Murphy's Law:

If I wear my hair down, I will have to do a lice check.

I wear my hair up almost every day I'm at work, and frankly, it's for my own peace of mind. I sleep better at night when I keep my hair tied away from the blood, puke, lice, and other gross things I am exposed to. I've made only a handful of exceptions to this rule since I started working here, and today was one of them. I was going to be at my middle school, so I figured I was safe - rarely do I ever have a lice check at this school. So, naturally, I had to call in a girl that was being teased by her classmates, rumored to have lice. This time the rumors proved true: I could see them crawling all over her head at arm's length, and for a brief moment, I wanted to lose my breakfast. I'll take a kid projectile vomiting all over the place before a lice-carrying one any day.

Unrelated, as I've mentioned before, I had been giving out tangerines to kids from my over-productive tangerine tree in my front yard. You can probably imagine my disappointment when I went out for some tangerines last week only to find someone had cleaned me out. No more tangerines for me. Today, a  kindergartener came flying into my arms to ask if I had any "orange-ies" for her. Luckily I can catch 43 pounds, and as I did, I told her I didn't have any more, leaving out the sad fact that someone ripped me off of all of them. She gave me her logical solution: go buy some at the store. Thank you, five-year old.

Happy Spring Break!

Update:

1. Blowing bubbles totally erased yesterday's dark day with my diabetic. Whatever hearing I lost to her screeching in excitement about it was worth it.

2. I have written a draft of a future lice policy I hope to get passed, with the aid of this handout courtesy of the Public Health Department. It's now being tabled until our April 25th meeting where I'm tasked with convincing our other nurses to have a less outdated policy than our current dinosaur-aged  Draconian policy. An easy task, most would assume, but I am realizing I work with people that have an unreasonable fear of change.

3. It's T-24 hours to my spring break. I know I always say these breaks can't arrive soon enough, and it's true again: morale is the lowest I've ever seen, and the period between Christmas break and now has been utterly exhausting for a variety of reasons that have nothing to with this job. I may just go sleep for twelve days.

Stop the tears

Today started out weird when I went to my diabetic's classroom to find her in neon yellow and pink leopard print tights, and a neon colored shirt. Normally she successfully does her best to look cute, so I couldn't hide my shock:

"What the heck are you wearing?"
"I lost a bet."

She wouldn't elaborate then, and she told me she'd spill the beans at lunch. At lunch, she told the full story, "It was with my cousin. We played a game on the trampoline where we had to punch each other and whoever lost had to either pay $250 or dress like this for a day. I lost, I puked first." I asked if any parents were present for this game, she said her step-dad was. Now, this girl tends to stretch the truth (she also said she had a fever of 105 yesterday), but this was just very bizarre to me. Even if the entire trampoline story was fiction, she certainly lost a bet of something to be wearing such clothes.

When it came time to calculate her insulin, I found the doctor's orders that are normally kept in her binder missing. I asked if they might be in her classroom, and she suggested she call grandma because they were probably at her house. As it turned out, they were in her backpack, and I expressed my disappointment that the papers weren't all together. I also told her I wanted her to give her own insulin that day, but as a compromise, I'd give the shot the next two days. As always, she put up a fight, but I didn't want to back down to an eight year old. She attempted to stick herself, got scared (though she's been able to stick herself for at least two years), and pulled back.

In all the time I've spent with her, I'd never seen her cry until today. She wouldn't look at me, and wouldn't answer my questions about what was wrong. Finally, I asked if it was just because she was tired of sticking herself with needles every day and just didn't want to hurt herself with the insulin needle. I got a very tearful nod in response, but I think something clicked then, and she seemed to get that I am aware of how much it must suck to be a diabetic at any age, much less eight.

We got through the ordeal eventually, with a promise on my end that I'd bring her a thing of blowing bubbles tomorrow, but holy crap. I really don't like to see kids cry, sometimes because I just feel really terrible for the kid and wish I could take their pain away, and sometimes because I think they're being overly dramatic and just don't like the sound of sobbing. But seeing this girl cry, this girl who generally acts rough and tough and twice her actual age, was miserable. And I realize there's nothing I can do for her other than try to help her manage the burden of Type I Diabetes she was born with, but...ugh. I feel so bad for this girl.

In better news, I got the nursing coordinator on my side about my lice policy change. One down, eight to go in convincing my fellow nurses of the change (including one that counts as one hundred)...more on that later, when I'm not super bummed about seeing my little diabetic so super bummed.

