About that lack of funding for school nurses...

I can say with confidence that nobody was going to call 9-1-1 for my asthmatic kid, and probably wouldn't have until the inhaler didn't show up in the backpack - which might have been too late. This week, one of my diabetics asked for help calculating his insulin dosage. It was the first time he's ever asked for help, and only did because his scale changed the day before and I happened to be sitting there. I know him well enough to say with certainty that he would not have asked the secretaries to call me had I not been sitting there, and he thought he didn't need any insulin when he actually needed 3 units.

That being said, we are not miracle workers, and it breaks my fragile little heart when I'm expected to be one. For example, I have a girl with a club foot at one of my schools, and she requires special shoes. The shoes are made for FREE by a local hospital, but the mother needs to take the initiative to do that. I went at this issue for weeks when I first started (back in the day, before I ever started being worn down by these kinds of parents), calling the hospital, calling the mom, talking to the daughter. Coincidentally, I called the mother the same day a CPS report was filed by the counselor for a suspected abuse issue. The witch of a mother assumed it was me who had called CPS, did who knows what to her daughter, and tried to hunt me down at the main office (I was at another school). The daughter, who previously visited me consistently every single week, won't even make eye contact with me now when she sees me in the hall. I will not call that mother again; I don't want her to hurt the girl. I've explained this all to the yard duty who comes to my office almost weekly to tell me we need to do something about the girl's shoes. There. Is. Nothing. I. Can. Do. She keeps asking me to ask the nurse who had my school previously to do something, and when I've passed this along to her she has the same frustrated reaction. We aren't miracle workers, and even if it looks like we're failing sometimes, it's not for lack of trying.

Excuuuuuuse me?

This afternoon I had a 5th grader in my office waiting for her mom to bring her Tylenol, and a 1st grader crying to me about how she didn't feel good and didn't want to wait five hours for her mom to pick her up after day care was over:

1st grader: "But... Five hours is so long, I can't wait that long..."

Me: "When you get old like me, you'll see five hours isn't really long at all."

5th grader: "You're not old - you're middle aged!" When I turned around in horror, she added, "You're in your thirties, right?"

I am not in my thirties nor do I believe I'll be middle-aged when I hit that decade... in five years.

Someday there will be nothing left of the school system

Jeopardy.

School Nursing is like a box of chocolates

Today, falling in the "other duties as assigned" category: I accompanied the principal to a child's house. She was taking a totally and repeatedly out of control boy home because mom was not going to be able to pick him up. This kid has, in the past, bitten, kicked, spit, and more on/at people, and when he gets out of control in the classroom, he gets sent to the office. When he gets sent to the office, no one can think through his screams nor relax for fear of being attacked, so he gets suspended. But when he gets suspended, mom doesn't have a car, so the principal's new and easiest method of coping is to drive him home herself.

War on Lice, Northern Front

Friday morning I was asked by the secretary to check a girl for lice. When she came to my office, she had some nits: enough that I wouldn’t call her “loaded” but enough that I wasn’t willing to pick them out myself. I called the mother and was met with a long and draining rant.

Sitting heavy

Yesterday I ate the school lunch - tacos - and the mystery meat sat so heavy in my stomach I didn't feel hungry again for seven hours, when often times the first thing I do after work is have an after-school snack. I would offer my services for this job, but I'm not interested in feeling I have a lead stomach for months.

Validation (a.k.a. Bragging)

Today I screened the 2nd and 5th grades at one of my elementary schools with a veteran nurse and our nutty and completely lovable health clerk. This veteran nurse used to have the school before I took it over, and she had not once introduced herself to me, showed me around the schools, or even said hi at our nurse's meetings. I'd been warned about her by the other nurses, who all said she was a cold-hearted, past due for retirement scathing woman with a sailor's mouth. I noticed the sailor's mouth at our meetings but stayed away from her until I was forced to work with her on these screenings at my school. Lo and behold, at 7:30 this morning I was met with warmth, intelligence, and experience. Granted, she may not be the warmest to the students, but I think it's efficiency that's being mistaken as rudeness by others. In any case, in every gap between students she educated me on useful things, asked caring questions about my background, and was really quite the conversationalist. More importantly, if I may brag for a few, she completely validated my work. She's been all over the district and assured me the schools don't get worse than mine, the kids and parents don't get more difficult than mine, and was nothing short of impressed at my screening method (efficient). I told her about last week's asthma incident and she commended my 9-1-1 call, complaining that most people do not take asthma seriously enough, and she was equally impressed when the health clerk relayed the story of my first day at the school.

There's a few things I took away from this. First - I've earned myself a pat on the back if this veteran nurse was giving me accolades of any sort, much less all day long. I need to start taking pride in what I do, because some days, it's a lot. Second - and this is something I learned well in nursing school - I'm my own judge. One person's opinion of someone else isn't always the same as mine, and in this case, I am totally looking forward now to working with this nurse again next week - something several of the other nurses probably would scarcely believe.

