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School nurse..is this too much to ask?

Discussion in 'Parents of Children with Type 1' started by Lorraine, Dec 12, 2008.

  1. Lorraine

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    My son Caleb is in half day K and we are having a little difficulty with the nurse. I have never found that she has taken an active interest in truly trying to understand HIS diabetes, nor to really appreciate some general concepts of Type 1 and pump therapy.

    I have a care sheet which provides guidelines of action based upon ranges of BGs. She is very strict to follow this, however we have run into this situation a couple of times:

    Caleb has a post breakfast high and needs a correction or is in range and is bolused for snack. He complains of feeling low within a short amount of time - 40 or 45 minutes. His BG is checked and he is indeed low or on the low end of acceptable. The nurse will refer to the BG ranges and course of action in my care sheet and proceed as specified there and does not consider the fact that there is active insulin in his system which will only bring his blood sugar lower.

    It horrifies me that the correction or snack bolus is not considered before 2 hours has elapsed. This has happened a few times and we have reviewed this concept and she is still not considering it. So my question is, am I expecting too much?

    I could amend his care sheet to provide a different set of ranges if before the 2 hour mark. But we already have a snack protocol, a bus protocol and early dismissal schedule and a delayed opening schedule. These seem to overwhelm her.

    The OmniPod will show IOB for corrections, but not for food boluses. So I could refer her to the IOB in the correction situation only. I am not confident, however, that she really understands that as she is still calling me for assistance in giving a regular food bolus. And to have something that applies in one situation but not the other I am worried will only confuse her more.

    He was in a different school with multiple nurses last year with the same care plan and without these difficulties.

    I am readily available and she calls me often. However I have a general discomfort with the care that is provided to him and she has admitted being uncomfortable without being able to pinpoint the reason. I have tried to explain the importance of this 2 hour mark and she says she gets it but at the same time suggests the wrong course of action. I have a meeting scheduled with her, her boss and me (at her request) next week. I feel like I am not asking too much, but need a sanity check from all you.

    I appreciate your input.

    Lorraine
     
  2. *Shannon

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    It is a lot to understand, but in her position, that's what is expected of her. She needs to understand why she's doing what she's doing. Not so she can go off the sheets and do whatever makes sense to her, but for more confident care. She should be aware of what insulin is on board. Should she understand what adjustments to make accordingly?? Probably, but that's a lot grasp. Is she a nurse or a clinical aide?

    I can tell you that Janie's school clinical aide has fewer situations for which to prepare. Besides the aide, there is an admin that can do tests/injections as needed.

    Janie drops off her kit when she gets to school. If she feels off, she goes to the clinic (with a buddy) to check. If she's near or below 70 they treat as directed in her file. If she's high, they call me for instructions.

    She goes in 15 minutes before lunch and tests to see if she needs a correction. They follow a protocol sheet for the correction and her lunch carbs that I've sent in and dose as needed.

    She goes to the clinic and tests if there's a snack the whole class is having (birthday cupcakes) and calls me for instruction (I'm in this equation a lot, eh?).

    Her class has reg snack time at 9:30, she either has no snack or a low carb one like cucumber slices, she doesn't test or treat at snack time... unless she's feeling off.

    I don't know if my reply is helping at all... I think you do need to feel comfortable with the care Caleb's getting. Embrace this meeting and maybe think of it as a mini training course if you feel ok "teaching" her.

    What size school is Caleb at? How many nurses/sides/backups are there?

    I hope you feel better after the meeting next week.
     
  3. Heather(CA)

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    What if you put on the sheet that if he goes low within X amout of time form the last bolus she is to treat and call you for further instructions...Would that work?:cwds:
     
  4. Lorraine

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    It might. At this point, she just calls me all day long, which I am fine with since she appears to be and has admitted to not being comfortable. It just makes me uneasy that she needs to. I also have the sense that Caleb spends more time than necessary in her office. I just expected at this point that things would be smoother. It took less time to have a smoother plan last year with more people involved. I expected this to be a little easier since it's the same person 5 days a week who dealt with a child on a pump for at least the last three years. I just have a general uneasiness with things.