Every kid's dream cut short

Do you remember the rumors at school that declared if the power is out for more than two hours, you get to go home? And do you remember how every power outage would last approximately one hour, 55 minutes; just when you were so excited about the prospects of going home early, your hopes were dashed by the return of the lights?

Yesterday I pulled up to school to find the principal and crossing guards still out in the parking lot, and kids still trickling in. I thought that was odd as I normally time my arrivals and departures so that I miss the student traffic. As it turned out, when the school opened, the power was out. The power company was forecasting it would be out for another 2-3 hours, returning at 11:00: 25 minutes before school let out (it was a minimum day). They decided then that they would send all the kids being dropped off by parents back home, and let the kids who had walked stay at school. Don't ask me the reasoning of half-opening the school. The power then returned at 8:15 or so, and they had to try to reign everyone back in with the use of the auto-dialer. All told, only about half of the kids returned to school. Half the school absent: that was a whole ton of money they lost that day, not to mention a valuable day of teaching. Every teacher said they were going to have to re-teach anything they went over, since half their kids were absent. The school felt like a ghost town, and I do not envy the person who made the decision to turn kids away, as I imagine they're going to have to answer to someone about that.

My diabetic was one of the ones that was returned to school, and she summed up her feelings when her mom answered the call about the return of power like any eight year old would: "I screamed."

Also, I saw the headlines of the local paper today describing two unrelated shootings, both not all that far from my schools. One was in broad daylight. Great.

The short straw

If you've been reading for awhile, or know me in person, you know this: I do not have good luck. Don't ask me what I've done to deserve such karma, but I once again drew the short straw: one of my three schools out of 29 in the district was chosen to have its vaccination records audited by the Public Health Department. I was notified of this on the last day of February, and didn't know what to expect. As it turns out, to no one's surprise, the entire process is a bunch of B.S.

To begin with, I am probably not the right person to be audited, because my attitude tends to be along the lines of: I have something better to do than what I deem to be useless paperwork. Instead, I stuck my health clerk on the task, and mostly watched from the sidelines. It involved the health clerk calling the public health nurse (PHN), who she stays on good terms with for good reason, and asking exactly who they would be auditing: 7th grade, and they would only be looking at the Tdap records. We (the health clerk, really) focused entirely on getting the 7th grade ready, and then called the PHN back to tell her we were good to go. The audit was scheduled for today amidst much hype: omg, an audit! I still lacked the energy to put forth any sort of caring, not when I have diabetics with blood sugar flying all over the place. The PHN arrived today, and we set to work. We (again, the health clerk) had already pulled every 7th grader's vaccination record and had them in alphabetical order. The PHN went through each one, approximately 300, and made sure all our i's were dotted, and our t's were crossed. And if they weren't? We corrected them right in front of her. It was simply checking to see that the student's Tdap vaccination date was printed in the correct location on the proper form: there wasn't even cross-checking against the real vaccine record to check that the date was right. She also interviewed us about our record collecting process, and we gave all the right answers...except the one that I was left to answer while my health clerk disappeared momentarily.

PHN: Do you offer the personal belief waiver as a temporary exemption from the requirement while the parents wait for an appointment, or while they can't find their child's immunization record?

Me: Well...yeah, sometimes.

I knew this was not the answer she wanted to hear, and she knew I knew it was wrong. We talked about the population of this school, and that when my choices are to exclude a student from school on account of either their parent's irresponsiblity, or an actual lack of ability to get the shot, or let them attend school and sign a waiver in the meantime, I allow the waiver because I just don't have the heart to kick deserving kids out of school. She was clearly on my side, despite the fact that that's not exactly what the rules specify, and even with my honesty about my waiver policy, we appeared to pass with flying colors. The PHN made a comment about the audit that pretty well summed up my feelings: "This is so stupid."

And that, my friends, is where your tax dollars are going. I apologize to anyone who is about to write a check out to Uncle Sam in the next few weeks, because what I wrote above probably made it just that much more irritating.

Oh, the kids

I had the radio on in my office tuned to the local mix station. My diabetic came in and blurted out, "This is the Black-Eyed Peas! I didn't know nurses could listen to the Black-Eyed Peas!" I thought back to my own days in school, where I couldn't comprehend that any school staff might have a life outside of work; seeing a teacher in the grocery store was both horrifying and totally bewildering to see they ate food like normal people. Yes girl, I do have a life outside of work.

She also told me her grandma visited "where God was born." She mumbled something more specific that sounded like Jerusalem, and I asked if she meant that. It quickly turned into a 3 Stooges comedy routine:

Me: Jerusalem?

Her: Yeah, Jershulam.

Me: No, Jerusalem.

Her: Yeah, Jeshularm.

Me: No, Jerusalem!

Her: Jeshulam, that's what I said!

I swear, one of these days I'm going to pack her in my car and take her home. She's hilarious, and I'm pretty sure her mom wouldn't notice.

And a hyperactive kindergartener came in for a scraped knee and then remembered that I had offered her a tangerine weeks ago. At the time, I was eating the only one I brought for the day, so I told her next time I saw her she could have one. Thankfully, I've since learned to pack several tangerines in my bag, so I didn't disappoint today. It's amazing what a tangerine can do for a kid. For this little one, it occupied her for a few minutes, meaning a few minutes where she wasn't using me as her climbing tree while waiting for her parents to pick her up. [Because despite the fact that kindergarten's release time is 11:30, some parents regularly don't get their kid until 12 or after, which is fun for the secretary and I who get to babysit while trying to do our regular job.]

Today's interesting news: Mysterious nodding disease debilitates children. Our planet has some crazy stuff that happens on it.

The highlight of my day:

Lunchtime, when the kindergarteners and first graders march past my office on their way to the cafeteria. Certain ones always shout at me, "I know you, you're the nurse [or doctor or other incorrect adjective]! You fixed me!" Or I get some, "Remember when...?" They love to remind me of that one day they had a bloody nose, or the time they puked in my office; the way they scream it while forgetting to walk in a line so that their teacher has to discipline them for both not using an inside voice and not maintaining a line is just the cutest thing ever.

Two weeks until Spring Break, layoff notices are out there, and everyone seems to be at their wit's end, particularly with the rainy week we've had (rainy week = rainy day recess). It's a good time to be the nurse.

Cafeteria ethics

Quite some time ago, I caught on to the fact that my little spitfire diabetic was not much of an eater, at least not for the school lunch. (I can't blame her: it's noisy, and the food is...well, pretty much totally disgusting.) She gets free lunch though, so I knew she had to be picking up a tray. It doesn't take a detective to deduce, then, that she was throwing away plenty of good - or at least semi-edible - food every day. As a joke, after she would come to my office to check her blood sugar and she was on her way to the cafeteria, I started telling her, "Bring me back a banana!" Well, she has. More days than not now, she returns with a banana (on the days they don't run out of them in the cafeteria first), or some pretzels, or some other equally transportable food item that would have otherwise ended up in the garbage can. I was thinking this was  no big deal, because she is just taking food that would literally have been garbage if she didn't bring it to me. That was until I saw the sign: "DO NOT TAKE FOOD OUT OF THE CAFETERIA." Oops. I am sure she is enjoying bringing me a "treat," but I didn't realize she was having to sneak it out. Will I tell her to stop on account of the posted sign? Probably not. This girl gets very little positive anything in her life, and I'm not about to tell her to stop doing something we always get a good smile out of. Am I encouraging her to break rules? Yeah, but there are worse things in life than taking things out of the cafeteria. They can blame me if they catch her, and whatever: I hate for food to be wasted. Also to the objectors, I'd tell them to take a look in the garbage cans of the cafeteria: they are FULL of untouched food. It's a shame they can't donate the food to the hungry, really.

 

Totally unrelated, I had a first today: I told a "sick" kid - a frequent flyer - to go back to class after a brief rest, and he refused. Though I have had many, many kids try to delay the return for as long as possible, and have seen my share of tantrums over the ordeal, not once has a child absolutely refused. It ended up being esclated to a principal visit. No child says no to me!

Rainy day reading material

It's raining. And if you know how dry it has been this year, you know how nice it feels. It feels particularly nice as a school nurse, when the kids are trapped in rainy day recess: no tetherball accidents!

Layoff notices are being distributed, and morale is low. Everyone is ready for spring break, a break coming four days late due to proposed furlough days being reinstated in the first week of break. (Am I the only one who would rather be paid my full salary?)

Anyway, I have for you some reading material, because nothing I've done for the last few days - like catch up on two months of timesheeting, and clean out medication cabinets I should have done months ago - is really worth writing about.

