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School Nurse questions

Discussion in 'Parents of Children with Type 1' started by thebestnest5, Sep 12, 2012.

  1. thebestnest5

    thebestnest5 Approved members

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    1. The school is saying that my kid must be evaluated by school nurse to determine that she is capable of performing the self-care tasks from the DMMP and IHP. The nurse will watch my kid perform a bg test (and anything that is checked "does independently") and evaluate if my kid is doing it correctly and I am told this is the responsibility of the nurse for legal and liability issues for care at school.

    Anyone else have to do this? We are the only family, ever, in the history of the school, who has had a kid with T1 test in the classroom--so this is new to the school.

    2. For older kids who do mostly self-manage. How much involvement does the nurse have in your older kid's care? Does the nurse get a report of bg's from your kid on a daily or weekly basis? How have you worked out the nurse's involvement in a kid who is doing so much more self-managing?
     
    Last edited: Sep 12, 2012
  2. Sarah Maddie's Mom

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    No, never evaluated by school - Dr checks off all the tasks that DD can perform independently and that's that.

    By 6th grade, pretty much no contact with nurse other than to pick-up supplies stored there. No bgs recorded.
     
  3. thebestnest5

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    That is what we had in 6th and 7th grade, the new school in 8th grade wants more involvement in diabetes care, and is nervous about not knowing the bg numbers since my kid is self-testing. The school tells me that my kid's teachers are very nervous about having a kid in class, who is not seen by the nurse on a regular basis.
     
  4. thebestnest5

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    How do you handle lows in classroom, is there a point that your kid would alert a teacher to a low, if it was quite low? Does the nurse want to know if your child has treated a low, maybe a certain low number?
     
  5. Sarah Maddie's Mom

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    Have your endo write a letter stating that DD is self-managing, that its vital to her emotional and physical wellbeing that she be permitted to continue the effective and developmentally appropriate self-management of her chronic medical condition without interference.

    IF any teachers are "nervous" ( and I doubt that) then tough luck. I do think it's important to meet with middle school teachers and in your case all the more so, but the meeting should focus on what tasks dd will be performing and how they can support her (having tabs/juice for lock down) and if needed to reassure them that dd is the best person to manage her body and it's needs and that nurses office visits are not developmentally appropriate.
     
  6. Beach bum

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    Never had this. Our CDE signs off on the IHP where it says she can perform X tasks.

    We are in 6th grade now, my daughter does a good chunk of the care on her own. She will call up to the nurse with her BG's when she's having a snack, the teacher knows the range of bg's for testing and will touch base with nurse as needed. She does pop in at lunch to test and on the way back to confirm bolus, but that is more a social call for her.

    As for lows, my daughter tests, treats and will call the nurse. So she will call and say I'm 75, so I had a fruit leather that's 14g. Nurse will call back in 15 to see where she's at, or if she is moving about the building will swing by and check on her. As for the teacher being nervous, tough tooties. I had a meeting with my daughters core team and we outlined what she can do, what is expected of her. We stressed the importance of her staying in class and that she actually can't stand missing class because she knows it impacts her learning. The teachers were on board with this and we talked about what they can do to help.
     
  7. hawkeyegirl

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    OMFG, this school is acting like you are asking for a KINDERGARTNER to do her own care!!!

    My son is 8, and in 3rd grade, and this is the first year that he is doing some testing in the classroom. I think the teacher had the nurse come down to the room the first couple of times, just to make sure he was comfortable with what he was doing. I didn't put up a fuss about it, because he didn't care, and I think it made the teacher and the nurse feel better. But he's 8.

    At this point, if my son is below 70, someone walks him to the nurse, or the teacher pokes her head out the door and watches him go. I could probably lower that to 60, but at this point, I guess I'd prefer to have him consult her if he is actually low, because (1) he's only 8 and new at this self-care thing; (2) if he has one low at school, he tends to have a low day, and I'd like the nurse to be aware of that; and (3) if his decision making is actually impaired, I want her there to help.

    But again, he's 8.
     
  8. liasmommy2000

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    It's times like this when I'm actually kind of happy that we have no nurses in our district. DD is now in middle school and barring a severe low does everything herself and in class or wherever she is. Teachers or other staff will help her if she has a severe low. If she has to change her site she is to go to the office but that's more because she doesn't want to do it in class and the bathroom, well ugh. But she's on her own and at times like this I like no nurse. The endo (new for us) keeps copies of signed DMMP's with some basic to all kids filled out and then we fill out the particulars for our child. I checked what she could do on her own and nobody said a thing. I completed her 504 (well actually she has an IEP which her diabetes plan is attached to) and they just read it over and signed it. Last year at the start of middle school the only hesitation to any of it was allowing dd to have her cell phone and text me when needed. Since I had already set it up with Verizon parental controls and told them that and she couldn't contact anyone else besides family during school hours, they agreed to that pretty quickly.

