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Expectations for school nurses

Discussion in 'Parents of Children with Type 1' started by DDmama, Feb 29, 2016.

  1. DDmama

    DDmama Approved members

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    We have had a number of issues with the school nursing since my son was diagnosed almost 1 year ago. What kinds of expectations do you have for school nurses? What do you think are reasonable expectations for a time frame for updating your child's IHP, for accuracy updating it, for following orders, for timing of training, and for competency of the trainer? Below are issues that we've had.

    -IHP updates: Nurse takes over 1 week to update the IHP with new orders. Every time, there are errors in the revision. Another week (or more) to revise. Still more errors. Another week or more to revise. So it usually takes at least 1 month to revise the IHP after any new orders.

    -Following practitioner orders: Orders aren't followed regularly, frequently the same ones repeatedly. Twice within the last month orders were followed that affected our son's safety, such as giving a corrective dose when shouldn't be given. He has been sent to the clinic more often than necessary (usually 1-3 times/week) and having BG tests and ketones tests unnecessarily because orders aren't followed. So he unnecessarily misses class and gets frustrated. The school doesn't respond to our concerns about this.

    -Training: Training is provided very delayed (usually 1-2 months after needed) and the trainers don't seem to have the required knowledge. Example: one nurse who recently trained the bus driver mixes up the names and functions of the pump and CGM.
     
  2. Christopher

    Christopher Approved members

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    Hi,

    Slightly off topic but I would suggest creating a signature where you can provide some basic information about your child (age, date of dx, type of insulin delivery, etc). If you go into "Settings" at the top right of the screen and then go to "Edit Signature" you can put that information in. It is helpful for people trying to answer your questions and you don't have to repeat the same info over and over. :smile:
    I see from your other posts that he is 8 and uses a CGM and pump, but others may not look.

    As for your questions, it has been a while since Danielle needed the school nurse, but it sounds like you are going to need to spend some extra time with the school nurse going over your expectations, and maybe going over them again if the nurse still is not meeting them. Since the relationship between the parent and the school nurse (and child with Type 1) is so important, I suggest treading lightly but firmly. You say the school doesn't respond to your concerns. How high in the school hierarchy have you gone?

    The issues you are describing above would not be acceptable to me, especially the ones regarding your son's safety. I would call a meeting with the nurse and whomever supervises them and/or the principal to discuss your concerns and your expectations. Again, I would stress a more collaborative approach with them rather than you just laying down the law (not that you would do that) :cwds:

    When Danielle was first dx I found this guide very helpful:

    http://www.niddk.nih.gov/health-inf...guide/Documents/ndep61_schoolguide_4c_508.pdf

    I made 2 copies and put them in 3 ring binders and called a meeting with the nurse and the principal and gave it to each of them. I couldn't find a more current version but it is still good info. Even if you don't give it to the school, it might be helpful just for your own reference.

    Good Luck!!
     
    Last edited: Feb 29, 2016
  3. virgo39

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    Our nurse promptly updates my DD's diabetes care plan, but sometimes I do the update. For us, the purpose of the plan is primarily if there is a substitute nurse as DD has been at her school for 5+ years with the same nurse who is outstanding. That said, we seldom have the need to update DD's plan. We pump and the plan provides that if an injection is needed it be "per pump settings."

    I would be very concerned about orders not being followed and would try to understand why that was happening. As I said, we've had issues with substitutes sometimes making a mistake, in which case we try to figure out what went wrong and address it (most tweaks to DD's care plan have been to address that). Have you discussed the instances with the nurse when they occurred? Mistakes happen, but repeating the same mistake is a definite concern. I think if I had reviewed things with the nurse and errors continued, I would escalate the matter. (Our school district has a nursing supervisor).

    I don't know the timing of training at our school, but this is not an issue because DD has been there for several years. The nurse has trained some office personnel to assist if neither she nor a substitute nurse were available, but that has never happened. I wouldn't expect a bus driver or her teacher to need to be trained on a pump or CGM, so as long as the driver knows that my DD has Type 1 and may need to test, treat, or call me on the bus ride, and potentially could need emergency assistance (in which case the bus driver would stop the bus and call 911), that would be okay with me. Of course, my DD has been able to provide the basics of her own care and her bus ride is 10-15 minutes.

    Good luck.
     
  4. DDmama

    DDmama Approved members

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    Thanks so much for your replies. I needed some 3rd party input.

