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504 Plans and substitute nurses

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

  1. dianas

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    Sarah, I live in Washington State and while my daughter doesn't have diabetes she does have other health issues so I'm familiar with the 504 and individual health plan process in Washington schools as we had to go through this when she was younger. Washington is one of those states where anything health related is supposed to go into the medical management plan. The 504 is for equal access to academics. Washington state is actually pretty good about 504's but it's about academics and not health related needs. Your issues are not a 504 problem but more that his health plan wasn't followed.

    So if I had a very young child with diabetes I would spell everything out in detail in the medical management plan related to his diabetes and not the 504 as that is where everyone expects to find that information. The 504 academic accommodations at that age would be minimal probably absences, parties, bathrooms, water, what to do about missed classroom time. Or at least those are the things I would address at this age.
     
  2. SarahKelly

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    Thank you Diana, I am setting up a meeting with the RN, principal and his teacher. I am going to reevaluate his 504 and medical plan to see where things need to be addressed further and what is being ignored. I am not upset about what is going on, but feel there are valid solutions for all these issues. I just need to put the time and effort into this so that by the time he's older it's more clear and his needs are met without resistance.
    So, thanks again :)
     
  3. SarahKelly

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    New year, same issues...anybody have extra advice now this round? I have already called the district nursing coordinator. Additionally it has been stressed to me that we are a "unique school in that no other school has their nurses go to their children with diabetes classes, but rather the children go to the nurse." In your districts is this the norm, do your kids go to the nurse or stay there? Are any of you having to be constantly available or at the school for incompetent subs? Any help is appreciated folks :)
     
  4. Ali

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    I will read though this all tomorrow and try and give specific advice but for now I want to say I am so sorry. Schools are big organizations, sometimes they are well run sometimes not...and even with healthy kids lots of issues pop up. I hear you that you want advice as to how to deal with this stuff, frankly if what they are doing is a potential ER call then just pull your kid out and home school or online school. If it is more minor, can you ignore or find a way around? This is hard, getting a change in a public or frankly even a private school takes a long time. Sadly you either have to decide to just pull your kid out or figure out how to work around the crap the school throws at you, please excuse the language, I actually hate that word, but I have dealt with this stuff myself in the school and corporate workplace. Sorry, it is just work. So do what is easiest for you and sometimes trying to move a mountain is not worth it, look at all your options.
    Ali
     
  5. valerie k

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    matt has always gone to the nurses office. I would be uncomfortable with the nurse going to him all the time when the school has 900 other students who may need her care, she should in my opinion be in a central location to help all. Even in 9th grade, he still goes to the office for his needs. This year is different, we do not have a nurse on staff at the charter school he attends, the nurse does go around to the district, but I bet she never stops by this school. He also carries his meter and low treats with him. He has no locker, so has to carry a backpack room to room-that's why we have him carry his meter. When he is low, he treats in class, if he needs to , he goes to the health room where he has other supplies. He always chooses to go to the health room when low, Mostly to miss class in my opinion....

    I do remember back in elementary, our great school nurse had a comprehensive cheat sheet made up for every child with special needs that she dealt with and how to deal with their care and phone number of parent in case of question. I guess I wouldn't expect sub nurse to come in and read every student with special care to read their 504 in detail.... its not practical. I would sit down with the nurse and help her make such a sheet with the daily important information right at her fingertips. Also a cheat sheet on how to run your pump would be helpful, because I expect nobody who doesn't have to use a pump to know how to run it. Not even a medical professional. Every time my dad was hospitalized, they requested I take him off the pump because they didn't know how to run it. I then started to opt to leave him on his pump, and made sure I was there 75% of the time to run it for them. I would go for breakfast, lunch and dinner, and be there at bedtime as well.... My days, spent wandering the hospitals.... go home at night. You do what you have to do tho.
     
  6. roo'smom

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    In our district, each individual nurse is responsible for finding his/her own substitute, from a list of subs approved by the district. The home nurse also leaves a blow by blow schedule of her day in the sub binder -
    10:00 - Student A comes in for inhaler before PE
    10:20 - Student B comes in for med
    11:30 - Student C comes in for blood sugar check before PE (call mom for any questions)
    etc, etc
    When my dd was in early elementary there were 9 diabetics in the school, and there was only one sub that would agree to come to the school, and that our nurse trusted to handle it all.
    Until my dd did her own testing (2nd grade) she would come to the clinic for all care - scheduled bg tests, feeling low, and random snacks/treats. There is no aide in the clinic, just the nurse, so I didn't think it was reasonable for her to have to go down to dd's classroom numerous times a day to handle her care. That was my choice.
    We would get a heads up for subs when it was planned, but not for emergencies, and didn't have any problems with her care on sub days.
    Also, as a sub you don't necessarily know who has 504 plans, but you do have a binder of all the health plans, so I would address medical management that you want the subs aware of in the health plan.
    Hope you get it all straightened out!
     
  7. mamattorney

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    At our junior high - the nurse/aide will come to the diabetic child who is feeling low and wants help. My daughter takes care of her own lows, but I believe she's the only one (out of 6).
     
  8. rgcainmd

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    In my daughter's school district, one nurse (RN) serves several schools (elementary, middle and high schools), so she is not at my daughter's middle school most of the time. There is a "nurse assistant" who I believe is a CNA or an LPN. None of the nurses have ever gone to my daughter's class (outside of the day my daughter did educational presentations on T1D for several of her classes with the school nurse's assistance); she has always gone to the nurse's office for all of her health needs. To be honest, I've never heard of school nurses routinely going to children's classes. If there were some kind of emergency, e.g. if my daughter suffered a serious injury or lost consciousness and began seizing due to a super-low BG, then of course I'd expect the nurse to go to her. But for routine diabetes care during the school day (BG checks, treating lows, bolusing for meals, giving correction doses), my daughter either goes to the nurse's office or takes care of it herself in her classroom. Perhaps these kinds of diabetes management issues are handled differently in elementary school; maybe parents with children closer to your son's age can comment on whether their school nurse goes to their child's class. Even though my daughter is the only child with T1D in her middle school this year, I'm reasonably sure that there are at least a few other children with health needs on any given day and I can't imagine the nurse being expected to go from class to class to meet every child's needs. Regarding incompetent subs, how often on average is your son's nurse absent? I estimate that our school nurse was absent about 2 or 3 days during the second half of my daughter's last academic year. Whenever she was absent, we never had any problems because the sub adhered to my daughter's medical management plan (or I assumed she did because nothing out of the ordinary happened and my daughter would definitely have told me if any of her diabetes needs were handled any differently than usual). If you don't mind, could you be a little more specific about what isn't happening that you believe should be happening? Does this problem (or these problems) occur only when there is a sub or are there problems even when the regular nurse is there? Is your son's medical management plan being followed most of the time? It's difficult to offer advice when I'm not very clear about what is transpiring at your son's school in regards to his T1D management.
     
  9. BarbDwyer

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    There is no nurse at our school. My son is in 7th grade. He goes to the office to test before lunch (right next to lunch room) and reports the number to the secretary. He manages his shots on his own, before PE testing, and tests/treats lows in class. He calls or texts me if he has a question. The school has a one page sheet I gave them for 'rules' to follow.

    I'm not sure what the set up is for for the elementary kids that can't be so independent. The only one I knew had a parent that worked in the school so he just went to his dad's office. They must train someone as there are two kids in high school with T1D and they've had it since they were grade school age.
     
