Get some Kleenex

A man called me at my elementary school early one morning: he is a single father, he explained, and his daughter had just started menstruating. Could I please check on her and make sure she has everything she needs? He works the night shift and wasn't able to get as many supplies for her as he wanted. 

Sure, I said. Easy. I called the student down: she has Down's Syndrome, as it turned out, and I went over some basics with her and her teacher. Later I found out that the daughter's mother, the man's wife, had passed away recently. As one of my friends said as I relayed this story to her: some people have real problems. 


Exhibit A

Exhibit A: Example of why we need full time health care staff at all school sites. 

Friday was a minimum day at my middle school and I'd told one of my diabetics - Mr. Redhead - that I would see him at lunchtime, which was taking place at 12:30 instead of 11:47 as it normally does. I went to my middle school at lunchtime to meet him as I always do, except he didn't show up. I checked his folder in my office that we keep his logs in and found that he had come to the office and given himself his insulin at 11:42, just like he does every day...Except it was a minimum day, and he would have gone to PE at 11:42 and not lunch. 

I freaked. For all I knew, Mr. Redhead was hypoglycemic and passed out on the steps of the school somewhere. School had just let out, so through the swarms of students, I looked for Mr. Redhead. (It was like reading a Where's Waldo book, but way more pressure to find him.) No luck. I asked the secretary to page him over the loudspeaker while I called his dad, who said he thought Mr. Redhead stayed for lunch and agreed that his blood sugar was likely dropping. I searched the cafeteria, asked the secretary to page him again, and still he did not show. I called his mom, ready to bawl my eyes out and tell her I lost her child. She answered, thankfully, and said Mr. Redhead was sitting across the table from her eating his lunch. Phew! 

The secretary, as I was leaving, said, "Oh yeah, I saw him come in earlier." What?!?! This is the deal with secretaries: they cannot be nurses and secretaries. They are asked to be, but you cannot have a secretary fulfill her duties and meet the health needs of the students at the same time. Mr. Redhead didn't ask for help, and so they let him do his thing on his own, because they don't know the consequences. I do. 

Poor Mr. Redhead got a lecture about it from me today. He said he realized his mistake as soon as he entered it into the pump, and didn't know what to do...so he went outside and went to PE. We talked about the fact that he got lucky - his blood sugar had been high - but that this could have been a really serious matter. I gave him my cell phone number and asked that he call me if I'm ever not in the office when he is again, and also made him promise he'd talk to the secretaries if he needed to reach me. Before Friday's incident, I'd planned on talking to him about going independent like the doctor's orders say that he is capable of. He said before I could that he still wants to be supervised...I suspect his mom may have given him a similar earful about what went wrong on Friday. 

It was a learning experience for many that I hope to not have to repeat anytime soon. 



I received an email from a secretary several weeks ago at one of my elementary schools that a parent had called to report that a student - not her own - had lice. I archived the email immediately, because I cannot believe every parent complaint, particularly concerning lice, where people like to point fingers. 

I received a second email last week that this other parent had called again to complain that the student still had lice, and that she would be calling the district office if no action was taken. This time I replied to the secretary that I would check the student, but it's no business of the other parent's whether or not the child has lice, and she should feel free to call the district office. 

She called again today, and again reported the lice. This time, she spoke with the principal, and informed him she has already made a report to the district office about this. She still wanted to talk to me, though, so with great dread I called her after lunch. She was surprisingly pleasant as I explained that I would not be reporting the results of the lice check to her, but that I had in fact checked the student, and also that the board policy is that students can remain in school with lice. (This was one of those instances where I take no credit for instigating this board policy...) She thanked me at the end of the call, and all was well. 

Here's the craziest part of this whole debacle to me: there was no lice! I did a *thorough* check, assuming if this parent was willing to go so far as to complain to the district office, that there must be a really obvious case of lice, but no. 

Some people are just busybodies. 


Crucial Conversations

If I may toot my own horn, which is essentially what this blog is a platform for doing, I had a really pleasant interaction with a parent this morning. She was upset because I had let her foster daughter call home when she complained to me that she wasn't feeling well. Instead of wussing out, for lack of a better term, I responded, "I get that that's frustrating, you don't want her calling unless she has a fever. The reason I let her is that I have had too many parents complain of their child not being able to call home, so my policy is to let the student work it out with their parents. Now I know that you would only like her to call home in case of a fever, and we will do that in the future. I apologize." She was *so* nice after that, and all it took was some positive communication on my end, instead of being either immediately defensive, or apologizing insincerely. Cheers to me! 

Also, a secretary came to tell me that someone had called and referenced me with, "the pretty blonde nurse" when she couldn't remember my name.
What a nice Monday. 


Chaos, just chaos.