    We tried to work collaboratively with the school, including providing resources (including the guide Chris mentioned above, contact info for the local ADA, and the local hospital, which has a great reputation for diabetes education). We have worked our way step-by-step to the top of the district, all the way to the superintendent, trying to educate and explain our concerns.

    The local ADA advocate got involved and she got the state DOE health services director involved. Both tried to help the school/district, without results. A state DOE attorney called the superintendent, but the superintendent denied any problems. I was told that this is usually all it takes for a school to make things right, but it didn't happen.

    I still try to work with the district, but the response we get is generally denial or playing with semantics. They have made some changes this school year which have resulted in some improvements, but we still have same issues of not following orders, not completing IHP, etc. We ended up filing a complaint with the DOE. The results were completely in our favor, but the school is not complying with the corrective actions as written, or they are changing some things on paper, but no practical improvement has occurred.

    The district told us that all parent communication needs to go through the district health services supervisor (who is NOT a nurse). When I voice concerns about orders not being followed or about training issues, she responds that orders have been followed or that proper training has been provided. It works best when I can talk directly to the caregivers or to the nurse writing the IHP, but I get scolded for it every time I do so.

    Virgo39, I agree, I'm not sure that the bus driver needed all the info about the pump and CGM. They said the driver was taught how to suspend the pump in emergency. But I think if it was taught, it needs to be taught correctly. And it really concerns me that the nurse who trained people doesn't seem to understand basics about diabetes or equipment. Both his NP and the pump rep who trained the staff expressed concerns to me about the basic diabetes knowledge of the nursing staff.

    It's been suggested to us that we file a complaint with the AG's office. Ugh. It is exhausting to think of going in that direction and the last thing I want to do is to fan the flames. But I think we have exhausted most other options at this point. We've considered moving, but it would be at a big cost to our family.

    Thanks for your support!
     
  5. Nancy in VA

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    Look into filing an Office of Civil Rights (OCR) complaint. Unfortunately, it will be a long (probably 12-18 months) but it might be your only other recourse.
     
  6. mmgirls

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    Ask that your school nurse responsible for training additional staff give a return demonstration of the skills that you want verified. If the school gives you issue then take it to the state licencing board for RN's.
     
  7. Beach bum

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    I put my answers in bold. But, it seems that you've got an incredibly stubborn school that in the end will just be making more work for themselves. You probably will have to file a complaint with OCR considering they haven't cooperated at any other level. Unfortunately, this will be a long time to fix.
    I would try and have, as much as possible, an open line of communication with the nurse. Most important, make sure all conversations are done in writing so you have a paper trail. Even if you spoke directly to the person, do a "just to follow up from our conversation email."

    -IHP updates: Nurse takes over 1 week to update the IHP with new orders. Every time, there are errors in the revision. Another week (or more) to revise. Still more errors. Another week or more to revise. So it usually takes at least 1 month to revise the IHP after any new orders.
    Ours are always updated immediately, because I am the one doing the update. I will hand in a new one (signed off by our doctor) with all changes bolded. I will also email a copy.

    -Following practitioner orders: Orders aren't followed regularly, frequently the same ones repeatedly. Twice within the last month orders were followed that affected our son's safety, such as giving a corrective dose when shouldn't be given. He has been sent to the clinic more often than necessary (usually 1-3 times/week) and having BG tests and ketones tests unnecessarily because orders aren't followed. So he unnecessarily misses class and gets frustrated. The school doesn't respond to our concerns about this.
    Keep calling them out on this. Use your pump readings and cgm readings as proof that they did it wrong. Request that your doctor step in and also remind staff that what they are doing is incorrect and unsafe. LOG EVERYTHING!

    -Training: Training is provided very delayed (usually 1-2 months after needed) and the trainers don't seem to have the required knowledge. Example: one nurse who recently trained the bus driver mixes up the names and functions of the pump and CGM.
    We had an outside party come in and train. It was a CDE from the hospital (this was for preschool), for all other grades we've been blessed with competently trained staff, who take it upon themselves to get refreshed every few years.
    There is absolutely no reason why the bus driver needs to work the pump. Identify and treat a low and call in is all that's needed. Glucagon training is a plus. Too much room for error as they aren't someone who uses the pump daily! Part of our IHP was "bus drivers are not to attempt to use/suspend pump." "Treat low and call in."
     

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