We have a winner!

Thank you all for participating in the drug handbook lottery, but unfortunately I can't afford to give one to everyone. (Actually, it's the generosity of the publisher, Wolters Kluwer, that's allowing this to happen. Thank you, Meredith!) So, by lottery, we have a winner: Pam M. Congratulations, Pam, and please contact me to get your prize!

Happy Halloween!

First, a news articles that captured my attention: this one. I find it a tad odd that a parent can have a child taken away for forgetting to pay for the $5 sandwiches they ate while shopping, but in my experience a parent can let their kids have pot cookies, neglect them terribly, etc. and still be together. Obviously a mistake was made here, and that's why it's on the news, but still. Maybe I can hope more of my parents will shoplift with their kids.

 

Second, Halloween at an elementary school is awesome. Not only are the kids adorable, particularly in the morning kindergarten parade, but I had a record ZERO phantom or real stomachaches. Everyone was way too happy and distracted by the costume chaos to feign illness, I suppose. 

 

Stay tuned for the drug reference handbook lottery result! 

Whatever it takes to get them out of my office

I have a first grader (Head Shunt boy) who for some reason reminds me of Mario of Mario Brothers, with his tiny body and oversized head - minus the mustache, of course. He is one of the most talkative kids I have ever encountered and everything is a challenge with him because it is impossible to get him to focus on a task. "Mario" has become a frequent flier, complaining of various ailments that he can never quite pinpoint. Today he came in with a stomachache, saying he needed to call home for medicine. With some kids it's easier to just call home and let their parents duke it out with them, so as he stood way too close, spitting all over my phone (and ignoring my "see, you need to step back because you just spit on my phone" requests), I dialed home. I reached his mother, what I imagine must be the most patient person on this planet, and told her I had her son wanting to talk. After prancing around my office while I had to tell his mom, "Well, he wanted to call, but now he won't talk..." he finally took the phone. He talked with her briefly, and when I asked to talk with her, he hung up. I asked what she said, and he answered, "She said stop running around and go back to class and call me later." I told him I agreed, and asked what time she said to call back. "3:30," he replied with confidence. I quickly agreed and sent him back to class, and told him he could return at 3:30. School lets out at 2:10.

Down for the count

The germs finally got me. After feeling well since school started (an amazing track record after last year, when I felt like I woke up with a sore throat more days than I didn't), I woke up last weekend with the dreaded sore throat. Things worsened through the week, and I realized I needed to go home on Wednesday morning when my little 3rd grade diabetic told me I looked and sounded terrible. I decided I would go home after I checked my diabetics at lunchtime, and was dreaming of snuggling under my covers when, while with my diabetics, I got a call from my other elementary school. Those people wouldn't know an emergency if it was screaming at them in the face, so I answered the phone with dread: what could they possibly be calling about? They were at wit's end, and a parent was demanding she talk with me about the lice situation at our school. I told them I was trying to go home sick but fine, I would talk with this lady: I knew exactly who this was and could not in good conscience just leave them with that lady.

I met Lice Mom shortly after, and immediately regretted agreeing to do so. She launched off on a tirade about how the school is infected and I'm doing nothing about it, she has a list of 23 students that have lice at this school, and that she was thinking about reporting me to the public health department. (Ha! As if that could scare me: it wouldn't be the first time.) I had to ask her to repeat a couple of things because I was so congested I could hardly hear, and when she looked frustrated at me for having to repeat herself, I explained I was ill and how "sorry" I was that she was having to repeat herself. Apparently that was the greenlight for her to go off about her reported pneumonia and kidney infection, as well as what color her urine was that morning - which her daughter so helpfully chimed in with (why does a 5th grader know what color her mom's urine is?).

No matter that her daughter's hair had been so poorly combed through that it wasn't just full of nits, but actually had live lice too. This woman just needed someone to blame, and I suppose give me a heads up in case the public health department calls. I meet many crazy parents, and crazy in many different ways, but in all cases I mostly feel sorry for the kids. In this case, Lice Mom said she is keeping her daughter out of school until all treatments are complete, despite my repeated explanations that she can come back before treatments are finished if she is nit-free (but that would involve spending time combing through her hair instead of complaining). I don't really care if parents are crazy, but it's the kids that suffer.

