Judgement Day, round 2

We have a monthly meeting where all the nurses come together to discuss our nurse business. Yesterday was the last dreaded meeting of the year, and our head boss even made an appearance. The new lice policy was on the agenda, and I was, yet again, disheartened by the fact that with the exception of the nurse who stayed after last month's meeting to help me edit it, no one had seemed to look at it prior to the meeting (they had an entire month to do so). My boss, who I rarely see, looked at me and asked what the differences are between my proposed policy and the current one. Gulp. I hadn't expected to be in the hotseat as he hemmed over it, gave a couple of suggestions regarding legal jargon in it, and then finally said, "okay." He asked me to send it to him with the edits, and after apologizing for the snail pace of goverment work and board policy changes, said he would try to get it passed over the summer. There have been rumors swirling about some...let's say extracurricular activities...that my boss has been doing and I was worried the gossip would cloud the potential importance of this policy change. Turns out I had nothing to fear as he assured me he will do his best - but makes no promises - to have a new policy for the next school year. I made the edits this morning and sent it off to him. It is officially out of my hands and pushing the send button has never felt so good. I have been working on and off for this lice policy change for a fair portion of the school year, and if it does get passed, I think I'm going to blow it up and laminate it for a certain teacher that inspired me to advocate for a policy change. For now, hallelujah: it's really out of my hands now, and on someone else's plate. Have I mentioned how good that feels?

Moving on - because I can do that now! - check out a student keeping a diary of her school lunches: http://neverseconds.blogspot.com.es/. (Thank you Kristin for the tip!)

Also, stay tuned for next week: it's the last one of the school year, and there will be a sweepstakes! 

Run in with Shoe Girl

Also known as the moments that make things like toileting His Majesty and Ritalingate totally worth it. I was at another middle school helping out with scoliosis screening when Shoe Girl came into the nurse's office to use the bathroom. (If you're new, find some history on Shoe Girl here, here, and here.) She had sprouted since last year and I barely recognized her. She came and gave me a hug and told me how she remembers me, how much better things are at the house than last year ("but my brothers still fight with each other!"), and how much better her feet feel. I thought I was over the moon with happiness for her, until as she was leaving she asked, "Are you the nurse at this school now?" I told her that I was just visiting to help out with screening, and got a typical 7th grade response: "That sucks."

 

"That sucks" in response to me not being her nurse is probably the best compliment I've ever received on this job.

I was back at the school a couple days later for more screening, including Shoe Girl's class. She was all over me again, and normally I can't say I enjoy bear hugs from people reeking of cigarette smoke, as she still sadly does. But, I'll let this girl hug me all day long if she wants - she needs to know someone cares about her. As we parted, she told me I should come by her house sometime. I didn't tell her I don't have the appropriate bullet-proof wear that I am sure I'd need if I ever met her mom face-to-face.  

Ritalingate

I generally try to keep the personnel politics out of this blog, just as I try to ignore them in real life, but, here they come. I was off one day last week, and made the mistake of looking at my phone after lunch. I had a missed call from one of my elementary schools, and I couldn't help but feel the need to check my voicemail. It was from Spitfire Diabetic's school, and her teacher had called me that morning (and apologized profusely for doing so when she discovered I was off) to let me know she'd been at the hospital the day prior. Concerned, I started listening to the voicemail only to discover it was another nurse covering for me: "Um...'ADD kid's' Ritalin is missing and I'm just wondering where you put it. The log says that you had it last and it's not in the cupboard..." and on and on it went. Annoyed, I called her back and was going to let her know that I put it back in the cupboard where it belongs, and instead was met with a long spiel about how she'd talked to our coordinator already, who said we'd have to re-examine our medication administration procedures, among other things. It was clear, by the tone of her voice, and what she was saying, that she didn't believe I put the medication back in the cabinet. I was frustrated and angry that someone - a co-worker - would have the audacity to seemingly accuse me of stealing Ritalin. I went home that afternoon to find two emails from the same co-worker, again repeating that she couldn't find the Ritalin, and that I was the last one to touch it.

