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Need Advice

Discussion in 'Parents of Children with Type 1' started by Mouchakkaa, Jan 28, 2010.

  1. Mouchakkaa

    Mouchakkaa Approved members

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    This week is early release everyday for parent teacher conferences. My daughter is home by 12:30. I had made arrangements in her 504 that she still has her snack and her lunch at the same times so that it does not mess her up too much. I have always trusted the school nurse. She loves my daughter very much, takes really good care of her and always listens to what I want done for her. I understand that this is a very crazy week for her and she also has a newly diagnosed child that came back this week as well. Here is my problem, every day this week the nurse has made some big mistakes with my daughter. The first day (Monday) my daughter gets home and BG are in the 400's. I look at her log and realized that she ate at 11:00 but was not bolused until 12:00, not even a prebolus. I called the nurse and she explained the crazy day and I was fine with it. The next day (Tuesday) my daughter comes home at 12:30 BG are in the mid 100's. She asked for a snack which I gave her and then I went through her lunch. My daughter was bolus for a part of her lunch that she did not eat (28 carbs worth). I went ahead and gave her more carbs to compensate for this. Yesterday (Wednesday) my daughter was prebolused for her lunch of 30 carbs, which we always do but the nurse forgot to give her the rest of the bolus at the end of the meal (45 carb). I notice this when she got home and I gave the rest of the bolus and called the nurse just to let her know what happened. The nurse felt so bad and was even crying on the phone. I know that it has been a really weird week with early release and having a new diagnosed kid told her that I understood. Well, when my daughter got home today I reviewed her pump and realized that she never got her pre-bolus of 30 carbs but the nurse did give her 9 carbs that was the rest of her meal. I am so upset. I love our nurse and I understand that it has been a hard week for her but I did not have the heart to call her and tell her she forgot to give the prebolus. My husband said I should call and offer to come in tomorrow to do do the bolus for my daughter. Friday is the last early release and everything should be back to normal next week. Do you think I should call the nurse or just let it slide and show up tomorrow to take care of my daughter. Any suggestions?
     
  2. bbirdnuts@aol.com

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    This is serious. I would bring it all to her attention and take over my daughter's care until someone is capable. This is not something they can forget about, do part of, cry about and it's all ok. I personally would not accept this as a crazy week. There is no excuse. The school nurse has a job to do and she is not doing her job.
     
  3. Becky Stevens mom

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    Gosh this is a toughy:( Did she tell you if shes having some problems at home or something? maybe an illness or death in the family. I understand you want to be kind to her as she has always been loving to your daughter. But, she is supposed to be doing a job there. If shes unsure about what needs to be done when she should contact you and write out a schedule for herself. She could also set timers if need be so that she doesnt forget. I understand that things are difficult when the school has early dismissal but she needs to be responsible about your daughters care when shes there.
     
  4. Nancy in VA

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    Can you suggest maybe having a daily notecard that she needs to check off when she's done certain things - and your daughter has to take it to her to get it done.

    So, she will do the prebolus (and the carbs can be written right there) and then check it off.
    Then she can post-bolus and check it off

    Sounds like its so crazy that she just can't count on her own memory to track what needs to be done - we all remember what it was like at the beginning of a diagnosis and we all have missed a bolus or two - so maybe a new system to help her track that she's done what she needed
     
  5. madde

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    Is it easy to get hold of the nurse during the day? If so, I think I would call and check in to make sure your daughter has been bolused correctly for the food she's eaten. You know, say something like, "I know things have been crazy for you this week, so I'm just going to check in the next few days to make sure everything is going ok today with (your daughter)."

    Maybe doing this for a few days will ease everything a little. I'm sure it will make you worry less throughout the day wondering if your daughter was taken care of properly.

    Hope things change fast, because you really can't let these types of mistakes go on.
     
  6. bbirdnuts@aol.com

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    I agree things maybe crazy at the school this week, but that is no excuse for the nurse not taking care of your child. I do not believe you should have to hold her hand, call her, or write note cards. "School Nurse" is her job and she needs to do her job. I do agree that calling her and writing note cards can be helpful and if that is what I had to do to make sure my child is getting properly cared for I would do that. I know you do not want to make waves, but this is your child. I'm sorry for your daughter and hope this gets resolved in a positive manner immediately.
     
  7. madde

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    You are right! The nurse's behavior is really inexcusable!!
     
  8. fdlafon

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    yes, call her.
    She needs to know that a significant error was made again.
     
  9. twicker1

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    I agree with Becky that this is a tough one. I TOTALLY understand that YOUR daughter HAS to be taken care of. Believe me, I feel the exact same way! I (WE) also remember how crazy everything was in the beginning. Yes, this is a NURSE, but I've also learned that just because you are a nurse doesn't mean you are superhuman. She must be frazzled with having to learn a new regimen for another child, who for all we know, is still trying to figure all this out.

    I like the ideas of helping the nurse with a daily checklist. Or even calling in, or having your daughter call you before and after lunch. As much as you are available by phone, I'm not sure.

    I guess you can do with the whole situation as you want. You can hold her accountable because you have the 504, or you could give a little slack and try to help the situation in any way that you can. Obviously, the nurse is overwhelmed at the moment.
     
  10. ecs1516

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    Do you how it is going with the new diagnosis? Is she having problems with him too? Are they the only two diabetics there?
     
  11. jtkzoe

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    We have a good system for our 6 year old; we write down the amount of carbs in her lunchbox. Before lunch, she goes to the nurse (accompanied by a friend) and gets her BG checked. After lunch, she goes to the nurse and the nurse calls us with the pre-lunch BG reading and explains what she ate so we can figure the carbs. We then tell her what amount of insulin to give.

    At 2PM, she is checked again, and the nurse calls to determine if she gets an afternoon snack or not.

    Our daughter also knows to tell the teacher (who is aware of her condition) if she feels a low, and if so she goes immediately to the nurse (with a friend) and gets her BG checked. If it's really low, the nurse knows to give a juice box or quick acting sugar without calling.

    Not sure if that's an option, but since our daughter is in the honeymoon period, things change day to day. I wouldn't expect the nurse (although she's great) to know what to do at this stage.
     
  12. jtkzoe

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    And by the way, isn't it the law that schools provide the proper care for children with diabetes? If that's the case, hectic day or not, this isn't proper care for a child with diabetes and I would think that if you can't get satisfaction directly from the nurse, you can take it up the chain of command in the school.
     
  13. Nancy in VA

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    I guess I just wouldn't jump to raising the issue to the principal or "up the chain" yet. Again, like others said, legally you could do that but I don't think taking a defensive position against the nurse is the right solution. She's not fighting against what you are wanting to do - she's just frazzled. I think a better solution is to work WITH her. She's done fine before so you know she can - this is just a rough week for her and I'm work more to give her extra support during the rough times rather than making it worse.
     
  14. bbirdnuts@aol.com

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    Nancy you're right. You seem to be laid back. I know you don't want to bite the hand that feeds you, so to speak with the school nurse. These issues are hard. The care of our children does not ever need to be taken lightly. Helping the nurse in some way could be the right thing to do.
     
  15. Yellow Tulip

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    We had a similar situation not long ago. Mistakes were made and it made me really upset, especially after seeing my son suffer the consequences of those mistakes. However, I have spent a fair amount of time in the nurse's office at school, and, personally, I don't know how she does it. Her office is like a revolving door, with kids constantly streaming in, with bonked heads, paper cuts, stomachaches, etc. On top, she has 3 diabetic kids to take care of, each with a different regimen and schedule.

    I feel that with the widespread budget cuts that are going on at schools, we're lucky to have a school nurse. Many schools around us do not have one. So to get to the point, I try to help her as much as I can. I pick up my non-D daughter from preschool at about the same time that my D son gets his lunchtime shot. I just go in and give it to him. I know it's her job, but she's not superhuman. We need to be partners in this, to help our kids get the best care possible, and when one partner needs help, I think it's only human to help out.

    I don't know what your situation is, if you're able to be there at lunch time or not. But the checklist sounds good. It should help her keep better track of what was done and what's still left to do. Good luck. I hope everything will get back to normal soon...
     
  16. GaPeach

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    Your trust in the nurse and her record of taking good care of your daughter must not be discounted. However, "crazy week" or not she has made too many errors to overlook or let slide by.