I wish I was making this up:

It was an incident I would think I'd find in a sitcom, and I was the main character. I hardly fax anything, but I went to the main office to fax a referral the other day. The fax machine sits in a separate but attached little room of the main office, with windows and doors open to make the person who works there feel more like a part of the team. She wasn't there, so I helped myself to the fax machine. I inserted the paper, dialed 9 before the rest of the number just like all outside calls at this school, and waited. The answer was on speakerphone: in a soft woman's voice, I was requested to press 1 if I was older than 18, with a description of lewd acts I could listen to if I was of age. Frantically, I picked the phone off the receiver and tried to hang it back up to no avail; cancel didn't work, and neither did any other number I pressed on the fax machine (and I pressed most of them). It was one of those things that was funny afterward, but in the moment all I could think was, "I hope the principal does not walk in now." I ended up asking the secretary to help me fax it; turns out you don't dial 9 when using the fax machine.

These are the people I deal with.

Whoever said that school nursing was a kick back, no stress job for nurses on their way to retirement obviously never worked at my schools. 

Friday Recap

A summary of my week:

Monday: Asthma attack
Tuesday: War on Lice, Battle of the Two Sisters with the Nice Mom, part one
Wednesday: Epilepsy's Mom (more to come); late afternoon "Non-Violent Crisis Prevention Training, part one"
Thursday: Nebulizer Girl with the B***h Mom, part one (more to come)
Friday: Kindergarten screening, War on Lice, Battle of the Two Sisters with the Nice Mom, part two; Nebulizer Girl with the B***h Mom, part two; afternoon "Vision Workshop for School Nurses"

I thought a three day weekend following a three week break was a bit silly, but after this week - I need it. Gah.

A triumph of sorts.

A teacher entered my office during recess on Tuesday to ask me to do a lice check on one of her kids. Sure enough, when the girl visited me shortly afterward, I could see from a distance why: her hair was *covered* with nits. Gross. I called her mom, thankfully reached her, and mom said she was on her way. When I went to the secretary to let her know this girl would be leaving, the secretary informed me she accidentally forgot to include me on an email about this girl and her sister. This was their first day at our school and at their previous school, they had an over 50% absence rate due to lice. Crap. When mom arrived, I asked her if she had heard of Healthy Start - something I realized I really need to get better about explaining. I faxed the referral to Healthy Start and scribbled their number on a piece of scratch paper for the mom "just in case." Stupidly, I hadn't pulled the girl's sister out of class to check her then, so I just sent the girl and mom out the door after a little chat about lice. At lunchtime, the girl's sister's teacher came to me and asked to do a lice check on her as well. Not surprisingly, she was loaded too. Again I called mom and again she said she was on her way. When she arrived, she told me she had called Healthy Start and that they said they got my referral and would call her back shortly.

For emphasis, let me repeat: this mother had called Healthy Start. My heart swelled! A parent that cared!! I can think of two other parents - in all my parent encounters at this job - in which the parent really tried for their child. I was beyond thrilled, and even if they still have repeated absences, I consider it a huge success that I a) initiated and made a referral all by my big girl self (a first!) and b) the parent actually worked for it too. To top it off, I got an email the next day from Healthy Start confirming they had helped this family.

It's premature to call this a triumph, I'll have to see how their attendance record goes. Still, even the smallest of triumphs, because they are so few and far between, are some kind of wonderful.

Welcome back, me.

I won't complain about having a three week winter break, but I was ready to come back to work today. Good thing: my first asthma attack warranting EMS happened after recess this morning. A kid who has come wheezing into my office before came in again, except this time when I asked him to get his inhaler out of his backpack, he said he didn't know where the backpack was. I got his emergency card and we went through every number on the card, his parents twice. While he was dialing, I called the nursing coordinator to ask just at what point I should call EMS. As I began to give my assessment, I realized I didn't need to ask: his color was starting to turn, his coughing becoming unbearable, and his sweating became profuse. I hung up and dialed 9-1-1, because the best we had from any of his emergency contacts was that someone who knew someone who knew where his backpack was would tell her to bring it to school. After a tortuous wait (is it ever not?) the paramedics arrived and whisked him off. [Father called soon afterward asking why he wasn't called first. If he wanted to speak with me directly, I would be more than happy to tell him we tried and didn't have time to wait for a call back, but the secretaries got the brunt of that one.]

When I called the nursing coordinator back to tell her the end result, she said asthma attacks are one of the worst parts about this job; it's not usually a black and white decision, and watching and waiting for their condition to deteriorate is tortuous. Further, it's preventable, and in this case, disgustingly so: we've tried sending the medical forms home for this child to keep his inhaler in the office multiple times, plus, who lets their kid go to school without his backpack? Interestingly, the backpack did show up with the aforementioned emergency contact just before the paramedics arrived. I thought I was about to feel really stupid and have the paramedics find a perfectly happy healthy fifth grader, but the pack was inhaler-less.

Just before break I had received materials on asthma education distributed by the county. I was shocked to learn that kids die of asthma at school (only on the very rare occasion, but still), and I wasn't about to be one of the nurses at such a school today. The materials also included videos of wheezing. I felt ill watching them the first time around but in real life, it is even more sickening to watch a child with a severe asthma attack. The wheezing and coughing make me cringe, and it also makes me want to have a little chat with the parents who decided not to pack an inhaler for their severely asthmatic child on a cold winter day.

On a totally different note, a kid came in to ask for an ice pack for a crick in his neck. I told him his pillow must not have been fluffed right last night, and his accompanying friend said he got two pillows for Christmas. And a shotgun. "A real shotgun. My mom said it's for if anyone tries to fight me." These were first graders.