I feel like I've had no time this year, and I just ran the numbers: it might be because I have nearly 3000 students this year across four schools. Usually by the fourth week of school, things are settling down; this year, I see no signs of that happening. 

Today's lunchtime chaos at my middle school was a good sample of how this year is going so far:

I arrived to find a girl in tears in my office. The staff said she hurt her shoulder and bumped her head at PE and mouthed, "Drama" to me behind her back. She wanted to go home; clearly, they didn't think she needed to, but she said the magic "head injury" words to me so I felt like I should let her call even though I couldn't see injury on her head. Her contacts were red-flagged in the computer, which means pay attention to whom we call as there are custodial issues for that student. I got her set up to call while I tended to my first diabetic. 

I think I counted three students that came in and out for ice packs in the next ten minutes before Spitfire arrived to check her blood sugar. Soon after, a teacher stopped by to introduce herself and tell me I need to have hearing and vision assessments done on several of her students by next week. 

Next, Spitfire came back after lunch to count her carbs and administer insulin at the same time three adults came racing in dragging a student. He has a fish allergy and his aide somehow (do not ask me how) missed the fact that he grabbed a tuna sandwich at the cafeteria. We had an Epi-Pen in the office, which I got out while observing him for signs of anaphylactic shock, which, thankfully, never presented. Drama girl stuck the phone in my face saying, "My mom wants to talk to you" while I got out the care plan for Fish Allergy Boy. Drama Mama was none too happy with me as I said that I couldn't see any head injury ("You are the nurse, I don't understand" - to which I responded, "There is nothing visible"). Luckily she was so annoyed she hung up on me, freeing up the phone for me to call Fish Allergy Boy's mom who, rightfully so, asked how he was able to eat tuna for lunch when he is supposed to have an aide watching him. I told her I wasn't sure how it happened, but she needed to come pick him up as soon as possible. Finally, I attended to Spitfire and released her, and sent Drama girl to go get her backpack, so it was just Fish Allergy Boy and his aide in my office. 

I sat on the edge of my seat with the Epi-Pen in front of me, watching Fish Allergy Boy, for the next 35 minutes until his mom arrived. Just as I sent him home, my last diabetic came in. Finally, when I was done with that student, I was able to leave the middle school to return to my first school site. Phew. 

Be careful what you wish for: last year I was wishing I was busier, right now, I'd happily take that assignment over this one. Hopefully things will continue to settle as the school year wears on, and I hope that the middle school aides learned a good lesson today with Fish Allergy Boy (who has many more allergies besides fish). 


Read. The. Bottle.

Everyone makes mistakes. In the medical field, they tend to be less forgivable as we are tinkering with people's health, but still, mistakes happen. Yesterday afternoon I received an email from a secretary stating that the medication bottle and doctor's orders for a student directed her to give 1/2 tablet, but that the other secretary that had been giving her the medication since school started three weeks ago had been giving the student an entire tablet. According to that other secretary, she was doing that because I'd told her to. 

My first reaction: WHAT. That other secretary had previously asked me to confirm that the brand name in the doctor's orders corresponded with the generic name of the drug on the bottle that was dropped off, which I did. I didn't look at the dosage as we'd received the same medication for this student's sister, so I only confirmed the name of the drug on the sister's order, and moved on with my day. I don't dispense the lunchtime medication for students as I am taking care of my diabetics at other sites then, and the secretaries in the district get a stipend for medication administration. 

I'll admit that I should have checked the medication of the sister as well, but I do not check in and review every medication. If I did that, students would have to wait up to a week to receive it after I was able to review it, as some sites I only get to once a week these days. Far more concerning was that the other secretary had been giving an entire pill for three weeks, when it is clearly labeled on the bottle to give only half, and on the doctor's orders as well. An occasional mistake I could understand. But to do it every day for 3 weeks is a much larger mistake. Apparently the secretaries aren't taught the 6 Rights, something I will be discussing with our lead nurse when she returns from vacation. [Yes, the lead nurse took a week vacation the third week of school. Awesome.] If they are getting a stipend for administering medication, shouldn't they have some training too?

Then I had the pleasure of calling the mother about this. I have never been so nervous to make a phone call in four years in this job. It was all for nothing: the mom said she wanted her to be receiving 10 mg, not 5 mg, and was frustrated at my insistence that we get new doctor's orders to reflect a 10 mg dosage instead of a 5 mg dosage. I tried to suggest she be the one to split the pills in half, but that didn't fly, and I was afraid to draw attention to the fact that our school had been over-medicating her child for the last three weeks, so I relented and told her I'd cut the remaining pills. 

<Sigh.> That secretary got off lucky this time, as I think we got one of the few parents who was totally unconcerned her child had been receiving twice the medication she should have. The scariest part is that the secretary thinks *I* am the one who got off lucky.