Violent Student in HS Nurse's Office

[CrazyTrainRN]

I need your thoughts and advice on this situation. This student has been a problem for years, but it has escalated to this. He is 17 and a senior, but failing. I do not feel we are getting support from the HS administration. There have been numerous meetings with this students parent.s They say what we want to hear but never follow through. I know he needs help, but it has gotten to the point where it is beyond our scope as school nurses. I have been physically sick since this happened and I am an emotionally a wreck, as is the other nurse. Neither one of us has ever experienced a student act like this. Words could never accurately describe what happened and how fearful we were. I will be as generic as possible to protect all those involved. Here is my account:

On Thursday, January 21, 2010, at approximately 9:25 a.m. Student X came into the nurse’s office. I noticed he had something all over his face. I asked him what it was. He said chocolate from chocolate donuts.

Nurse A told Student X that his father called the school and was looking for him. (The previous weekend he had been missing for 3 days and when the father found him, he had no insulin and a blood sugar of 800) He said he left school to get donuts with friends. When he returned to school, he did not go to his first hour class because he had work to do and went to the library instead. Nurse A asked him what his blood sugar was earlier and he said 123. She told him that since he ate donuts he needed to take his blood sugar. I watched him take his blood sugar (because he lies to us about his numbers) and it was 509. I told Nurse A that his blood sugar was 509 and Student X replied that he needed to go home. Nurse A called the assistant principle to come to the nurse’s office. Student X became agitated and started talking to himself, using the word “f***.” When the assistant principle assigned to this student. He arrived, we told him the situation, and he asked Student X to take a walk with him.

Student X returned to the nurse’s office to get his book bag. I asked him what he was going to do. He said he was going to class and left the office.

The assistant principle then came back to the nurse’s office. There was discussion about Student X and the concerns we are having with him, such as uncontrolled blood sugars, possible substance abuse issues, mental health issues and his disruptive behavior in the nurse’s office. We agreed that his father and his doctor should be contacted regarding these issues. Nurse A told Assistant principle that it was not safe for Student X to be back in class with a blood sugar over 500. Nurse A called the father and left a message on his phone to call her back regarding Student X.

Student X returned to the nurse’s office. We requested he give us a urine specimen so I could check his keytones (neg). Student X's father called him on his cell phone and after talking to him a few minutes, Student X handed the phone to Nurse A. While Nurse A was on the phone with his father, Student X became belligerent and agitated. He yelled several times “Let me talk to my dad! I wanna talk to my dad!” I told him that she would let him and he needed to be quite. He continued to cuss, stomp around and yell. After Nurse A was done talking to the dad, she handed the phone to Student X. He began screaming and using foul language, such as “I f***ing want to go home!” “The nurse is a f***ing liar!” “The nurse is always in my f***ing business!” “I am not on f***ing drugs!” His dad hung up on him. He called his dad back and continued to yell and scream as loud as he could. His behavior was threatening and becoming more violent in nature. After 10 or more minutes of this behavior, I felt as if Nurse A and I were in danger. I did not want to agitate Student X further by calling for help on my radio, so as discretely and quietly as I could, I dialed Officer Q's (resource officer) extension. He answered the phone and I whispered in the phone “come down here,” then was quiet so he could hear Student X screaming. Officer Q came directly to the nurse’s office and witnessed Student X's behavior on the phone with his father. He told him to calm down.

Student X handed the phone to Nurse A to talk to his father. Officer Q tried talking to Student X, but he continued to scream and yell. Officer Q told Student X to lower his voice. He was screaming and cursing so loud that Officer Q told him to lower his voice as he was taking that as a threat.

The head principle came into the office. Officer Q said “This is a safety issue.” Student X continued with his rant. His face was red; he was crying and grabbing his face and hair. He was screaming and yelling things such as he was going to “gouge his eyes out.” He was continuously screaming, “I want to go home.” Officer Q again stated “This is a safety issue.”

After this going on for many minutes, the head principle convinced Student X to walk to his office. They escorted Student X out the door. Nurse A stated as Student X walked out the door, he mouthed the word “die” to her.

Later in the afternoon, we had a meeting with the head principle, 2 assistant principles and the nursing supervisor in the nurse’s office. We agreed that before Student X returned to school, several things would happen: 1) Student X's doctor would be contacted and written medical clearance would be obtained; 2) a 504 plan would be implemented, or medical homebound would be put into place; 3) we would have a meeting with Student X's’s parents, which would include nurses, all assistant principles and principle. The head principle said he would call the parents and let them know that Student X could not return to school until these things were accomplished.

On Friday morning (January 22), I was informed that Student X was allowed (by the head principle) to return to school, but was asked to leave because he did not have his diabetic supplies. (Not because of his behavior the previous day!)

Student X's behavior has created a hostile work environment for Nurse A and me. He should not be allowed to return to school due to the unstable, irrational and threatening behavior he has displayed in the past, and on January 21. It is a safety issue for Nurse A and me, as well as the students and faculty. If Student X will be staying with the school district, it is my recommendation that he be placed on medical home bound.

my name and credentials

position in the district

[CrazyTrainRN]

I would also like to add this is not the first display of violence in our office from this student. I was not in the office the first time. It was back in the fall of this school year. The other nurse said he was screaming and banging his head on the concrete wall and cabinets and punching himself in the face. The resource officer and asst principle responded. She talked to the head principle about what occurred. Not one thing was done about the situation.

[Purple_Scrubs, BSN, RN]

Holy Cow! I really don't know what to say, except my thoughts are with you. And maybe contact HR if the school staff continues to put you in danger by allowing this student on campus without the very reasonable terms you laid out being enforced. Hugs to you.

[pvtschoolnurse]

Sounds like there is alot going on at this students house....have Child Protective Services been involved?

I hope you have a better week.

[Flare, ASN, BSN]

i feel your pain. nothing worse than when your principal is an in effective disciplianarian. this student is not a young child - he should know how to control his behaviors. Threats against you and the other nurse should be taken as serious. I mean if these threats were against another student there would probably me harder repercussions. I would contact your nursing supervisor immediately and let him/her know that the conditions for the student's return were not met and that head principal went back on the condition set forth and allowed re-admission despite none being met. Snce this is a student that you have frequent anticipated contact with, you are within your rights to feel threatened. If you don't get satisfaction from your head of nursing, contact your union rep.