor who would say that to a parent over the phone. she also said that she had been taking pictures of it on her cell phone and sending them to the doctor and he told her it was fine. she has told many, many lies in the past and no one around here believes a word she says. she came and picked him up monday and took him to the hospital to have his finger checked. she is now saying that social services told her that i (the school nurse) was the one who turned her in. i know for a fact that ss does not release any information about anyone who calls. i didn't even make the call. the only thing i have to do with the whole situation is relaying the message from the guidance counselor that he needed to go to the doctor. the mother is convinced, somehow, that i'm the one who is "against" her and is causing all the problem. she has demanded a meeting with me and my principal to "discuss" everything. the principal says he's not meeting with her at all, unless she keeps on and on about it. she is supposed to be here this afternoon to volunteer in her son's classroom (though she doesn't usually show up) and i'm really hoping she doesn't come around me. she seen me in the parking lot this morning and gave me a dirty look. i don't see that we've done anything out of the ordinary. what should i do?

[Purple_Scrubs, BSN, RN]

Do not have any interaction with this woman (and preferably with her child) without a reliable adult witness. Document the heck out of everything. Chances are she is not going to raise too much of a stink about it because she was lying about it. If she continues to talk about this "doctor" who she sent photos to, ask for his/her name and number so you can discuss the case. Try not to stress over it :)

In the future, you might be able to get your principal on board and medically exclude the student until you are given a docotr's note permitting the student to return. You could make a case that the finger appeared to be infected and with MRSA being pretty much everywhere now, you need a doctor to rule that out before the student can come back to class. If you do this, make sure the parent knows that any days missed will be unexcused unless you have a doctor's note with a stated "return to school on" date.

[mustlovepoodles, RN]

I would say you did everything right. I have had to do similar things when parents would not get proper medical care for there children. I even had one parent who blocked my clinic number so she wouldn't have to talk to me. Both her children had chronic illnesses and I had to communicate with her at least once a week. She refused to take my calls and I had to call the grandparents--who live inthe same home! Grandma would take the call, turn to mom and say "That nurse says you need to pick up Angie again!":confused: and then mom would stomp up to school, muttering and cursing, cuz you KNOW it was aaaaaalllll my fault. You can't win over people like that. Then never get it.

I agree with the PP. Don't allow yourself to be alone with this parent. She may be full of hot air, but she may try to hurt you or tell someone that you hurt her. Don't put anything past this parent. If she wants a meeting I would insist that the meeting be held in the presence of an administrator. No admin, no meeting. simple as that. This woman will tell you ANYTHING. Don't believe a word she says.

OP, you did the right thing. It doesn't matter how this was brought to the attention of authorities. If she tries to engage you in that line of thought keep saying, "I do not know anything about that." And you don't! Tell her she'll have to take it up with the principal. And don't turn your back on her.

[LACA, BSN, LPN, RN]

She didn't show up for her volunteer time, which didn't really surprise me. I'm not willing to meet with her without the principal, and unless he absolutely decides to make me, I may not be willing to meet with her at all. I have nothing to say to her. Her son's finger still looks terrible, regardless of what the hospital said. His nail is almost completely fallen off, it got bumped today and he came to the clinic crying because it was hurting so bad. The teacher attempted to call Mom because I had to clean it and bandage it, but she didn't answer the phone. The teacher finally got a hold of the child's dad and he was really nice and was fine with what we did. Will keep you posted if anything else happens.

[llg, PhD, RN]

I think there needs to be a meeting of some kind -- and the school nurse needs to be involved. Someone needs to speak up for this poor little kid and be his advocate. If the teacher, administrator, and nurse all look the other way... then that is a shame.

Certainly, there are correct procedures to be followed ... and I would insist that no one meet with this mom alone ... but society should not stand by and watch the kid suffer until something REALLY BAD happens to him.

Too often, nurses (and others) fail to get involved to protect a child who needs help because we are uncomfortable with confrontation. When we do that, we are failing in our duty to protect the children entrusted (by society) to our care.

[LACA, BSN, LPN, RN]

We HAVE gotten involved, hence the call to Social Services. But there isn't much beyond that we can do. I can't endanger myself or allow the staff here to be endangered dealing with this woman. Meeting with her is NOT going to solve anything at all. It's only going to add fuel to her fire and make the situation worse. We are advocating all we can for this child, but until the Mom realizes that things need to be changed, we're stuck between a rock and a hard place.

[bergren]

How did the finger get injured?

[Flare, ASN, BSN]

I have no problem if a parent is mad at me because I am trying to protect their child. But I also do not meet with that parent alone and i won't speak over the phone unless it is on a speaker and i have another employee there as my witness.

Since dad seems a bit more reasonable, it may be time to call him, and have a frank discussion about your concerns and inform him that the child requires medical attention beyond an alleged phone call to a doctor suggesting that a lancing be done at home. Perhaps dad has no idea what's going on medically with this child and has no idea that mom has been saying the things that she has about her fabulous home care skills.

If no action is taken immediately - then a follow up call to the state is in order. No one like to have to report a parent to the state - but it's part of our job and i'm never apologetic to parents for doing my job and advocating for their children.