  10. SarahKelly

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    So, a little more background may be helpful.
    First, my son is six...not MS or junior high, but just started 1st grade in a classroom that is outside of the main building and has a public walkway (that is constantly being used) between the main building and his wing. The idea that has been suggested is that he is able to walk outside to the (sub) nurse for his BG checks regardless of if he is low or not, accompanied by another first grader. This is not safe. Additionally, his snack times are scheduled at 10:40 and 2:15 and are on a schedule that is always printed up for the subs along with the other students with medical needs schedules for when they need their treatment(s), too. What happen was on Friday he went into the nurse on his way to lunch and asked to be checked, she told him no you go eat first. He said, "I need to be checked." Her response was, "go eat!" At that point he started sobbing and went to the office staff. He stayed with her for a few minutes and then she got him to go the the lunchroom, he came back in at 11:58, at which time the nurse asked, "did you eat?" and he said, "no because you didn't check me, so she checked him and made a comment about his BG being high(it was 240) and that it was probably good he didn't eat." At this point he starts crying again and asked for her to call me, she calls and said, "Isaac must be ill he won't eat". I get over there and after I convince him to eat I find out what all happen...and the nurse tried to tell me that she did check him at the beginning of lunch. I showed her the history on his glucometer, then she said, "oh yeah, it was too busy in here before lunch and I told him to go eat." UGH! This is the same type of thing that happen repeatedly last year that led me to have to be there whenever there was a sub, I am trying to get back into the work force and feeling rather frustrated with no change happening at the school. I have called the nursing director and just need to know how to make this work so that he is feeling safe again. I believe that the nurses are overwhelmed at the school, but honestly I don't believe this is my problem. If the district sets this school to be a "medical" school than they should send staff that can handle the work load. And honestly it is a school of 450, 5 students have t1d and the other kids with medical conditions are kids that have epi pens, inhalers, or medications that need to be dispensed at regular intervals. The regular nurse is very organized and has things readily available when she is out so that things should flow smooth. Any other tips or suggestions?
     
  11. Sarah Maddie's Mom

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    I think that back when Maddie was 6, if I couldn't count on the sub nurse I would demand that I be notified of any absence of the regular nurse (at 6:00 AM or whenever it is known) and I would keep him home or be at school myself. That's a lousy solution, I know. But I think if he's not safe (emotionally as much as physically) then that's what you need to do. AND you need to document everything so you can build a case for finding qualified subs in the future.

    I wish I could suggest something less disruptive.

    Good luck.
     
  12. SarahKelly

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    Yes lousy solution, but honest. I guess I wouldn't mind if I had to be there the few times that there is a sub if his current teacher wasn't acting so upset about it...she seems to feel that I am an overbearing parent and I am having to ignore her and just focus on my child. I just keep wondering though why they can't find more highly qualified subs, at least ones that will listen to my child when he asks to be checked. Sometimes I just feel so flabbergasted by how others don't believe that a child can know what is best for them medically, I mean he's been living with this for almost 5 years now - he knows a thing or two!
     
  13. SarahKelly

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    and thanks for your input about your experience. It does help to know I am not the only mother that has spent hours at school just to do checks!
     
  14. mmgirls

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    HOLD IT,

    is your child at a "medical" school by choice??? Or because the school district "sold" you on it???

    I am School district Sub clinical aide and have easily dealt with 5 or more middle school T1D kids at a time, because they are my top priority, everything else can wait in the clinic. (that is the nature, and assumed responsibility at any time. T1D first.)

    We do have 1 school in my District that is a medical needs school, yet I would never let my child go there merely because of T1D. If she had other health issues that had to be monitored then maybe. BUT, our kids should not be segregated/directed to "special" schools because that is where the care staff is.

    Any sub nurse has their license on the line if they do not follow Dr. Orders, So please make sure you understand the Dr orders and how a school nurse may interpret them. It is never a black and white topic, and by understanding how the staff "sees" the info can be very beneficial.
     
  15. SarahKelly

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    I still am just shocked at how frustrated these sub nurses get with all that is on their plate, when in reality as a nurse it would be easy peasy if they were in any other setting.
    URGH...we have a meeting tomorrow meeting, I am hoping everybody is willing to make positive changes and stick to what is the law for children with diabetes.
     
  16. dpr

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    Our school is more like your neighborhood school with a part time nurse. The nurse is only there something like 19 days of the school year. This seems to have actually opened a better door for us rather than dealing with a full time nurse and the ease of making the policy of "going to the office for everything".

    My daughter was diagnosed 6 months before she started kindergarten and was the youngest diabetic the school had ever had. All the other diabetics were/are older and self managing. This opened up a new problem of how to deal with her. My wife and I basically came up a plan and with minor adjustments from the principal and staff the school accepted it. The way it works for us, and it has worked very well, is the teacher and aides have been trained on how to test, treat lows and highs. The teacher and her class aide have also been trained on blousing for lunch and highs and know and understands her 504 and treatment plan. The yard staff understands how to recognize, test and treat lows.