    I certainly agree with Bbirdnuts post. The nurse is not accomplishing her job. However, I also agree with Yellow Tulip (quoted below). I firmly believe that if you were to chart out the daily mandated health plan tasks for students with T1, asthma, ADHD, etc. and the variable tasks of bandaids, vomit, ice packs... that our school nurse must complete in a day you would find that there are not enough hours in the day to do it all.

    This is why it is vital to have backup caregivers to help in overwhelming overload moments or in the nurse's absence. If a parent can go and help out, it of course would be great. BUT, not all parents have the flexibility to do so.

    Mouchakkaa, you know that I am pushing for this in Georgia. My legislator has been in contact with Crystal Jackson @ ADA and has asked for additional info from me. Since you are in Georgia, I'll keep you up to date as things move forward.


    When at all possible, work things out with the nurse. However, I have used the situations in the past to point out the critical need for additional backup for the nurse. My school nurse knows that I am VERY appreciative of all her efforts. She also knows that I will let the ones "up the chain" know that errors have occurred and I expect an action plan to prevent them from reoccurring. I have been able to do this in a way that acknowledges the nurses intent to meet needs and yet point out the dire need for more help.

    Most school nurses service a higher volume of "patients" than a nurse in an office or hospital for far less pay. Yes, they have decent hours and lots of school holidays off. But, they are overworked and undercompensated.

    I hope things settle down after the "crazy week".
     
  17. Mouchakkaa

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    Thank you everyone for your response. I did go in to see the nurse this morning. She could not believe that a bolus was forgotten again. What I believe happened was that she gave the bolus and then she went looking for it in the history to see it and I believe she wiped out the bolus because she did not know how to look at the history. This is what we believed happened yesterday. I am going in at lunch today to show her how to look at the history. She has also put together a check list that she will check off when she does everything. I know she knows what to do. The pump is new, since December, so she does not know all the ins and out of it (we had cozmo before that).

    I do believe help is needed in these bigger schools for the nurses. We have close to 1000 kids in our school and while I was sitting there talking with her about 15 kids came into the clinic, including my child and the other two diabetics. I have no idea how she keeps the clinic going, and to think they were trying to get rid of the nurses last year.

    Once again thank all of you for the support.
     
  18. selketine

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    I would go in and talk to her. I can understand a mistake or two but this seems like too many. I am more concerned that she was given insulin for something she didn't eat which can cause a dangerous low.

    Our school has a health room tech and a nurse so that helps. Any day the nurse is there alone it can be total chaos. I'd be concerned that if the nurse admits she needs backup help that she would be somehow "penalized" by the school nursing admins for not being able to handle it. I realize that is unfair - just a thought. Perhaps for this nurse, with a new diagnosis - she could request temporary help - like an aide - for minor problems so she can handle the big stuff.
     
  19. Toni

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    Too many errors. Not sure if the reason is the newly diagnosed child, and nurse feeling overwhelmed or a personal issue. My opinion is talking to her will make her feel bad but it may or may not improve performance. Because you have talked to her. I would simply take control back into my own hands. I do and we have an R.N. I would provide your daughter with a cell phone to contact you. But I would have your daughter call you on the nurse's phone at every blood sugar check, before and after gym, before getting on the bus, and before lunch. You can control everything over the phone. Ask the nurse to supervise the numbers on the pump, though that is not necessary as you should be able to tell if amounts of insulin given for the carb bolus are correct if you have a calculator handy. If she's low stay on the phone until she receives the juice, tell her to sit down and either you or she can call in ten minutes. There are about four phone calls a day sometimes but it takes very little time to manage. I don't know what I would do about the nurse long term. Don't know if you have a say in switching nurses or....... It is entirely possible that you have a wonderful, caring nurse who is a nice person but was never performing up to par, just that numbers were good anyway and you never had occasion to question her performance before.
     
  20. Jessicas mom

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    tough one

    I think I would have to say something to the nurse. I understand she is normally wonderful but that sure doesn't make it ok for her to put your child in an unsafe situation. I am sure that all of us parents have had to take care of diabetes when we had other things going on that made it diffult.

    My daughter went on the insulin pump eight days ago. Three days after she started the pump I came down with a horrible case of the flu. I still had to get up with her and check blood sugars every three hours around the clock. I had to watch for trends and keep her log books current. It was difficult but you do what you have to do. The nurse should feel the same way. She has a job and has to make things safe for your child.
     

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