    The 2 hour issue is not the only problem. Caleb was deprived a snack last week that a child brought in for the class because it wasn't sugar free. He sat and ate nothing while the others partook. Not only do his instructions clearly state he is allowed to have anything the other children are, but if you understand the general idea about pump therapy, you would know that asking if the snack is sugar free is rather irrelevant.....thus my continued uneasiness. Why I wasn't asked about it on one of the four phonecalls I had that morning, I do not understand.

    I would like to work this out, I welcome the meeting, I just need to get a sense that my expectations are ok because I'm starting to wonder...

    Lo
     
  5. wdhinn89

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    You are definitely not being unreasonable! She is a nurse, she should get it. I would go to the meeting and set it straight now. Is this the same school and nurse he will be using next year in first grade? If so, more the reason to get it straightened out now.
     
  6. Gwyn

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    Hi,

    I think you are doing the right thing by continuing to stay in touch on a daily basis and to keep educating. I do not think you are asking too much, generally speaking. These are concepts that the nurse must understand if she is to keep your son safe and to give him the care he deserves.

    However, speaking from experience, it seems that some nurses will never understand why or how these concepts matter. It is likely that all of her previous training runs counter to your suggestions and that she has limited time to come to terms with new approaches. We were in a similar situation a couple years ago and are now homeschooling.

    I wish you all the best and hope everything works out!
     
  7. Lorraine

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    Thank you - I am so exhausted from dealing with this. I want to be kind and respectful, but at the same time I am completely bewildered because a trained nurse, whose job includes my son's care, does as much as I would expect of a neighbor when Caleb visits for a playdate. That doesn't add up for me.

    I'm sad to hear when anyone resorts to homeschooling because of this (I have nothing against homeschooling, just being forced to do it). I think about it sometimes but am so hard-headed I don't want this D situation to make such a decision for me.

    As I was trying to offer assistance today, and tried to pinpoint the area of "discomfort", she was not able to come up with specifics. She came out and said, "maybe I need to transfer". Meaning she should transfer to another school. I was disappointed that that was the only solution she could come up with. She pulled back and then suggested the meeting....

    Lo
     
  8. irenehlm

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    Would the nurse be willing to meet with a dietician or a trainer to learn more about carb counting, insulin effects, time of onset, etc. just like we learn after diagnosis. This would help further her education (there may be more children attending the school with diabetes in the future) and also make her more comfortable with Caleb?
     
  9. twicker1

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    I'm not all that familiar with the Omni, obviously, but does it have some sort of Wizard that does calculations? I was just thinking that if it did, then when you try to use the wizard it should take into account what insulin is still being used. Or if she is doing all of this manually, does it tell you what is still working? If so, she could still do her calculations for insulin, but subtract what is still in him. Again, I don't know what features you have available...
     
  10. betty6333

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    She would have to enter every food bolus as a "BG Correction" bolus to have that happen where it would show how much insulin was left, and even if she entered the food bolus amounts as a correction bolus to get that # , the nurse would probably still act the way the nurse wants to act, so it is best to just try to teach the nurse to use a brain and try not to feel so overwhelmed.
     
  11. Lorraine

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    What size school is Caleb at? How many nurses/sides/backups are there?

    There are about 300 kids in Caleb's school, K through 2. The nurse is not new to pump therapy or Type 1 diabetes. I have been in touch with the mom of s Type 1 child who just "graduated" from the school. On the same campus is the 3-5 school, with it's own nurse, who provides me great comfort and is her backup when unavailable.
     
  12. Lorraine

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    It calculates IOB for corrections but not food bolus'. At this point she struggles with delivering a normal bolus, I certainly could point the IOB function out - it's worth a shot. I do worry that it will only confuse her more.
     
  13. Lorraine

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    She has spent the last 3 years at least, with another Type 1. Claims to understand treatment, and has been trained. There is continuous training - one planned for January, which her supervisor and I have discussed.

    Thanks for all the feedback folks. I think I have a plan for Thursday. I will remain hopeful that we can work through this and come out on the other side with a positive outcome.
     

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