 

I woke up early and went to search the medication cabinet to no avail. The coordinator made a call to the district office on my behalf letting them know a bottle of Ritalin was missing, and they told me I would need to inform the principal and assist her in reporting a "theft" to the police. I was still insulted by the whole ordeal, but moving on with my day when I pulled out another kid's medication at lunch time only to find the missing Ritalin bottle behind his in the same cubby. Eureka! Luckily this happened prior to any police report, and luckily for the co-worker, she was nowhere near me when I made the discovery. To say I was perturbed that she had a) basically accused me of stealing Ritalin, b) didn't see it herself when she had been giving the other kid his medicine, and c) blown it so out of proportion on my day off when it was something that could have waiting until the next day would be an understatement.

 

Like toileting His Majesty, there were some good take-home lessons from this nightmare. 1) Trust thyself. Of course I put the medication back in the cabinet. Granted, I put it in the wrong cubby, but that's a pretty honest and easy mistake to make. But I NEVER leave it out on the counter for someone to grab, the bottle is only ever in two places: my hands or the medicine cabinet. I would have saved myself a day of stress had I trusted myself a bit more. 2) It was very interesting to hear the reactions of others. The principal, my trusty health clerk, and the coordinator were along the lines of, "I have no doubt you put it back, and it's either lost in the medicine cabinet or someone stole it. You did nothing wrong, I believe you." The co-worker and site secretary's words went something more like this: "You signed off on it on Tuesday. It's missing Wednesday. What did you do with it?" Ouch - but at least I had the satisfaction of showing it was in fact in the medicine cabinet the entire time, just as I'd been insisting on.

Toileting His Majesty

Something I do very rarely in my position is the "dirty" work of nursing. I give insulin every day, but I'm nearly done with my second year of school nursing, and last week was the first time I found myself responsible for changing a student, a 6th grader with muscular dystrophy. I teamed up with another nurse and we got to work, having run over to the school during a break in scoliosis screening halfway across town. The student's aide was out on bereavement, the back-up aides out sick, and our own LVN, who would have been third in line, was off that day. I don't think anyone can pretend it's rocket science to change a diaper, whether for a baby or a 6th grader, and we finished our work quickly so we could get back to the other school in time. The student wasn't happy, missing his usual aide who has been with him since kindergarten, and let that fact be known to his mother when he got home. It was hardly a surprise, then, when I opened my email a couple days later to find something from one of the "higher-ups" in the district office letting me know a complaint about my work had been received regarding that day's toileting experience. I have grown accustomed to parent complaints about everything I do wrong, but about toileting? How incompetent have I become?

You can't please everyone, and there were a couple take-home lessons from this experience. One, do a job badly enough and you won't be asked to do it again. Mom specifically asked that the other nurse and I do not touch her son again, even if all aides are out, and I was happy to oblige that request. Second, I do not miss changing people, no matter what size. Cheers to the CNAs and people of other titles that do this work for us. Third, it may never cease to amaze me how parents can take their kid's complaint to heart over. The mother does not want two registered nurses taking care of her son, because he said so. Never mind that we did a completely safe and thorough job all while he was complaining about us right to our faces and being totally disrepectful. Awesome - beaten by a 12 year old, again.

Ice Cream Social

I stopped by my middle school to read a TB test and ended up having a very interesting afternoon with a couple of students. Two girls were in the main office waiting to talk with the principal about some incident, and they asked if the could come in and ask me a couple of questions while they waited. Given that just hanging out with the students is pretty much my favorite thing ever, I welcomed them in and they took a seat. The conversation started out innocently enough, asking me about lice. It quickly turned interesting when they asked me about emphysema, and I turned the questions back on them, asking about smoking habits of their peers. I didn't think they'd actually open up to me, but as soon as I realized they were going to, I had them shut the door and scooped myself a bowl of ice cream. I spent nearly the next two hours talking with two 6th and 7th graders I'd never met before about the drug habits and drama of the school. I felt like I was watching a fascinating reality TV show as I savored my ice cream over their juicy gossip. At 27, I'm far less removed from middle school than some of my fellow nurses in the district, but even I was a bit shocked by some of what they were saying. At one point, I asked how many students were high at school, and the more boisterous girl of the two announced, "You know all those kids walking around here that you think are tired? They're high! All of them!"