    Things were a little more difficult in elementary school to say the least but still nothing like that. Good luck, what a pain.
     
  9. liasmommy2000

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    DD is to let the teacher know if she is so low that she thinks she needs help. They are to call the office for assistance or if she's passed out/seizing or other wise non responsive, call one of the the staff members we have trained in glucagon administration.

    At the beginning of the school year last year and this, I sat down in a meeting with all of her teachers to go over her care plan and any questions they have. That seems to calm them. Thankfully dd rarely goes so low that she can't handle it herself with ease. Bad lows only seem to happen after unusual activity/foods which are rare in middle school.
     
  10. 3kidlets

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    Prior to this year, Hana was in the public school and they were very versed in Type1, having had 12 kids in the past 5 years with T1. We never had any issues. The nurses are incredible. They did as much or as little as we wanted. They were incredible when Hana was dx and we got out of the hospital. I learned so much from our nurse in 3rd grade. she kept me calm and cool those days after dx. I never feared for her safety at school, knowing she was in the best hands.
    The past 2 years, we had the best school nurse ever! She is a saint. Once Hana hit 5th grade (last year), she was pretty much responsible for all her own care - other than if she was very low and she would go to the nurse's office to be watched for a bit. Or if her POD failed. The nurse knew how to change them. We are very fortunate.
    This year, we took Hana out of the public school and she is in a small Christian School. She is their first with T1. But Hana is 11 and is going on three years with T1. She does all her own BS checks, blousing, treating, can change a POD. But because the nurses do not know anything, they are really on edge and nervous wrecks and making things much harder than they need to be. Beside the nurse approaching me on Monday saying that Hana needs to come to her office for all blood sugar checks because she will contaminate everyone - that didn't go over well and I gave her an education on the law and contamination via test strip right there in the parking lot where she decided would be an appropriate place to confront me (My husband who witness it, said the 2 nurses looked like deer in headlights as I educated them), she also said that Hana needs to report all her numbers to them because they need to know. I told them it wasn't necessary. Hana knows what needs to be done or not done. She doesn't need to report her numbers. The teachers have been alerted to the symptom of serious lows and Hana knows to ask for them to call the nurse if she is very low. But other than that, reporting anything is completely unnecessary, disruptive and a waste of everyone's time. She's 11 and responsible. We aren't talking about a 1st grader here. Even in 3rd grade when she was first dx, she was doing all her own BS checks in the classroom. They only called the nurse when she was low or high.
    I hope to get this all straightened out this week. I miss our old nurses!
     
  11. CAGrandma

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    It's always about "legal and liability issues" isn't it? The problem here is that the school is assuming that they have the obligation/right to manage your child's diabetes care. That's why they want to evaluate his ability to self treat, and why they want to see his BGs. It is none of the nurses business what his BGs are, and if they are high she has nothing to say about it. The school really needs to learn what their responsibilities are - the nurses job is to help keep necessary people informed as to what to do in case x,y or z happens. And whatever else YOU want her to do. Your 504 should spell out what you want her to do and what accommodations your child needs (testing, water, etc.). The last thing a teen needs is a school nurse 'evaluating' his self care, BG numbers or diabetes routine.
     
  12. LoveMyHounds

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    No, we didn't do it. My DD (7th grade) is "independent". She doesn't see the nurse at all. The nurse has glucagon, extra meter, some strips, glucose tabs, extra snack, and that's it.
     
  13. selketine

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    I believe it is in our state's "guide to Diabetes management at School" and also they print it on the state forms (and local forms) that for self carrying/self treating of this or that (including epipens, inhalers) that the doctor, parent and nurse signs. Each year the nurse has William show her proper technique to verify he knows what he is doing and then she signs off.

    I don't think it is a problem. If the doctor and parent agree that the child can do something - I think the nurse would have a very difficult time keeping a child from doing it based on this demonstration of ability - when all is said and done.

    I can understand the concern if you think they will use it to say your child is not responsible enough to do this in the classroom without going to the nurse of course. I just think it would be hard for the nurse to use this as the reason why a child that old cannot self-care if the doctor and the parent say they can.
     