Black students face more harsh discipline. I can vouch for this in my schools.

Parents, let kids know they're great. Seriously.

Fatter but fitter. Some good news.

Happy Pi Day!

Take it, not take it

A little girl came to the office today holding not one, not two, but three inhalers in boxes all taped together. She said her teacher sent her there to drop them off because no one is allowed to carry medication without proper paperwork, much less a darling, tiny second grader who probably can't even press down on the inhaler on her own. Begrudgingly, I called her mom, fearing the normal retaliation I get on this issue ("but I already went to the doctor, I don't want to go back for paperwork," etc.). Instead, I got a pleasantly horrified mom who explained, "Before she went to school this morning, I told her to take her inhaler. But I meant take it, not take it - and certainly not all of them!"

The poor girl was just following mom's orders, and knowing her, she would never be doing anything but that. It made for a good laugh to start off the day.

O.M.G., the gurl drama.

Yesterday was a whirlwind day at my middle school, and yet, sadly, totally normal.

Various incidents throughout the day:

I was alone in the office and heard some people come in behind me: two police officers, wearing bulletproof vests. Gulp. The principal was summoned, and when we asked what it was about, the response was, "I can't say, but it's a very serious matter and I don't want to blow it." Turns out the student no longer was attending our school, so I was safe another day there.

I came in after checking my elementary diabetics to find the school police officer sitting in the office looking at Facebook, surrounded by three girls, all of which he wrote citations for. Not sure what about, but when I asked the attendance clerk, she said our officer has been at the school regularly these days due to Facebook issues. Lovely.

In the afternoon, my only diabetic there came in. She is 13, independent, and I only check in with her on the days that I'm there anyway. She looked pale, and no wonder: her blood sugar was 55. I gave her the last of my graham cracker stockpile, and waited a few minutes before escorting her to the main office, where I was assured her mom would be arriving shortly since she had already been called. She checked her blood sugar again there, and at this point, did not look good at all: blood sugar was 37. I told the attendance clerk to watch her as I went sprinting back to my office for glucose tablets for her to take. Thankfully she was still conscious when I returned, she took them, and her blood sugar leveled off at 55 by the time mom came for her. (Note to self: put glucose tablets on the shopping list.)

I was glad I was there for this blood sugar crash, because despite telling the attendance to watch her while I ran for the sugar tabs, I don't think anyone even noticed she was in there; even when I told her afterward what happened, it didn't seem to faze her. They may have been distracted by an enormous fight after school that broke up, requiring a police call to break it up. The fight: two girls going at each other. The drama in the lives of 13 year old girls is unbelievable. 

Reality bites

A girl came in to package up a tooth she pulled out. As I was putting it in the little plastic mouse container we have for them, I asked what I ask every kid whose teeth I pack up: "What do you think the Tooth Fairy will bring for this?" Sometimes they say a quarter, sometimes nothing, sometimes several dollars. But this time, Toothless just looked at the floor and said, "Actually, this morning my mom told me she's the Tooth Fairy. She said I was too old for it now." I don't think she could have stuck her bottom lip out any further as she was saying it.

Poor girl! Toothless said - as dramatically and sadly as possible - that other kids ruined Santa for her when she was five, and I told her to remember how that felt when her friends asked her about the Tooth Fairy. We decided it's up to her to keep the magic going for the other little ones.

Back to the drawing board...

I'm sure you're all dying for an update on how my meeting went with my boss yesterday in regards to the lice policy. The good news is that he supports a change. The bad news is that there are other people not in support, including...drum roll...other nurses. My sixty minutes of fame I was looking forward to at this meeting, the first I had ever requested with my boss, and one of the few times I found myself willingly sitting in the district office, was tarnished by the presence of another nurse that sat in on it. She was in his office to discuss something else with him and apparently felt like sitting through my meeting with him, as well as giving her two cents, which is that our no-nit policy is "easy."  Now, in my humble opinion, or perhaps my youthful naivete, just because a policy is straightforward (no nits, no school) doesn't mean it's at all appropriate. The change will also take some time, as I expected, and realistically we can't expect it to happen in this school year - I'm hoping over the summer. In the meantime, it is my task to prepare a load of evidence advocating my position for a no-lice policy over a no-nit policy, and then write a policy that the other nurses are in agreement with. My boss supports it, but I have to convince the other nurses it is worth supporting, a task I was not at all expecting. Time to pull out my killer EBP research skills.