Free drugs!

Okay, not really. But free information about drugs, really, in the form of a drug reference handbook: keep reading and enter to win a copy! Wolters Kluwer Health, the publishers of a drug handbook reference that I'm sure many are familiar with - past editions, if not this one - sent me a copy so I could step up on my pedestal that is this blog and write about it: Nursing2012 Drug Handbook.

It's been awhile since I've had my hands on an up-to-date drug book, and oh what fun it has been flipping through this one! Besides its bright shiny pink cover, which is a plus in any messy office, the inside is pages and pages of readable text on every drug I could think of. For every drug, there is complete information including adverse reactions and interactions, just as you'd expect in a reliable drug handbook. Equally important as the content is the fact that this is a totally readable text: a pronunciation guide for those weird looking drugs, black box warnings easily found, and, a pet peeve of mine solved, pages that are not so thin you can see right through them. Drugs are arranged alphabetically, which is my preferred way to find them, but is not for everyone. In the middle of the book is a small "Photoguide to tablets and capsules." It's not something I think I could use easily, but if you're double checking you're holding the right drug - and it's one of the 396 tablets represented in the pictures - it could be useful. As a nurse who spends most of my time in front of a computer, the most handy part of this book isn't in the actual book; it's the subscription to Lippincott's Nursing Drug Advisor that can be found online. A free one year subscription is included with the purchase, and, let's face it, Google should not be your source for drug information. The online drug advisor includes all the information in the book, is searchable, and you can limit the information you are looking for (e.g. adverse reactions), so as to not be overwhelmed. All in all, it's no wonder that this is the bestselling drug handbook for nurses.

Also, if you're wondering why the pink little bookmark ribbon, it's because the publishers are donating a portion toward breast cancer research via Susan G. Komen for the Cure. And if you're interested in updating your reference bookshelf with this book, you can buy it here, for 20% off.

And finally, if you've made it this far and want to be rewarded, here's your chance: leave a comment with how you can use a drug reference book in your life and you will be entered in to win a free copy for yourself! Contest closes October 31st at midnight EST; a winner will be chosen by a random number generator. I'll announce the winner then, and you'll need to contact me with how to claim your prize - no claim within 24 hours and it'll go to the next person by lottery, so be sure to check back on November 1st! One entry per person, and karma bites, so no cheating please.


Disclaimer: I received a free copy of Nursing2012 Drug Handbook from Wolters Kluwer Health for review; however this review is entirely my own. You can make friends with them yourself here or find them here.

The Great Divide

Most of you know that I have two schools in the hood, and another one out in suburbia. The contrast between the demographics is amazing: in one area it feels like every phone call I make is a disturbance to the parents; in the other, parents are breathing down my neck and demanding to see accident reports. In one area, a white girl like myself is like being "a fly in a bowl of milk" as my health clerk calls me, in the other, I have not once been able to practice my weak Spanish skills. But the difference between the demographics is never more apparent than during special events/days/weeks. For example, on September 11th, my suburbia school got a "field trip" to walk to the park next door to meet some firemen transporting a piece of steel from the World Trade Center. Back in the ghetto, there was nothing. It's Red Ribbon Week, and in suburbia, every child is wearing an "It's my responsibility to be drug free" ribbon, classroom doors are decorated, every pillar has a red ribbon tied onto it in a lovely bow-tie, and there was an assembly that supposedly incorporated an anti-drug message into a skateboard/bike demonstration - including a half-pipe set up on the blacktop. Back in the ghetto, there's not been a single mention of it. I know that suburbia kids need to hear the anti-drug message as loudly as the ghetto kids, but I also think the ghetto kids need to hear the message as loudly as the suburbia ones do. (Yes, I said equally loud. There was a time - before drug training - I'd have claimed my ghetto kids needed it more, but kids of all backgrounds are users, just different kinds of drugs. Ritalin, anyone?)