    We communicate with the teacher and class aide via text most of the time and by cell phone when a more immediate problem occurs. We are notified when she's low or high and treatment taken and modified by us if necessary and what her lunch bolus is. The first 5 months of kindergarten she was still on injections and under FAPE the school had to hire a nurse to come in every day for lunch and bolus her. So far all her teachers have all been very open to dealing with diabetes. It has created very close relationships with all of them which I think also helps with her education in general.

    This year we are trying something new in addition to the teacher being trained to help her start to learn to be more independent. She brings her IPod to school and is allowed to text us regarding anything diabetes related. She understands that I will not tolerate the IPod being used for anything other than diabetes at school and it will "go away forever" if she abuses the privilege. So far it has worked out well.

    It took a bit of time and training, but once everyone was up to speed it has worked out well. In addition, when my daughter was in 1st grade an older boy had a really bad low on the play ground and was very confused and un able to help himself. The yard staff recognized the problem because of training we implemented, went and got my daughters low kit because he didn't have one, and saved him from what would have previously been a trip to the ER.

    The last thing I should say is we live in a small town of about 18,000 people, so making things happen and being listened to is probably easier than in a big city school district.
     
  17. KatieSue

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    I'm so sorry you have to deal with all this. Mine wasn't diagnosed till older so I don't have any advice. I do agree he's way too young to be walking all over the school even with a buddy if he's feeling low and needs to be tested. I think what Sarah said having them notify you that there is a sub, so at least you can be on the alert if you need to go take care of things. It sounds like the office people are helpful. Is it at all possible they could be a sort of safety net and that he could go to them and they would call you if he was having a problem? Then at least he'd have someone who would be able to contact you and you could proceed from there.

    And it does seem that if they're going to the trouble of setting up a "medical" school they would have competent staff coverage. Are other parents having issues with the subs as well? Just thinking maybe you can approach as a group rather than and individual it might have more impact.
     
  18. susanlindstrom16

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    So sorry you are dealing with this. I'm with you, I would think that the sub nurses working at the medical school would be a little more competent than what you describe. My daughter is 6 and I also would not feel comfortable with her walking between buildings with low symptoms, and with only another first grader. I actually can't believe they would even suggest that to you.

    The nurse at my daughter's school calls me in the morning when she will be out sick and lets me know in advance if its a planned absence. Sometimes there is a sub, sometimes not. When there isn't a sub, i would arrange to work from home and come over to school at lunch. But I never really worried because her teacher last year was very involved with testing etc. Haven't had enough experience with her current teacher yet to be able to tell.

    I think KatieSue's suggestion of talking to the other affected parents and approaching as a group is a good one.
     
  19. SarahKelly

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    I agree the group approach probably would have been useful. I pulled the trigger quickly and emailed the nusing director because of last years experiences. Then the principal wanted to meet this morning. She seemed to believe that our schools parents of CWD are a little too demanding for the sub nurses. I reminded her that I had offered to stay if necessary, but was told that wouldn't be necessary. Therefor I should have my childs needs met, but if I am told to go and things aren't done appropriately I have reason to express concern. I kept reminding the principal that these aren't "demands", but our children's rights and if the school can not figure out how to meet them that isn't on me but rather on the school district as children with diabetes are covered under ADA and 504. Oye! I have offered to be a part of the solution and meet with the head nurse and help find ways to make this work, right now I am just finding that I will need to be available for all sub needs until further notice. Not horrible, but I don't believe it is the best solution.
     
  20. Beach bum

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    At the elementary level, we had two nurses. One was stationed at the k-1 school, the other 2-4. At the 2-4 we also had an clinic aid. Both of these nurses were full time employees who divided the week between the 2 schools so that they knew all the kids (we are a smaller town). When one had to be out, the other nurse would always go to the school with the T1d kids, and then the sub would fill in at the other school. This way there was consistency with knowledge of how to treat d. The only time it was a sub at both was an extreme emergency and I was an armchair nurse for the day, helping the sub through d care (though she was pretty well versed, it was more pushing pump buttons). I wonder if they could do something similar in your case? I would definitely let the principal know and come up with an alternate plan for sub days. I would stress that you and your child don't feel the nurses have his best interests at hand (emotionally or physically).
    Sorry this is happening, it really stinks.
     

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