What is your head lice policy?

Purple_Scrubs, BSN, RN · May 18, 2009

We have the same no lice/no nit policy. I hate it, it goes against the recommendations of virtually every major pedi organization, but we keep it because parents would throw a fit if we did not.

So, we are supposed to exclude for lice or nits, and our paperwork says that they can be treated at home and come back the following day. No additional days are excused. They have to come to my office to be checked to make sure they are nit-free. I have never found one to be 100% nit free the next day. If there are only a few, I comb them out myself. If there are tons then I send them back home to try again. I apologize and let the parents know it is policy and my hands are tied.

It is very frustrating. Our job is to keep the kids in school yet we have to send them home over something so minor, that is usually not passed around at school anyway (slumber parties are the big culprit!)

cowgirlBSN · May 18, 2009

Thank you so much for replying! I'm trying to decide whether I should make it manditory for them to be out 24 hours. Like you said, I've never had anyone free from lice the next day. That's my reasoning behind making them stay home 24 hours. (Not sure that it would do the trick but maybe make them work on it a bit harder...)

NurseLoveJoy88, ASN, RN · May 18, 2009

Our policy is home 24 hours after start of treatment. We must also have proof that the student has been treated my bringing in the box of treatment used. We also have to do a head check one week after the original visit to make sure student is in fact nit free. Students may return to school either after starting treatment or after all nits have been removed manually.

Artistyc1 · May 18, 2009

My school is following the Harvard School of Public Health Protocol. We don't send children home for lice, but call the parent to let them know that the child must be treated. We advise the parents on the importance of removing nits manually. When parents are not diligent about this, obviously we will have a certain number of chronic cases. We can keep checking the child, but since we can't follow up on who may have lice at home, sending the child home over and over seems to be punishing and stigmatizing the child. There will always be parents that either won't put in the effort, or "don't have time". Since it is not a hotline-able issue, there is not much more to do. Old no lice/nit policies in the past for my district only forced the same kids to stay home for many days- it certainly didn't help the kids that needed to be in school the most.

cowgirlBSN · May 18, 2009

I agree and have shown our administration a lot of documentation on head lice and whether allowing them to remain in school or not. We are a small town school and changes aren't made too often. They were dead set on this issue.

Maine17 · May 19, 2009

I agree completely with Artistyc1-we do the same thing. Cowgirl-Part of your job is not only educating your students/staff, but your administration also. Send them copies of what AMA, NASN, Harvard School of Public Health etc. all say about No nit policies-they are all against them.

kidsnurse1969 · May 20, 2009

I am in the same small town, no change, lice-phobic situation. None of the evidence-based, best practice documentation has done any good in my district either.

Just last week, I had a teacher send me a note telling me that if this student has ANY (underlined-twice!) nits, she was to be sent home as per the policy (she is on the policy review board and ignored all of the professional documentation that I had sent to them). I responded to her that if she wanted to manage this particular case that I would be happy to step out of it completely.

I try to play down the lice as much as possible. I do my best to educate people. I get nowhere!

Artistyc1 · May 20, 2009

I am in the same small town, no change, lice-phobic situation. None of the evidence-based, best practice documentation has done any good in my district either.
Just last week, I had a teacher send me a note telling me that if this student has ANY (underlined-twice!) nits, she was to be sent home as per the policy (she is on the policy review board and ignored all of the professional documentation that I had sent to them). I responded to her that if she wanted to manage this particular case that I would be happy to step out of it completely.
I try to play down the lice as much as possible. I do my best to educate people. I get nowhere!

Oddly, I had little difficulty in breaking the news to all the teachers at a meeting, that we had changed our procedure district-wide. They seem to trust the district medical staff's judgement on this issue. However, I have had much difficulty in convincing the other staff (teachers aides, etc) of the wisdom of the new procedure. I have tried education, stats, etc. They have the attitude "I just don't want it, PERIOD!" They still cling to the old wives tales, etc. One aide told me that the "child may now be lice free, but I know that they didn't treat the cat", but didn't believe me when I advised her that they are human head specific. :banghead:

cowgirlBSN · May 20, 2009

Maine, I have made several attempts to "educate" our administrators on this issue, as I had said in a previous post. I can only suggest what I think is medically best, show them evidence such as the Harvard School of Pub Health protocol, and then they ultimately decide. I have to follow what they have set in place and make the policy per their decision, which has been no lice/no nit.

LucyGoosey · Jun 9, 2009

All No Nit Policies are not written the same. Discussions like this demonstrate just how far the confusion goes.

The No Nit Policy we know and respect is not about dismissal or treatment. It's about educating the community in advance about head lice and helping families learn how to screen and detect them as early as posible so they can send their kids to school lice and nit free. The statement (link below) is proactive --prevention based AND in spite of the bad press and misinformation ...it's also evidence-based.

Sending kids home as the first step in managing head lice is reactive, treatment- based and promotes chaos and potential harm to kids who get treated again and again with products that never were and never will be 100% effective unless all the nits are removed. Your No Nit Policy may not resemble the standard No Nit Policy in any way. The No Nit Policy is about doing the best we can in an imperfect situation. Pediculosis is a communicable disease that requires a communicable disease prevention approach.

Hope you will have a chance to read the No Nit Policy statement on headlice.org. It was written to help nurses as much as it was written to protect kids and families. It's an administrative policy not a treatment policy. It's a prevention policy not a punishment policy. You can download it from here as well. http://www.headlice.org/downloads/nonitpolicy.htm

Artistyc1 · Jun 9, 2009

I understand the CONCEPT of the "no nit policy" just fine. The problem is- people have to want to be educated. Many families routinely don't take very good care of their kids, and they have to want to do that as well. I know it is un-PC to say so, but there it is. If the parent is too lazy, "busy", or whatever else to remove the nits, the kid is punished. It is not a CPS offense, until the parent is reported for educational neglect after the child has missed a huge number of days of school because of lice. The child's classmates know why the child is out, and the stigma can last a long time! Since nits themselves are not transmissable, I still feel that the headlice.org policy is not a better policy than the Harvard policy.