Just another Monday...

Arriving first thing in my inbox this lovely Monday morning: an email from a teacher, subject line "Smell from student." Yay.

Happy Food Day!

That's right, it's Food Day! Who doesn't like food, right? This isn't the first Food Day, and hopefully it won't be the last. (You'll have to do your own homework on it, because I'm too lazy to summarize it for you.) I'm excited for all the many places that are having events for the big day, unlike my own schools, and I'm going to add this to the growing list of things I would change in my own district if I had endless time and energy to make all the changes I wanted to...Yeah, I'll keep dreaming.

Crushing

A little boy came to my office complaining of a stomachache, so I told him to lay down for a few minutes on the cot in my office. After a few minutes, I asked if he felt any better. He said it was still "a little bad" so I told him we could call his mom. She didn't answer, but he decided he was well enough to return to class, and off he went. A few minutes later, his mom called to ask if he was okay. I told her why he'd been in my office, and she laughed: "You know, I think he has a crush on you...He only goes in when you're there and when he gets home he is always fine and wants to tell me about you. I'll have to talk with him when he gets home today."

Lolz. A second grader with a crush on me? It's almost cute, but also just weird. (In the lawsuit riddled age we live in, I told mom I'd be keeping him out of my office unless he was really sick or injured.)

Unrelated, we are having some personnel issues in our district with a nurse soon retiring and one soon on disability. We're being stretched quite thin, and there's a forecast for four schools in my future. While I am totally ready for it, it's mostly disappointing for the kids' sake. :( At least it's the weekend - happy Friday!

Edit: It's less than a happy Friday. No thank you to the a**hole who scratched the school nurse's car this morning. :(

Would you call a parent please?

Mrs. X called concerned about [her daughter] needing to use the restroom as needed during her cycle. [The principal] asked me to have you call her.

This is an actual subject line and email I received from my middle school's secretary today while I was at another site. Sometimes my job cracks me up. (I haven't been able to reach Mrs. X but can't wait to hear the full story.)

Screenings.

Performing hearing and vision screenings on approximately 160 eighth graders in one day is exhausting. Managing hormone crazed, know-it-all teenagers is no easy task and I'm not quite sure how teachers do it on a daily basis. But performing such screenings when your LVN (that is supposed to cover your diabetics twice during the day across town for you) calls at 8:45 am when school, and therefore screening, starts at 8:55 am to say she won't be able to help you today makes the day even tougher. Then when you can finally steal a lunch break, and you check your email to find a teacher whose classes you screened last week has sent a nasty letter, cc'ing the principal on it, complaining about how disruptive your state-mandated screenings are, that just doesn't help your day. When you just want to go home and sit down with a cold beer watching Game 1 of the World Series, and your day has been so terrible that you wonder why you even bothered to go to extra school to do such a crappy job, a parent might call you. A parent that you used to hate (Epilepsy Mom), but has since fallen in love with you, and came to drop off - albeit very belatedly - a seizure care plan for you as well as to thank you for your support - well, somehow, that makes most of the mess worth it.

Laughter is the best medicine

Today was a sad day for two reasons. My little Spitfire diabetic has a mother and a step-father - her second step-father - and spends every other weekend at her "real" dad's house. I had figured this out myself when one day her teacher told me she couldn't say the specifics, just that she knew little Spitfire would no longer be staying at her dad's, and suggested I google his name. I did, and what I found was disappointing: Spitfire's dad was involved in a high-speed chase in the wee hours of a Sunday morning, and the people involved were arrested for various things including driving under the influence and resisting arrest. Spitfire hadn't mentioned it to me until today, when she saw a newspaper. For some reason hearing her talk - brag, nearly - about her dad being in the paper a few weeks ago just made it that much worse. :(.