  14. KatieSue

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    DD was diagnosed at 13 so right before 8th grade. That year the nurse had 13 T1's and actually knew way more than we did. Some of the kids came into the nurses office to test etc some not. She was fine with whatever the parents/doctors wanted. Mine went in a lot the first month or so then tapered off. She treated lows in the classroom then went to the Nurse. The nurse never kept any records of her BG's. She'd call me if there were any issues.

    Now in High School she only goes in if she's way high/low and not feeling well or needs some of the supplies kept there. There is a student in her grade that HAS to go into the nurse to test/bolus and she records it all but he apparently at one point quit taking insulin altogether until he ended up in the ER so that's a special case for that one child.

    I'm not sure I'd have a massive problem with the finger poking demonstration. What are they going to say they didn't poke well enough? Maybe it will make them feel more comfortable seeing that it's not a big deal and that the child has no problem doing it?
     
  15. jules12

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    We had to go through a check list in grade school - going from 5th to 6th grade with the same nurse!!!! She had her checklist the first day and watched him check himself in the classroom and later showed up at lunch to watch him bolus - even though he did this all on his own the year before. I think she got some heat about not having all the paperwork completed properly.

    In 5th grade, he was required to write down all his BG in a notebook and the nurse would review them. He did fine until one day she freaked because he reversed two numbers and it was OBVIOUS that is what happened. From that point on, I put an end to the recording of numbers. In middle school, he does all his own care and only goes to the nurse if he is above 240 and his first attempt at a correction did not bring him down OR if he is really low and feels bad. Therefore, he never sees the nurse in middle school but she is there if he needs her.
     
  16. Flutterby

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    Never heard of this. I'm sorry your school is filled with a bunch of asshats.
     
  17. Mish

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    Even though most of us have never had to deal with such a request, when I've looked at many state's policies regarding checking the classroom (or individual school districts) many actually do have the stipulation that the nurse sign off on the tasks, since the nurse IS the one responsible. I'd be inclined in just about any other situation to say just go along with it -let your daughter do a supervised BG check to shut the nurse up. However, I think what will happen is that the nurse will find something wrong with that way she does it and deem her not qualified. I'd also suggest having the doctor write a note though that might not absolve the nurse. It still, like it or not, her responsibility. I don't think they're going to make this any easier on you.

    For us, this year, the nurse has almost no involvement at all. (7th grade) he's not going to the nurse at all nor do I give her BG records. She does have backup supplies - back up meter, glucagon, and extra glucose tabs as well as I've sent granola bars and juice boxes, so DS knows that he can go to her office if he needs something more substantial or if he's got a low that won't budge.

    And how I worked it with her was that I simply told her that this was what was going to happen, this was what we were doing. Frankly, she's old, uninterested and I think she's happy that she doesn't have to do anything. And she seemed to indicate to me that she's never really had any kids with diabetes spend any time in her office that most were quite capable of self managing and then she detailed about "the one kid who was 16 and still couldn't do her own shots....." So, it's a bit different in our case.

    but your daughter - 13? I think they're over estimating how much the teachers care about a kid in class who isn't seen by the nurse. Every bit of info that I've received so far from my son's teachers has been "he can do whatever he wants." It's like they really are not into hand holding at this age. And they shouldn't be.
     
  18. Mish

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    oh, and I wanted to add, if you do go ahead and let the nurse observe a BG check, maybe have your own CDE write down step by step instructions so that your daughter can follow those to the letter, while doing the check, and remove any question the school nurse has as to proper procedure. :)
     
  19. Joretta

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    Our school require a check sheet it is just the first year each skill starts. A form is completed and in her file. I do feel they have a right and a legal right in our sue happy society. If they do not document and the child skips testing or does it wrong a parent can set a school up for a law suit because they can claim something else. Our lows only involve a teacher if it persistent or impairing her behavior. My DD keeps a log book and checks it with the school to prove she is being responsible. I personally appreciate the help as my child responses better to immediate consequences. Her waiting for me to catch later means nothing.
     
  20. tuckerce

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    As a RN/NP and a mom of a child with diabetes, I really don't see the harm. I look at it as competency check and more than likely for those of who allow our children some level of indepence in their diabetes managment, they would do just fine in front of the nurse because they must be doing it well enough for us to give them that liberty.
    Also, it is a relief to know that in the event that something happens and our children are unable to manage themselves, you have someone (nurse or school staff) capable of caring for them until a parent can get to them.
     

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