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Getting annoyed with my daughter's nurse

Discussion in 'Parents of Children with Type 1' started by missmakaliasmomma, Sep 28, 2013.

  1. missmakaliasmomma

    missmakaliasmomma Approved members

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    First, my daughter has a 1:1 RN that's with her at all times. I really and truly know I'm very lucky to even have this accomodation but lately I've been wondering if its more of a PITA than helpful.

    Every other day she needs something in the orders changed. Seriously, it's like every.other.day. My doctors office is probably like WTF is going on?? Sometimes I feel she thinks she's all high and mighty because she has a masters in nursing. I'm sorry, but I still know more about my kids diabetes than you. I just can't stand when people act like they know more than you about your own kid, kwim?

    At first the order said "child is to check their sugar _ times a day, before lunch, etc etc (you know, a generic statement in the medical orders). She needed that changed to "nurse" To me, this is... "duh"... My kids 4. She could check her sugar but wouldn't have a damn clue as to what to do with it lol. How would you checking her sugar be illegal? Come on.

    No matter how many times I tell this lady, she keeps bringing this one scenario up... She keeps saying.. "At over 250, it's really beyond the scope of what I can legally do" UM, no, what it says is that if she is that high, to check ketones. It doesn't say you can't give insulin. What is the point of having you if you don't want to correct highs??

    For snack one day, she calculated that she needed like .45 units to cover it. Told me at the END of the day (didn't bother to call- I could've came in) that she didn't give her insulin because she doesn't have the authority to round to .5 units. So, an hour later,when she was 230, she had to correct her with :rolleyes: a half unit... I later explained to her that unless my daughter is 120 and has exactly 21 g of carbs at a meal, you will always have to round.. so, you're doing it anyway.

    Now I'm thinking, why don't I just try to get my daughter a CGM and when it alarms, at least she'll have time to make it up to the nurse before going too low.. There's another kindergartner in her school with diabetes and I don't even think he has an aide, he's fine.

    The whole 504 group thinks my daughter's diabetes is sooo weird, because she can go high after playing. Yes, in the heat she goes high. They're :confused: by this all the time. They're confused as to why she's so insulin sensitive. Hello, she's the size of a toddler (petite little thing) and only 34 lbs. a 1/2 unit too much could make her very low and vice versa.

    We recently had an updated 504 meeting because they actually wanted to replace her with someone who would be cheaper to pay. The nurse wrote a letter to everyone and in it, my daughter is considered a "frail child" That pissed me off too. Really?? She's one of the healthiest kids I know.

    And jeez, it takes her like 10 minutes from start to finish of checking her BG and giving her insulin. It'd take less time for me to come to the school to do it myself lol.

    Every time I come to pick her up, it's something different.. It's getting sooooooo damn annoying.

    I guess this was really a rant. She just irks me.
     
  2. Lizzy731

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    The only reason I can think of why the orders have been changed so much is because they recently changed laws in NY State in the nurse practice act regarding administering medication. I know my school nurse is not allowed to take directives from me anymore and must have an MD order for any changes in insulin regimen IF she took the directive from me...however we get around this as Bethany has a cell phone and takes the directive for me (like taking off carbs if she's on the low side before lunch). Maybe the laws in your state have also tightened up...I am not sure from your post if she's having to change dosing often.

    Also, sometimes having a nurse as the aide isn't always the best thing as they are nervous and know too much...so to speak. My mom is a nurse and she would always jump to do a stick when DD's sensor would say she's a slightly high number when it could have waited until I got home. My DD has had a 1:1 aide since pre-k and they have always communicated with me via text...however I believe having Bethany on a pump made dosing so much easier.

    I'm sorry you are having such a rough time with this and I am unsure if I even offered any helpful advice but I do feel your frustration. I hope you can get this resolved and come to some sort of middle ground with this nurse. Good luck.
     
  3. Lee

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    I thought you fought the school to have a 1:1 aide, so can your really consider the care of the other K kid with Type 1? Also, this aide has only been here what, 1 week maybe? Things take time to settle in. Honestly, and yes, I know this sounds rude, you are in a situation where your child is under the constant care of a nurse with a Master's Degree. Do you know how many people on this board would love to have this, or even half of this? How many people don't even have a school nurse, let alone a 1:1 aide? I think, instead of fuming over every phone call or dosage issue, you should be thankful that you have a nurse that is trying to work with you, and in the confines of the new law, instead of complaining on a VERY PUBLIC forum about a nurse who might just come here to read about information on Type 1.
     
