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Does the nurse listen to you?

Discussion in 'Parents of Children with Type 1' started by Pammers, Nov 10, 2008.

  1. Pammers

    Pammers Approved members

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    We have a written diabetes plan at school. But as you know, things can go off plan, some times we need to use judgement.

    My question is, when the school nurse calls you, will she do something different per your instructions? (like give an extra juice or reduce the bolus amount).

    Our school has only a healthcare aide, who has been fabulous, but her boss (the nurse under whose license she practices) is telling her not to take verbal instructions from the parent. If its not written by the doctor, she can't do it. (and a doctor's order: "follow the parent's instructions" is not acceptable). They are telling me this is because of Florida statutes.

    Nurse's quote: this is not rocket science.

    My response: No it isn't. Rocket science is exact and diabetes is not.

    Does YOUR nurse follow your verbal instructions? Or do they make you come to the school for every little variation?

    I don't think I'm EVER going to be able to go back to work.
     
  2. Haleysmom2214

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    Our nurse is great. She listens to what we tell her. We have a plan but there has been a couple of times she didnt do as it said. So when she has called I am like stop doing that and do this. A good nurse is really hard to find! We had a bad one before a miss knowitall!
     
  3. Pammers

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    They're even arguing with me, telling me that I should be giving complex carbs instead of sugar at certain times. That's not their call and I'm getting really frustrated. Darnit, I feel like I need a medical degree, a legal degree, and an education administration degree sometimes.
     
  4. Sarah Maddie's Mom

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    Ain't that the truth! Well put! ;)
     
  5. Flutterby

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    we don't have a nurse, but whomever calls me goes by what I say... they call 2 or 3 times a day, when something isn't right, or they just have a question. They are getting to the point where they know what to do, but tehy still call and verify with me (which is fine by me) they make a note in Kaylee's notebook/log every time they call me and what Itold them to do.. seriously, if we had to call the dr. every time we did something, well,the dr's wouldn't get anything done.. its a self manage disease, our kids aren't old enough to do the self managing so we need to do it for them.. the nurse should be taking the dr's orders and let you OK any changes or suggestions.. I know there are others that have the same problem that you do.. i think its silly these nurses won't take the dr's orders..
     
  6. Lee

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    YES! every.single.time!
     
  7. Flutterby

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    you are right, its NOT their call, its yours and the dr's call.. they obviously don't know what they are talking about.
     
  8. wvchinacat

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    This is such a great idea. Our 504/Health plan was written by me/and our endo and then put into the 504 paperwork. In the beginning I was told that everything had to have written dr. orders for any changes or modifications. So the Dr wrote change/vary as necessary per parent. The nurse signs off on everything that she does from checking BG to admin. insulin. What I worry about is when Willow gets on the pump and will need more than just 1 bolus daily . . .oh well we'll cross that bridge when we come to it!

    Vicki
     
  9. Jboudo01

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    I'm in Florida too and I don't buy that "per FL statutes" stuff. Our school has healthcare aide who works under the county nurse. I did have a hard time in the beginning. School nurse is an ANGEL and she will follow my instructions. County nurse wants to send DD home if she is over 300 and no ketones! She TOLD me that they would give glucose gel if dd had seizure instead of Glucagon like my doctor's plan called for. I had to get Endo and CDE to write something in e-mail to confirm that we preferred the glucagon since gel can cause aspiration. She was really tough until she realized I knew just as much about diabetes as she does. She has backed off after a face to face meeting...I was very pleasant, but firm and confident. She stated that "the county" prefers MDI instead of the pump. So as we transition to the pump in the next 3 weeks, i anticipate another round with her. But again, the school nurse is awesome! Also, the Diabetes Medical Management plan that Endo wrote is very thorough and has some flexibility built in and we built it into 504 as well.
     
  10. etringali

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    I assume by "county" she means herself.

    Our nurses are great. In general, they follow what we tell em to do, and if there is a concern that we tell them something outside their guidelines, we just have endos office fax an emergency order, or I pop on over.

    It hasn't been an issue so far since we a re the pump programmers. I send in a carb counts for snacks and meals and the pump in general does the rest. they call me with any questions/concerns they have. I should probably take the nurses out o dinner or something since we see/talk so much :)

    Good Luck with MDI to PUMP switch.
     
  11. PokesforLife

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    Our Nurse is flipping fantastic!!! She is always emailing and calling, she has even called me in the evening because she didn't have time before she left for the day. We are in close touch everyday, I assume over time I will back off some but it is so new for me still.

