The IEP was finally held for the student whose grandmother is concerned about the fact that he likes “girly” things…Despite my previous distaste for her clear sexism, I warmed up to her a tad at the IEP meeting. I know plenty of people have the ability to dismiss all immigrants to this country (for whatever reasons they think are valid), but when you have a woman speaking to you through a translator about how much better the education system is here, and thanking you for supporting her grandson – while his mother continues dabbling in the drug trade in Mexico – it is hard not to feel at least a little empathy. The child we were meeting for was born very prematurely, is developmentally delayed, and is being evaluated for other medical issues (because someone finally convinced the grandmother that a physical evaluation and medical care was worth the risk of deportation). The grandmother told us through tears how grateful she is that he even is allowed in school – in Mexico, she explained, the child’s older brother was expelled for epilepsy.

The heaviness of the meeting was interrupted by an unexpected fire alarm. While standing around waiting to be allowed back into the building, I asked our speech therapist if she knew why one of our students wasn’t coming to speech therapy, thereby preventing me from ever completing an assessment on him. The speech therapist explained, “His mom said she has very bad gas and has been on bed rest for it.” I’m not sure how she managed to relay that information to me with a straight face, but the mother is not pregnant, and truly has not brought her child to speech therapy because of rumored gas issues. Awesome. 

So. Much. Writing

I typically have 10 or less IEPs in progress at a time, meaning I have received notice I need to do a health assessment on a student but either have not done the assessment, or finished my report, or tied up any loose ends.

For the last two weeks I have been holding steady at 25-28 open IEPs…AGHH!!! I got slammed with requests and just haven’t been able to finish them up completely. Why? Examples:

• Turns out one of the kids has seizures but has never had a health care plan written for him, so I need to do that and then get it signed by the parent...Which should have actually been done several years ago when he joined the district. Oops. This is what happens when caseloads are too large. 
• A significant fraction are due to parents not turning in the required form on their student’s health history that I need
• A student needs glasses according to her grandmother, but passed my acuity tests without them, and continually leaves them at home “on the counter” so I can’t complete my assessment.
• A small fraction are preschool students, which involve getting in touch with their parents. No easy task when I have access to a private phone line about 1.5 days per week.
• One of them is a 4^th grader whose teacher brought him to the office because his left upper lip appears paralyzed in speech. He couldn’t cross his midline easily either: ask him to touch his right hand to left ear, no problem; left hand to right ear was slooooooow. A call to dad via the translator prompted an immediate doctor’s visit. His parents had also noticed “slowed speech” recently in this student. No word from what transpired at the doctor’s yet (and parents do claim they took him), but when I called him into my office the following week, he had zero difficulty crossing his midline. He told the translator his dad had helped him practice the movement….Huh? Suggestions, anyone? Needless to say…still an open case.  

Disaster averted

The short version: A parent packed a PB&J for his kid that is allergic to peanuts and has an Epipen. I kid you not.

The long version: The secretary came in a huff to my office today to tell me that a student that we have an Epipen and care plan for had a PB&J in his lunch. He’s in the special day class and had an IA watching over him, who noticed the odd sandwich and called the office. I was given the suspect sandwich and brought the student back to my office. I could not imagine it was actually peanut butter, so I figured it was one of the alternative peanut-free butters they have on the market now. Still, it smelled like peanut butter…looked like peanut butter…After a couple of tries to his parent’s cell phone, dad picked up. I explained the situation, saying, “I’m sure it’s not, but have to double check just to be sure…”

“Yes it’s peanut butter,” he said matter-of-factly, as if to say, what’s the big deal?

“Well, he’s allergic to peanuts, according to his emergency card, and we have an Epipen for him, so I’m not going to let him have the sandwich.”

“Oh…hmm. I thought he’d had peanuts recently…I’ll have to talk to his mother.” 

Okay. I do not care if you hate your child’s other parent, you at least have to work together enough to keep the kid alive. I bit my tongue, “Well, it’s possible that he grew out of it, but I’m not going to give him the sandwich. I’ll find him something else in the cafeteria.” I didn't feel like rolling the dice on this one. 