I don't believe 100% of 6th graders are stoners, but my afternoon with these girls made me realize just how prevalent it is, at least in that neighborhood. Don't ask me how they're going to get past middle school if they're stoned at school all the time as 12 year olds.

Hold your horses

Dear Readers,
Due to being under the weather in a Benadryl, Hydroxyzine, and Prednisone-induced nauseated zombie state, I have failed to properly blog what has been an exciting time at school. Thank you for your patience, I will do my best to update just as soon as I can keep my focus long enough to do so. Stay tuned, because highlights include being under fire for a missing bottle of Ritalin and a run-in with Shoe Girl. Yay!

Apples don't fall far from the tree

Scoliosis screening is always an adventure. Get a bunch of 12-14 year old kids in a room and tell them to take their shirt off: there will be jokes, resistance, embarrassment, and more. We were screening the 7th grade girls at my middle school yesterday in the locker room, and while I was with a student finishing her screening, a large commotion was happening by the lockers. All I heard was a bunch of yelling; come to find out, one of the students led some others in a protest against the screening. The volume and vein-popping anger was atrocious, all over something as trivial as a scoliosis screening. At the request of the PE teacher, who was present for this rally against us nurses, we reported the incident to the principal. I was left wondering how a 13 year old can scream such spiteful things toward people she doesn't even know (particularly those that are just trying to help) until the principal called me on my lunch break: she had the mother on the phone who was screaming obscenities at her and claiming the scoliosis protest incident was a work of fiction, and needed my statement of the incident as a witness. So, a student was suspended over her outrageous reaction to the scoliosis screening, and yet, she's going to be staying at home with a mother just as furious at her sentence as she was at the screening. Lovely.

:) x a million

I came to my elementary school to check my two diabetics at lunchtime, just as I do every day. My spitfire diabetic came in and plopped on my desk a "Large Print Crossword Puzzles" book. She told me it was my (only slightly) belated birthday present, and recalled I liked crossword puzzles from a conversation ages ago. It was before Christmas break, where she saw me working on a crossword puzzle and solved a couple of clues with me. I told her how much I love crossword puzzles, and she told me she was going to get me a book for Christmas, and then, when that passed, for my birthday. I gave her a big hug and told her how thoughtful that was, and she replied, "Well, just don't tell the other nurses, because I don't normally get my nurses presents." It proves what I tell anyone who listens: this girl has a bigger heart than most people think. I rest my case.

Scoliosis Season

I scheduled four days of scoliosis screening over the next two weeks, covering 8th grade boys and 7th grade girls with another nurse I teamed up with to screen two of our middle schools in the district.

Tuesday's 8th grade boys screening, by the numbers:
Boys screened: approximately 150
Boys referred for possible scoliosis: 6
Screenings I conducted before changing my verbal directions for the students from "bend over" to "reach for the floor": 3

Weighing In

As part of 5th grade physical fitness testing, I weighed all the fifth graders at one of my elementary schools today. Doing so confirmed two things for me. One, I cannot guess weights. Two, childhood obesity is a real issue. (Though I know this part better than most, as I spent a summer working for a weight loss camp for teenagers.) Kids weighed in ranging from 52 lbs to a staggering 194.4 lbs, a weight that did not correlate with her height in a healthy manner.

Today I also received a link to this in my inbox: http://theweightofthenation.hbo.com/films from the CSPI mailing list. I hope it does the issue justice.

Meanwhile, an anti-obesity drug is moving forward. