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504 Plans and substitute nurses

Discussion in 'Parents of Children with Type 1' started by SarahKelly, Oct 17, 2013.

  1. SarahKelly

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    We had one heck of a day today due to a sub nurse, let's just say her abilities were far below expectations and she didn't follow Isaac's 504 plan at all.
    How would you proceed?
    Do I let the principal know?
    Is there somebody in charge of the nurse pool that should know about all the bumbling mistakes that made my kindergartener now even more afraid to go to school?
    What happens when your child goes to school and their is sub nurse?

    any input on how to proceed would be appreciated. I don't want to go into too many details as right now I am still too amped up to just relay them without venomous anger. :) I am just hoping tomorrow the regular awesome nurse is back!
     
  2. Sarah Maddie's Mom

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    If you feel that the plan was not followed, or that your child was unsafe at school then you absolutely should contact the principal. I'd start there and see how that goes.

    Also, if you have a good relationship with the regular school nurse I could not hesitate to communicate to her that things went awry with the sub.
     
  3. mmgirls

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    I would let the Principal know, but try to handle the situation and future plans thru Student Health Services or whatever the name of the department is that handles school nurses.

    Where the errors made Diabetes tasks related (nursing duties/ medical )or more a accommodations related ( 504)?

    I would demand that any Nurse assigned to your child has personally gone over the Health care plan and 504 and that you be informed when a sub has been assigned.

    Depending on how that convo goes, then you may need to go back to the Principal.
     
  4. SarahKelly

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    thank you both -
    we had medical errors occur (lack of technology understanding) and 504 wasn't followed.
    I am documenting, meeting with the principal, meeting with the regular nurse and adding even more to our 504.
    Any other tips for how to deal with nurse subs? Do you get called when your child has one? Are they pretty competent when it comes to pump/cgm technology?
     
  5. cdninct

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    Does your district have a nursing coordinator? I would ask to meet with her/him, too, because for us, that is the person who decides which sub goes where.
     
  6. missmakaliasmomma

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    I would definitely go to the principal. The sub nurse for my daughter was hired as a sub for when my daughter's 1:1 nurse isn't there. The sub usually covers the nurses lunch so my daughter is comfortable with both. They both know that when in doubt, call me. I make it very clear. However, I'm sure it's easier for them since they just have one kid to worry about, not the whole school.

    If there were a day this year (mines in K too) that neither nurse was there, I'd probably keep her home. The school nurse has basically nothing to do with my daughter.
     
  7. Christopher

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    Did you first attempt to find out if the sub nurse was instructed on the 504? Maybe her "bumbling mistakes" were due to a lack of understanding/training rather than gross negligence.
     
  8. SarahKelly

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    Christopher, that is a good point. And it is definitely my understanding that a nurse would refer to a child with diabetes' 504 plan as our school district has them in place for all CWD. But that is an assumption that I need to clarify.
    However, her mistakes were under the category of "gross negligence" regardless of whether or not she referred to his 504 plan.
    I did follow up with the principal and she has already referred the incident and her concern to the nurse coordinators.
    Today I found out that I wasn't the only parent with major concerns as other parents of children with medical conditions had issues, too.
    Right now I just need to make sure that we have a better plan in place for sub nurse days, something that screams CALL MOM :)
    Today was a great school day for him though, so thankfully his generalized anxiety about returning to school diminished with sight of his normal nurse.
    I will be following up on this though as I want him, and other children at the school, to be better taken care of when the regular nurse is out.
    I was just overwhelmed by what happen and felt I had missed something serious in regards to his 504 plan.
    Thanks for the responses :)
     
  9. virgo39

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    We have had issues with substitute nurses. I tell the school nurse about it, she invariably apologizes, then she discusses the issue with the sub and the district nursing coordinator (who may or may not take it up with the nurse or may remind all subs of an aspect of care), and then she and I discuss whether or not to make changes to the care plan or to our instructions.

    We have changed the instructions and care plan to clarify and simplify things. Our nurse gives me a heads-up if she knows she will be out, and we often have the same substitute nurse, which helps.

    I don't expect the sub to be briefed on the 504 plan so much as the details of DD's care plan. They also seem comfortable calling me, so that helps a lot.
     
  10. swimmom

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    When my daughter was in elementary school, our regular nurse would always send me an email if she was going to be out. I could warn my daughter and go up to school at lunch time to manage her insulin. Maybe ask your nurse if she'd be willing to give you a head's up when she's going to have a sub?
     
  11. SarahKelly

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    I think that is another good point, to ask the nurse or even the office staff for a heads up about when the sub is out. I do feel that they should be able to call us if the nurse is out as there are a small handful of children at the school that have medical conditions and depend on the nurse daily. It was a bit frustrating when I got the message about all that was going wrong at noon and I had to drop everything to be there for the rest of the day. I am thankful I could do it, but it definitely wasn't in the plans.
     