I also received bad news about another parent I know, and will never forget. The mother of my favorite twins is in the hospital with severe burns. (Rumor has it there was a kitchen fire and, no one else's surprise, it didn't get smothered when she poured water on the grease fire. I believe that she'd pour water on a grease fire, but I'm not convinced she wasn't concocting something illegal.) She's been in there for two weeks already, and has had multiple surgeries and is expected to have several more before being discharged for rehab - assuming she makes it. I don't know who is taking care of the little girls, but I don't know how they're ever going to make it in life. Double :(.

I was feeling pretty bummed until Spitfire interrupted my moping to ask if I had any grandkids. Never in my 26 years have I been asked about having grandchildren.

Reason #84 I like my job:

Drawings delivered to you after school, just because. :)

All in a day's work

I screened kids that were absent during last week's mass screening all morning, in between curing or sending home the miscellaneous "not feeling well" kids. There was a calm before the storm, and then lunch hit. Tetherball accidents, soccer ball accidents, zip line accidents, and more. At one point a group of five screeching children came in all demanding ice packs for reasons varying from back injuries to splinters. In the mess of things, a kid came in complaining a soccer ball hit him in the head, a student with a shunt in his head, one who though only appearing to be about 3 foot tall has a voice that can carry like a football player. Shortly after, another kid came in - escorted by a teacher, which is never a good sign - saying he "bashed his head in" after a zip line accident. His head looked mostly fine, until I took a look at his eye: it was bleeding, and he was yakking about how he just had surgery. Bleeding Eye kid also happens to have ADHD to an extent I rarely see, and absolutely never stops talking. (And don't ask him if he ever stops, because he'll ask why you're asking.) So, together I had yelling Head Shunt boy and Bleeding Eye kid in my office with head injuries. Frantically, and magically, I was able to make contact with parents in both cases and they were on their way. Still...It was a solid twenty minutes of nonstop yelling in my office, because when you get two yelling ADHD kids who just cannot stop talking, it turns out that 1+1 does not equal 2...It was more like having ten wild children in my office, all screaming about something. Head Shunt boy was picked up quickly, while Bleeding Eye kid's parents took a little longer - or maybe it just felt like it. While still being shouted at by the impatient Bleeding Eye kid, I was summoned down the hall to find a student on the ground, supposedly unable to walk. Little Ms. Drama Queen complained of not being able to feel her legs after hanging upside down on the monkey bar. By now it was far past what my stomach thought was lunchtime, and I was in no mood for this girl's antics. I told her my assessment of her injury (there was none, and she was pretending), and why, and then proceeded to give a lecture about how it can be dangerous to lie to the nurse. She broke down in tears, told me other kids were teasing her and she just didn't want to be in class (and when I asked her to name the attackers, one of them was her friend that had summoned help). I told her I'd tell her story to the principal and walked her back to class, and, after several more "not feeling well" cases, was finally able to sit down to lunch, nearly two hours after the storm hit.

 

This is a very run-on paragraph to repeat the point of this blog: school nurses do actually do things sometimes. When I had multiple head injuries sitting in my office, both potential 9-1-1 calls, everyone was looking at me to call the shots, and not a single person offered to help any of the other munchkins that were streaming into my office at the time. When I went to retrieve Drama Queen, the principal was with her, but after a few minutes of not getting anywhere with her said he was hungry and left her with me. I am not complaining about either of these things, I am just here to report that I earn the leeway in my job, because when the pressure is on, I'm standing alone.

 

Note: If you're wondering why 9-1-1 was not called for those head injuries, mother of Head Shunt boy asked that I let the emergency contact pick him up and take him to a doctor unless he was showing immediate signs of trauma, like slurred speech - he was not (and I could hear him loud and clear). Bleeding Eye's dad told me his eye was already bloody still from the surgery - but since I didn't know what he looked like before/after, and that's not really the kind of family I want to be the target of a lawsuit for, I asked that someone pick him up anyway.