The saddest part about this is that this kid did not understand why his dad would pack him a sandwich he could not eat. Cheers to his IA for looking out for him. 

Pink Legos

(That's Lego bricks to you, if you're outside North America. We say Legos, you say Lego bricks.) 

I was helping with vision screening in a new school, and I’m not sure what I did differently that morning, but I had more than a few of the elementary student girls say to me, “You’re pretty.” It was a nice compliment, but now that I have a daughter of my own, I think about these things more...Why is a second grader so concerned with how I look?… Which brings me to the topic of pink Legos.

Pink Legos are not the kind of thing that I pictured myself taking issue with before I had my daughter. But when she received a Christmas package containing pink Legos, I felt it was my motherly duty to intercept and exchange them for the “regular” kind. For those that don’t know, Legos apparently come in two different kinds now – the mostly green/red/blue/yellow set you’re used to, and a pink set marketed for girls with pink/purple blocks. First I thought I time-traveled back to the 1950’s, but no, pink Legos are a thing because, you know, girls need separate building toys. What?! I can sort of understand it when, say, a 7 year old whose favorite color is pink picks out the pink Lego set. Cool, she’s building stuff. But to give only pink things to a 1 year old just because she is a girl, I can’t stomach it, and would rather risk offending a gift giver than suggest to my daughter that she can only have pink things because she’s a girl. (She’s a girl whose favorite color happens to be blue right now, by the way: blue socks, blue pants, blue blankets.)

The toy I found more offensive than Pink Legos though, was given to her for her first birthday: a Fisher Price mirror set with makeup brushes. Because that is what a 12 month old needs, right? WRONG. I won’t even link the toy here because I am grossed out by the positive reviews on it.

A couple of link-worthy articles on the subject:

•  Let toys be toys.
• What the Research Says: Gender-Typed Toys.:  “I am not sure how surprising this is to me but it might be to parents: Moderately masculine toys encourage children's physical, cognitive, academic, musical, and artistic skills more so than moderately feminine ones."
• The Princess Industrial Complex.  

Target has its problems, but even they are inching toward neutrality, by fixing their toy aisles and making some pretty cool kid bedding. (Kid bedding. Not boy bedding or girl bedding.)

My daughter turns 2 (TWO!) next week, and if there’s one thing I want to do for her, it’s to teach her she’s more than just a pretty face. 

IEPs

I don’t generally go to IEP meetings because I’m not relevant to most and feel like I have better things to do with my time. In the last few weeks, though, here’s a smattering of some I’ve had the privilege of attending:

-          For a student who has absence seizures who frequently does not take her medication. Is she having seizures all day long at school, then? Perhaps. Do we think that may be impacting her learning? Um…yes. Mother of this child, do you understand you are the parent and are in charge of whether or not she takes her medication? Apparently not.

-          For a student whose grandma has turned in doctor’s notes for 35+ days of absences this year (in addition to the multiple funerals and other days she’s been excused from). Guess what, granny? I spoke to the doctor himself, and he says she needs to be in school. Hey doc, can you stop writing notes for this kid when she’s not actually sick? Oh…well, it’s my medical assistant writing them. Turned out the student qualified for a more restrictive environment/special education class, and would clearly benefit from that, but Granny is going to let the kid decide. Granny, her IQ is in the 50’s and you’re the legal guardian. YOU decide what’s best for your child, you don’t let a 7 year old make a decision like this about her education.

-          For a student who I heard was a picky eater. When I asked the student himself about his eating habits, he said, “I eat only carbs, mostly sugar.” I asked him what was in his lunch for the day and heard, “Fruit Loops and cookies.” I called his mom to discuss my report with her – and his incredible anxiety during my low-key vision/hearing screenings and got caught on the phone for a 45 minute call with mom in tears at one point telling me her many, many worries. This would be an example of ATS: apple tree syndrome. Didn’t fall far here. The good news: the kid eats like crap, but at least the parents care. (The entire family is in therapy.)

I’m also in the process of preparing for another one for a student reported to have been born very prematurely into a toilet in El Chapo’s town of residence. On his health history page, grandma writes under concerns, “doesn’t learn, likes girly things.” First, everyone learns. Second, granny, liking girly things is not a health concern, or a problem of any sort. Welcome to 2016. 

BMI testing

Our state does height and weight measurements as part of the physical fitness testing in 5th grade (and maybe other grades, too). I *HATE* doing both. It is incredibly stressful to the kids, particularly the outliers in both height and especially weight. I do it as privately as possible, but it still sucks for them. It never fails that I hear later that someone returned to class crying, no matter how discrete I am. An obese 5th grader will already know he/she is larger than his/her peers, and doesn’t need a scale to say so. So, here’s another study in which research dollars funded an obvious answer to a question: BMI measurements at school are ineffective.

Irony:

When your work computer craps out on you and when you turn it into Tech Services for repair, they say they'll email you when it's ready to be picked up. Also, they don't provide loaners, you have to go around begging for a spare computer to use to write your reports. Gah.

On another note, join a cool club here! Research is important, these surveys hardly take any time at all (and sometimes you get Amazon gift cards in return), and you're doing something good for our species. If you're a nurse, join in the fun.

FAQ

There is only one Frequently Asked Question I get, and it’s this one: Why aren’t you posting as much anymore? The answer is, I don’t see kids as much anymore. Unless I am covering for an LVN – which, per my contract, I am not supposed to have to do – I can easily go a day or two, or more without even seeing a single student. Your next question is probably going to be: what the heck do you do all day then?

Much of my work time is IEP assessment-related. It is coordinating an assessment with the staff (usually the school’s resource teacher or speech therapist), assessing the student, and then writing the report on that student. Parents fill out a detailed questionnaire on their student’s health history, and I include that in my report along with hearing and vision screening results. The majority of times, the students pass hearing and vision, I type up verbatim what the parent’s form says, and  move on. It feels like busy work, and unfortunately, what I spend the most of my time doing, I like the least. I just don’t see the point of spending an hour or two writing a lengthy report on a student that has been in Special Ed for five years for, say, a lisp. I don’t see why whether he was born via a C-section vs. vaginal delivery is of any relevance to his IEP. It can be interesting stuff sometimes (it is incredible to me the number of children whose mothers smoked during pregnancy), but we’re trying to further the kiddo’s current education, not perform a study about how smoking affects kids. I’ve made the suggestion to my colleagues that perhaps some of these things we are expected to include on our report are not actually relevant to the reason we’re having a meeting, but I was shot down immediately.

We also do state mandated hearing and vision screenings. In my previous district, I coordinated all these screenings, often did them by myself, and input the results in the computer. Here, they contract hearing screenings to an outside company, so I do none, other than the ones I do for IEPs. We have health clerks that coordinate the vision screenings, and we use SPOT vision screeners, so all I do for vision screenings now is show up, point, and shoot. Clerks record all the results, and send out referral letters for those that don’t pass. Boom, done.

Then there’s the case management stuff I do. Health plans, which are most in the beginning of the year but still come throughout. Following up on kids who need glasses, who aren’t taking medication, etc. It’s what I consider to be the most important role of mine, and also appears to be a last priority. The district gets reimbursed for my time for IEP assessments, money talks, and I don’t make the district any money by ensuring a student gets a much-needed pair of glasses.

In the other slivers of time I find, I might do a little first aid, talk with my co-workers like I actually like them (and some I do) or, you know…Pinterest. 

Friday Fact

1. The nationwide poverty rate is about 14%. 
2. California's adjusted poverty rate is about 23%.
3. The poverty rate in my school district is 52%.

Golden Rule, please

I was finishing my lunch at my desk, the only place besides my car that I ever eat at work, when one of the translators that I share an office with approached me in a huff. “I see that you’re eating your lunch, so you can wait until you finish, but there’s a situation in Room D-1 that you need to check out. A little girl’s breath smells like poop.” Well, thanks for that description while I eat my brown, meaty pasta dish.

I tried to refrain from rolling my eyes at her and acted like this was definitely a situation that she could not have waited until I finished my lunch to discuss with me. “So, what’s going on with her?”

Translator, impatiently: “I don’t know, her breath smells like poop, you need to go find out.”

Me: “Have you had her open her mouth? Maybe she has an infection.”

Translator: “She says she brushes her teeth every day.” (Did not answer my question, but thanks for that tidbit, lady.)

If there is one thing that particularly irks me, it’s adults being mean to kids, including treating them as “less than” when they have something going on they cannot control – lice or bad breath or any other issues. I went to check out the “situation” for myself. I took the little kindergartner outside of her classroom, got down at eye level with her, and introduced myself. I had her open her mouth, and saw some metal fillings in the back. She told me her teeth hurt in the back, but that she hadn’t told her parents yet. Poor thing also said, with no mention of breath from me, “I know my breath stinks. The other kids tell me so.” We had a nice little talk about how that might be a sign of infection, and she promised she would ask her parents to take her to the dentist. I let the teacher know, and she said she’d talk with the parents about it at pick-up time.

I returned to my shared office with the translator, and told her that, besides not being able to detect a hint of bad breath myself, the girl is self-conscious about it. As in, stop making a big deal about it, woman! This translator is probably the same type of person as the school nurse I’ve seen that says to a student after a failed vision screening, in front of all of his or her classmates, “You failed. Your parents will get a letter in the mail, you need to see an eye doctor.”

Calm. Down.

I think the vast majority of us on this planet – or perhaps just those with first world “problems” – need to take a chill pill. Most of the time, we are not in a life or death emergency, and even if we are, freaking out about it won’t do anyone any good. I may not be saving the world as a school nurse, but the least I can do is calm people down.

When a student came into the office sobbing after lunch, and when his friends said he “collapsed” in the cafeteria saying his head hurt, I was not surprised when the secretary came to get me. The other aide in the office whose position I have not figured out (a secretary for the secretary, it appears), reported the student’s temperature as 101.7, while the secretary anxiously exclaimed, “They said he didn’t hit his head, I don’t know what happened!” It took about 1 minute for me to interview the kiddo and discover that, besides his fever, he hadn’t eaten since the day before. Hmm. I don’t think it takes a rocket scientist, or even a school nurse, to figure out why his head was hurting. Still, I had to spell out to the secretary, who watched over my shoulder as I assessed the student, “He needs to go home. He’s sick.” As in, close your gaping mouth, this is not an emergency, let’s move on with our day, he’ll be fine.

I know some of her worry comes from the lovely ladies and gentleman at the district office following a threatened, or perhaps real, lawsuit related to a first aid incident at the school earlier this year. (My own perspective on that: someone’s wanting money and the school is not at fault.) But seriously, folks. It’s a fever. Kid hasn’t eaten. He has a headache. Calm down. 

I am often amazed that I am paid to dispense common sense. 

Life with a Toddler

Because my life doesn't revolve around work anymore...We were getting ready for the library one afternoon, and I explained to my daughter she would need to put some pants on so we could go. I helped put her pants on after snack, at which point the tantrum erupted. “NO PANTS!” She dissolved into tears, and as I tried to explain why she needed the pants, she flung herself on the ground in a screaming mess. I tried without success to comfort her, and, feeling my own temper rise, I decided to take a break from it all in another room. She followed me, after she took off her pants in the other room, still crying, “NO PANTS.” Then, as suddenly as a light turns on or off, she asked for “cuddles.” So, we cuddled, and I again explained that to go to the library, she needed to be wearing pants. I asked if she wanted to wear a different pair of pants and heard, “Yes. Blue!” She happily put on the blue pants, and off we went to the library.

At the library we read a book about a duck. She seemed interested, and I told her we could take it home, but she said, “no.” Several times over the course of the library visit she picked up the duck book again, but every time I offered to check it out, she said “no.” We went home, opened the door, and I hadn’t even set my keys down before she asked, “duck?” She broke down in tears when I said the duck book was still at the library.

Ahhhh…toddlers.

Happy Endings

There was a situation just before break that my LVN called me about: a student that gets migraines did not have any medication at school, and “just FYI, you may want to contact the parent about it.” In hindsight, she clearly knew something I didn’t, because when I emailed the parents, the father had already been made aware of the situation and was FURIOUS about it.

There’s good and bad to having this correspondence by email. On the plus side, I didn’t have to have an immediate response and could craft my response to him slowly. On the other hand, it’s in my inbox, and able to be re-read whenever. In a phone call, I may not respond with the exact verbiage I’d want to later, but at least it’d be over as soon as I hung up.

Anyway, craft I did. There was more to it than the student not having medication: supposedly she had turned in a medication form earlier in the year, and supposedly she had asked to call home and the office hadn’t let her. I wasn’t on site when this transaction occurred, but still had to play the messenger: contact the office, get their side of the story, etc. It was enough to give me a headache. To top it off, this dad was sure to leave in his email signature that he has a higher degree in education than me.

He didn’t respond and I dreaded what would happen the next time the student had a headache.

Fast forward to this week, when I reached out to him and asked if there was anything else I could do for his daughter (implying, ahem, that he still had not turned in the proper paperwork and we were still waiting on the medication to be left at the office). I dreaded the “new email” ping on my computer, and instead was relieved to find this from him:

“Dear [Mrs. Nurse]:

Thank you very much for your note, for following up, and for your empathy. I am most touched by your commitment and professionalism. 

I will take care of this as soon as possible. 

Sincerely,

[Dr. Dad]”

It often feels rare that I get an angry parent to come down from his soapbox. I’ll take it where I can get it.

Welcome, 2016!

The first day back from winter break, I was scheduled to cover for an LVN’s assignment – part at my school and part at a school foreign to me. (This was a result of the fact that our work was sponsoring a conference, unrelated to the medical field, for those interested. I didn’t feel like it was worth the cost of what they wouldn’t be covering for the trip, so I passed.) The day was to involve four diabetics of varying independence levels and a G-tube feeding, which I haven’t done alone…um…ever. I tagged along with the LVN on her assignment in December to meet the kiddos while trying to ignore the fact that I had somehow volunteered to do this assignment despite the fact that a) RNs in our district are not supposed to have to cover for LVNs (a breach of contract, I’ve learned!) and b) the middle and high schools were scheduled for a “work day” without students, meaning at least a handful of LVNs had nothing to do the day I would be covering this assignment. But I digress. I met the kiddos, was reminded how to do a G-tube feeding, and then went into winter break with a small cloud over my head reminding me that my first day back I’d be covering in uncharted territory, and our lead nurse, supervisor, and every other veteran RN I knew were on a work trip.

It was a dark and stormy day, literally, and I hoped for many absences to make my day easier. Not my luck: all the students I needed to see made it to school. The day went by in a blur and I loved it. I remembered that I really do enjoy what I do sometimes. I taught a first grader how to change her lancet, and she said, “Thank you! I didn’t know how to do that before.” How much better can a job be? The G-tube feeding was for a second grader who chatted happily with me the entire time about the puppy she is getting next month. I was told if you don’t keep her distracted, she complains she’s full and tries to stop the feeding early; instead, I had to remind her it was over and time to go back to class, and she asked to see me again. And, once more, how much better can a job be?

Unfortunately, that job was covering someone else’s job. She’s an RN herself working as an LVN, and she told me when I met her she didn’t want my job…I know why. I get paid a ridiculous hourly rate for what I do, can work from home sometimes, and have all the holidays off, and I still don’t think that is enough anymore. The longer I’m a school nurse, particularly after finishing the credential program – in which I became convinced every other district has similar problems, the less sure I am that I want to do this any longer. I tossed out a couple of resumes last month to see what the job market was like and was 2 for 2 on interview requests. I declined because I’m not ready to break my contract just yet, but it was good feedback. When I originally became a school nurse, I didn’t feel I had other options and just needed a job; now, I have options and am not sure I’ll be staying here for eternity…or the next school year. (Which I’ve said for five years now, and then summer break comes along and I suddenly have amnesia about any of the problems in this job.)