  12. SarahKelly

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    So, the regular nurse (the M-F LPN) has set it up with us that she will call if there is to be a substitute nurse the morning of so that we aren't surprised at drop off.
    The Wednesday RN, whom comes in just to do paperwork, let me know that I couldn't "pick and choose which nurses cared for my son."
    I asked what she meant and she said that I couldn't decide after meeting the substitute whether or not they could do his care, I'd either have to be there all day whenever there is a sub or none of the days.
    Does this sound right to you guys? Is this legal?
    I feel so befuddled about this because the issues he had with the sub weren't minor issues and me being asked to hand over care to somebody incapable wasn't going to happen. I should also add that two of the other four parents of children with diabetes ended up at the school that day also due to the variety of issues the sub nurse was having with managing care for these kids with d.
    I just want to know if you guys have a plan that works with your nurse or if you end up going in most days when there is a sub?
    Keep in mind that Isaac is in Kinder and still not doing his own care, he is very aware of how to do things and can verbalize many parts of his care, but he can not do it alone nor does he argue with adults if they are wrong.
     
  13. ksartain

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    We have three people at Christopher's school trained to be able to care for Chris if the school nurse is not there. Would it be possible to do that?
     
  14. Sarah Maddie's Mom

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    The mistake seems to me that it is getting twisted into a personality thing by the managing nurse.

    I think you need to clearly and calmly bring it back to the medical management plan and document how things were not followed. You don't expect to pick and choose the nurse but you demand that there be continuity of care and that established plans be followed. Don't let them make this personal.
     
  15. Beach bum

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    You and the other parents need to get the message through to the managing nurse that while you don't expect to pick and choose the sub, you are expecting a sub with a level of competence to manage multiple kids with D.

    It seems that the managing nurse is on a bit of an ego trip. Take that out of the picture and just deal with the issue at hand: reasonable expectations of care for your child when the regular nurse is out. Proper adherence of the medical plan by the sub.
     
  16. missmakaliasmomma

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    You can't pick and choose??? I would have taken great offense to that, even though I shouldn't. Um... that's fine but you need a COMPETENT person to take care of your child. That's their responsibility as nurses! I would be livid. Talk to whomever you need to talk to, as many times as you need to. Make them know you mean business ;) lol
     
  17. SarahKelly

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    Thanks guys. It was definitely not a personality issue as I don't know her personally but was only worried for my child's care as she was confused, made him miss large chunks of class and didn't follow his 504. I believe that these things need to be followed regardless of whom is the nurse in charge. I will follow up with the managing nurse and reiterate the issues and expectations. I don't mean to make mountains out of molehills, however I do believe that if this school has a full time nurse, makes themselves "THE" school for children with diabetes then they need to have nurses there that are competent.
    So, thanks again.
     
  18. Beach bum

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    Yes, agreed. Valid argument.

    Where you forced to go out of your normal district because this was a school that would manage all the kids with diabetes? I never understood that logic, train someone properly and let the kids stay where they should be.
     
  19. sincity2003

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    That would bring up an entirely new issue. It's against the law to force D kids into certain schools. There's actually a school district near me that's currently in a lawsuit for this exact reason. Parents, with help from the American Diabetes Association, are suing the school district for designating four schools as "D schools" that are outside of their home districts.

    On another note, I agree with others about the ego trip. While it may not seem personal, having to deal with a district (or school) nurse that thinks they know what's best, is aggravating to say the least. I'm dealing with it this year, as well as dealing with denial of a 504. It's a horrible feeling to drop your kid off at school and not know if they are going to receive the care they need that day. ((HUGS)) to you!
     
  20. SarahKelly

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    We weren't forced out of district, but aren't at our neighborhood school, however we could be. The neighborhood school has part time nurses and will have a designated adult trained if you want your child to go there, but the school we were able to have him attend has a full time nurse. We thought it would just be better for him to go there. I am just confused about how they keep telling me that, "it's not how it normally is," when speaking about things like how I want his testing done in his class, I don't want him walking alone (or with another kindergartener) to the office if he is low, nor do I want him missing out on snack if his BG is high (according to their definition of high not what I put on the 504)...and many other small details. It seems that the 504 I did at the beginning of the year hasn't been read and even more trouble occurs when there is a sub whom isn't tech savvy, isn't aware of how t1d care has changed in the past 10 years, and has not patience for getting up to care for kids anywhere other than the health care room.
    So...I feel like I just have a lot more advocating to do. It is a great school, but I don't feel like I can compromise on these issues.
    I am now gathering more information on how to get these rights implemented before I need to contact an advocate. Oye!
     

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