Politics

I usually try to stay out of them, but this bill that was recently signed made me about as disappointed as I get when it comes to this stuff. (I was concerned enough to actually write a letter to the governor about it - a form letter suggested to me by the School Nurses Organanization, but a letter nonetheless.) There are so many problems with this, it feels a bit ridiculous. To start with, who invented a medication for grand mal seizures that is administered rectally? Has the inventor never witnessed a grand mal seizure? As someone who has, I'm not sure how this would even work. What's worse is that this is supposed to happen at school: a public setting, with children and teenagers, mostly connected to the digital age with cell phones. Can you imagine the youtube videos that would be posted when a high school math teacher has to pull down a student's pants during a grand mal seizure and poke a medication up her rear end? Or the liabilty of suggesting, say, an old man teacher touch one of his young female students, much less access her rear end? Neither can I. And yes, I may be biased, as this is just one more thing that used to be reserved for nurses and now everyone can do...But still...This just seems stupid.

TGIF

This morning a girl came in with severely chapped skin under her lip, from licking her lips and seeing how far her tongue could reach (she did a lovely demonstration). After searching my office for some non-medicated barrier I could put on it to no avail, I told her she'd have to ask her mom for lotion when she got home. Her response: "My mom doesn't have money, she can't buy anything. She works and so does my dad but they don't have no money ever." <Sigh...> Something to add to my growing shopping list.

Also this morning, a kid came in with a bloody nose. I knew it wasn't his recess, so I asked how it started. He told me he was sitting on the class rug and it started. I asked where his fingers were when it started, and he shrugged; then I asked if anything might have been in his nose when it started. With a sheepish smile he pointed his finger: this was! Well, buddy, that's what you get for sticking your fingers in your nose.

Still this morning, I received an email from a secretary at another site letting me know a parent was none too happy that her daughter came home Monday with a sprain while the nurse had only given her a bandaid. Apparently I just read the teacher's note that said she needed a bandaid and in the whirl of what is often the state in that office, didn't question her for any other injuries; later, mom ended up taking her to the doctor's and getting x-rays. There are plenty of things I can think of in my defense: that x-rays are taken for the most ridiculous of complaints as a CYA thing for the medical office, that you should stop babying your 5th grade daughter, that just because your doctor diagnosed your daughter with a sprain does not convince me she has a serious injury when the injury happened on Monday and she is only coming to the office to ice it for the first time on Friday, etc. Bottom line, still: oops, a big oops in this neighborhood, and I feel pretty crappy about it. Yay... This is perhaps the 3rd time this year that a parent has complained about the healthcare at  that school (though I believe only the first I was at fault), and it's a reminder to me that I do prefer the lower income areas where parents can hardly be bothered to clothe their children, much less complain about the school nurse. Gah.

Though I may not work the longest hours, this stuff is why I get home exhausted, especially by the end of the week. Other nurses have warned me: this job will suck the life out of you if you let it. I haven't even had the energy to touch on what happened Wednesday, but the short of it is that I had a diabetic in my office with a blood sugar of 48, and for the first time heard that this has been a pattern for the last three weeks - once reaching a low of 37 at school. You read that right: three weeks into a very alarming blood sugar pattern, the nurse finally finds out. Go me.

Edit: The mother who was complaining about me, and, possibly, might be interested in filing a lawsuit against the school about the incident, has reportedly explained her obesity by saying, "I had a C-section and when they sewed me back up they put too much air in." That statement made me feel a lot better about her complaint...

These are the people taking care of your children:

I had a full day of screening 2nd and 5th graders at one of my elementary schools yesterday. In the morning, we called a classroom and asked the teacher - a substitute - to send half of her class down to the nurse's office to begin screening. Her response: "Should I come with them?" 

Yes, and leave the other half of that 5th grade class alone in a classroom. Great idea. 

Artifacts from an archaeological dig:

I dug deep into the bowels of my office cupboard, and found these: a 14 minute cassette and film reel called, "Why Do Girls Menstruate?" It's courtesy of o.b., dated 1975. If I had a tape player, I'd totally put this in and follow along with the reel, where I see pictures of girls skipping around and lazing in the pool. I also think o.b. should probably get a new marketing department given the advertisement appears to have not changed in over 35 years.