    Anyway I have talked with her on this exact subject. What she would do if her "boss" came in and started throwing out the "book" directions? She said the "boss" wouldn't do that and that her boss knows that she has close personal relationships with each family. As long as I have it in writting someplace I am the one in final charge and she thinks thats how it should be!!! I wouldn't trade her for anything, DS gets her this year and next then we have someone new, new school.......I pray she too is as much a saint as my current nurse is!!!

    She also faxes between herself and our Endo. so everything is in writting pretty much that day, as things arrise.

    Good Luck, I know I am lucky and I will take it as long as I can!!!
     
  12. dorothy's_mom

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    Mine has to. It is stipulated in the paperwork that the parents can make changes to the insulin ratio's at will depending on her numbers. Just last week, I got a call from the nurse that Dorothy came to her feeling funny, thinking she was low, however she was in the 300's! Come to find out, #1, she did not eat what was on the menu since they were out and had to pick differently after already being dosed, #2, they figured out her insulin wrong for the original carbs to begin with, so she was over carbed and under dosed. I directed the nurse to give Dorothy 3 units and check her again in 1/2 an hour. Worked perfectly.

    You need to have your endo stipulate in the paperwork that you have the right to change their doses at will. They have to follow the paperwork, or they are in violation of your child's health and lawsuits can happen if something goes wrong.
     
  13. Amy Jo

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    We are lucky that our school nurse is computer savy and emails me all her bloodsugars throughout that day. This is NOT something I asked her to do but she wants me to know what is going and and she knows I will call her if I see something is not quite right. She follows the doctor orders on insulin admin, checking blood sugars and treating lows BUT she knows that the ART of diabetes is important too. It is not cut and dry and if she has any problems she calls or emails. She keeps all emails and writes down anything we do in our daily communication book(she photocopies each page in the book to keep in Shaelyn's file)- IE:- Disconnected from pump before gym, pregym BS___- etc. I created a neat communication book that has her "must eats" and her "carbohydrates" that need to be programmed into the pump.There is a daily system that the nurse follows based on what we agreed in her 504 meeting. We are lucky. The doctors did have to write in the orders that changes to the pump can be made by parent as needed.
     
  14. sammysmom

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    My son's para will do whatever we want or ask. The district nurse know this also. Just today we did some temp rates and such. Everyone did just as asked , no problems.

    shannon
     
  15. Gomod71

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    Our nurse is learning the hard way not to fly by the seat of her pants. The doctors' orders help, but can't cover everything. I stress time and time again to always call me - I am always available. She finally seems to be getting that.

    I had our CDE write on the orders "okay to accept verbal orders from parent" .

    Good luck! I feel your pain.
     
  16. selketine

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    I was having this problem at the beginning of this school year and I would do two things:

    1) if it is because of some regulation - ask the nurse supervisor in writing for them to provide you a copy of the specific regulations that show why they cannot accept changes from the parent

    2) try to work with your doctor to get some parameters for things - we have parameters for changing his dose, corrections, combo boluses, etc. Some of it is stupid (like the percentage of insulin for the combo given up front can be between 10-90% for example - which is pretty much all of the options available - it gives us wide latitude).

    When I asked for the a copy of the regulations they realized that they could not produce them - because there ARE NOT any - exactly - just the way they were interpreting some broad thing. The parameters seem to satisfy the requirement for specific orders from the doctor.

    It is dangerous for them not to allow you to make changes to insulin ratios, corrections, etc. We only wish it was so simple it could all be written down on one of their silly forms!:rolleyes:
     
  17. dmjrn

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    ugh

    Well, Macy started kindergarten this year and it has been a nightmare. The nurse goes exactly by the doctors generic orders. She won't do anything I suggest. She expects us to get every little thing in writing from the doctor. Needless to say I am very stressed. I work night shift and the nurse is always wanting me to come to the school during the day when Macy is high to give her extra insulin. There are many days when Macy has been in the 300's all day at school because the "doctors orders" don't say to give a correction before 3 hours since last dose. I don't know what we are going to do. I can't get the doctor to cooperate either. They think those generic orders should work for every kid....WRONG. I hope your experience goes better than ours!
     
  18. kyleesmom

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    Our nurse and the secretary(we only have 1 school nurse k-12 so she helps out when the nurse is at another school) will do whatever I ask. Most of the time they call and tell me what Kylee's blood sugar is(when high or low) and ask what I want them to do or they just follow the chart I made. They have never seen actual written orders from Kylee's endo, they just go by what I say. In fact Im getting ready to write the nurse an email write now to update her on Kylee's endo appointment last Friday and tell her about the changes we made.
     

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