  4. wilf

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    You want to be thankful you have the nurse, and be patient and encouraging in training her about the intricacies of managing your DD's diabetes. She will respond positively to being treated nicely. She won't be perfect, but neither are you or anyone else. You can make it work. :)
     
  5. shannong

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    On the one hand, as you say, it is great that you have a nursing care for your child, but on the other hand, I would find it very frustrating if the person taking care of my child took directions from someone other than myself. You are of course the expert on your child's diabetes.

    In Canada, we have no nurses in the school, so my son's teachers take direction from me. Honestly, I have read so many posts where people have had frustrations with their nurses, that I now see the positive side of not having to deal with a school nurse. This year, I don't even really deal with the teacher because my son just calls me for every bg check. Your child is obviously too young for that, but one day this will be the case.

    Good luck. It sounds like you will have to work through things, and I am sure you will.
     
  6. mmgirls

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    I know in my dd's school they can not round up either it is always a rounding down, many of the school nurses work with this and "make sure" that there are things around that can get the carbs over the thresshold. My dd's school nurse has a jar of jelly bellys or skittles that are 1 carb each and she will give 1 or a few to make sure that she can give a dose of insulin. Not all nurses are OK with that, but many it is just making your wishes known and give them a solution to the problem.

    I would cut any conversation short that is unwelcome about your dd's "diabetes", it is no ones business to comment but to just accept and be mindfull in all situations that you indicate.

    Have you spoken to the regular school nurse? Or to her teacher? Would you be concidering a CGM anyways?

    Is it possible for her to have a 1:1 aide(non-nurse) in the class to observe her for issues with BG and take her to the regular school nurse for insulin only? That way the regular nurse gets to know your dd personally instead of it all being new to her in the future.
     
  7. swellman

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    There's a big difference between rounding up, not rounding up and can't round up so eff the bolus. Not doing the bolus is ... well, it seems criminal to me. Tell me ANY medical situation where a nurse is asked to administer a drug and NO drug is administered due to a rounding issue. That one thing, in and of itself, see to be a big middle finger in the relationship. Maybe there are laws that make this happen but they need to be addressed.

    On the other hand, be careful what you ask for.
     
  8. missmakaliasmomma

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    Lizzy- we're in NY too and I was expecting issues with the new law because I read your post about it. I can't wait until my daughter is old enough like yours and can do her own thing just by calling me.

    Lee- I didn't fight the school at all. I wanted an aide. During the summer, the regular school nurse called and told me that she pushed for my daughter to have a 1:1 RN because she thought having an aide that couldn't deliver insulin when she has 900 other kids to take care of was pointless.. Those were her words, not mine. I only pushed for a 1:1 aide. I didn't ask for a nurse. I am grateful, like I said in my original post, I'm not wondering if it's worth the hassle I'm getting.

    Wilf- I'm very nice to her, trust me, even when I explained to her that she rounds at lunch and for corrections, so she's rounding anyway. If my daughter's a little under target and has a little less than 21grams of carbs, she'd be rounding up...the problem with her not bolusing though, thats an issue for me. I tell her everyday "if you have any problem, need to contact me for any reason, please do. I can be here in 10 minutes" It's not like I don't want to be bothered. I'd rather know what's going on when it goes on instead of finding out 3 hours later. Couldn't she have texted me saying " I can't give her insulin for this snack because I can't round up, can you come do it?" I can walk to the school, I really.don't.mind.

    MM- I'm considering a cgm anyway, yes. I emailed her dr about it just tonight. My daughter's teacher told me that sometimes she can't finish her work because she's being tested so much. It does take awhile for the nurse to do it since she has to put gloves on, wipe her finger, etc. She definitely takes longer than I do. The not finishing her work really bothers me. She's such a smart kid and for her to not finish work is just not her.. I have went to the regular school nurse, in fact I went there Friday morning.. she's honestly not the easiest person to talk to though, she just says, "talk to the nurse about it" She's going on maternity leave in December, I kinda feel like she probably has checked out already. I don't think she wants to deal with the "complexity of my daughter's diabetes" .. Her nurse also has everyone believing that a regular aide is legally not allowed to check BG. Because of this forum, I know that is not true. I know they just can't give insulin. But you're right, she's going to have to get used to the regular nurse as well because I don't want a 1:1 forever.

    Swellman- Right, I would've at least liked to have been called/ or had this made known to me before she went high because of no insulin.But again, I didn't ask for a nurse, I asked for an aide. Actually, before school started, she was supposed to be in the same class as the other boy with diabetes and they were supposed to have a 2:1 aide. I don't really know why that fell apart and legally they can't tell me of course. It would've been nice though for my daughter to get to know someone who has diabetes like her.
     
  9. ksartain

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    I know in NC, nurses are required to go by the doctor's orders, nothing more. Our doctor's rods say 1 unit of insulin per 15 grams of carbs. It is against the law for them to give 1 unit at 14 grams of carbs because that's not what was prescribed. It is probably similar in other states.
     
  10. missmakaliasmomma

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    im sure its like that here as well. The problem is 1. she's already rounding for lunch and corrections. If my daughter is 120 and only has 18g of carbs, that calls for less than 1 unit, but she's always given 1 unit.. and 2. If I'm called, I can come in and do anything I want with the insulin and they're not liable.. why not just call me? Not wait until she goes high..
     
  11. ChristineJ

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    In ALL states, nurses are required to follow doctor's orders. Having said that, when medication administration involves dose calculations, as is the case with insulin, there's some judgment involved on the part of the nurse. If the calculated dose comes to .45 units, it would be acceptable to round that up to .5 units. I, and every other RN I know, would do so. If the nurse, for whatever reason doesn't feel comfortable with rounding up like that, then she has an obligation to do something about it OTHER THAN not giving insulin at all. Not giving insulin, in my opinion, would be more of a medication error than rounding .45 to .5 units. (Not that I believe rounding up in that case would be considered an error.) The easiest solution, as PP mentioned, would be to find a way to add additional carbs to bring the dose calculation up to where it should be.

    If that's not felt to be an option, then a phone call needs to be made. In the hospital or rehab setting, a call to the MD to address the question of what dose to give would be in order. In the school setting, if permission to speak directly to the MD is not available, the parent should be called and made aware of the situation. Here in MA, Endo can still write in the school orders "parent is allowed to adjust dose and timing of insulin" or something similar. The parent could then make the call about what dose to give. In states like NY that have new laws in place, that obviously makes things more difficult. The parent would at least then have the option, as the OP mentioned, of going in and giving the dose themselves.

    Christine
     
  12. Lizzy731

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    Agreed but in NY you cannot write a standing order that the parent can change dose. They need an MD order every time a dose is changed. It's the nurse's license on the line. However I agree that not dosing because you couldn't round up to .05 could be considered endangering the child by not giving insulin at all. Come on now!

    I'm sure this has been considered or even done already but there must be orders in place that allows the nurse to round up or down or the parent can provide some extra food that will even out the dose to half units. Also not calling the parent when she could of come in to dose is unacceptable. And why couldn't she dose when her BG was high...or did I misunderstand your original post?

    I know some people are telling you to be happy you have a nurse and some people would love to have an RN but if this is what happens when you have an RN the school can keep their RN. I really think a 1:1 aide would be better and the school nurse can dose (it's her JOB!). It's also a personality thing...the nurse you have is nervous about her license and that's why you are having so much trouble. There are gray areas in diabetes and the nurse needs to realize this.

    Also I would definitely get a CGM...sounds like your daughter and you can benefit tremendously although this will make the nurse even more nervous. Believe me...I have a nervous school nurse and she jumps at every little thing and I end up talking her down and calming her. She's a lovely and caring woman but I'm glad Bethany can dose herself. But that's because she's on a pump.

    Schedule a meeting with the 504 director, principal, and school nurse to voice your concerns. The 1:1 aide needs to watch your daughter so she shouldn't expect to be in on this meeting. This will give you a chance to diplomatically voice your concerns. Keep your emotions out of it and state facts. This back and forth between you and the 1:1 is not working.
     
  13. missmakaliasmomma

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    Right, I actually give the nurse little cookies so when her BG is close to low 100s any time during the day, she gets one. If she gave her one, that would've made it .5 units.

    Waiting on an email back from the endo regarding a cgm. Hopefully we'll be able to get one and it makes things easier.

    I'm also possibly thinking about (when omnipod gets their new pod issues sorted out) doing the cut the cord when they offer it and trying out the new insulin in the pod since the insulin itself has been working really well for us. I think it would make things easier than having the tubing. That's just up in the air though. I didn't write the pump completely off. She could want it again in a year, or even 3 years. That should make a nurse less needed also. And eventually, she will be able to dose herself like your daughter does. She calls you from school right?

    Unfortunately, the nurse does attend the 504 meetings because they have a sub nurse that will sit in class with my daughter. I do feel bad about not really wanting her anymore because she quit her old job to take this one. I feel guilty about that.

    The school district wants to replace her with someone who will cost less to pay, unfortunately, the school nurse, her teacher, and the guidance counselor all think she needs a nurse.
     
  14. ChristineJ

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    Yes, that's what I was referring to when I said "In states like NY that have new laws in place, that obviously makes things more difficult." :)
    I honestly feel this is more about this individual's personal comfort level than it is about her being an RN. If there were another RN in this position, the outcome may very well have been different. Either way, a 1:1 aide with the school nurse being responsible for dosing is absolutely a very good option. It's definitely unusual for a school to provide a 1:1 RN for a CWD, particularly an RN with "a master's degree".

    Christine
     
  15. missmakaliasmomma

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    She did correct when an hour after she was 230
     
  16. Lizzy731

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    Bethany texts me any time her cgm alarms and before she eats. And I give her the directive. She knows to drink juice if she alarms low or feels low and she also has a 1:1 who is taking a back seat to all this to prepare her for middle school without an aide. If she didn't have the pod, she wouldn't be able to dose herself.

    I agree to save yourself aggravation you should consider the pump again. And if you're waiting on the Omnipod because you believe they have issues, I wouldn't wait. The new batch of pods that I received after the original batch have been fine. No occlusion alarms in 2 months. Going forward they have fixed this issue. Yes there is a shortage I believe but since you do MDI anyway that shouldn't concern you. Having your daughter on the pump will probably be the only way you can fix this dosage issue and eventually move her towards independence. Have her wear a dummy pod and see what she thinks.
     
  17. hawkeyegirl

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    One thing I would figure out is why on earth your daughter is missing work because of being tested? What is the point of having the nurse in the room if your daughter is missing class time being tested? Your daughter is working at her desk. The nurse brings the meter over, swipes a finger, pokes and done. No work missed.
     
  18. mamattorney

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    My take on this is that you now know this nurse is going to be a stickler for the rules. It may not be the perfect situation in your book, but at least its a consistent one.

    You may need to keep changing the doctors orders at first, but I have to believe that your doctor is getting this "hassle" from more than just your child's nurse based upon the changes to the law.

    There will probably be several other "firsts" over the next few weeks which will have you rolling your eyes at the rigidity of her "order following" ways, but you will get the orders changed again (and again) to accommodate all the possible scenarios that come up.

    By December, you'll probably have virtually all of them covered and second semester will be much smoother sailing.
     
  19. Lizzy731

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    The nurse that was in Bethany's previous school was "realistic" and made appropriate judgement calls while working with me. She seemed more concerned with taking care of Bethany than worrying about her license and making sure MD orders were in place. In the situation when the nurse didn't dose because she wasn't authorized to round up, my previous nurse would have rounded up and worried about getting the orders later. Or she would have called me to come in.

    The OP nurse seems to be more of a hindrance if she continues to act in this way and doesn't learn and move forward differently. Yes she needs to learn her daughter's diabetes and behavior and this may take time....but not dosing because she is worried about her license is just not right. It's worrying about herself and not the child. MD orders can always be dated earlier...it happens in the medical field all the time.

    On the whole having a nurse taking care of your daughter all day at school does in theory sound like a wonderful idea, but it's also a personality fit ;)
     
  20. Lizzy731

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    I was thinking the same thing when she said the process takes 10 min. But she must take her aside and give her a shot and can't really do this at her desk. But she can test her, let her get back to her work, and then pull her aside for the shot. She also puts on gloves and does everything by the book so to speak....I can see why it takes so long....
     

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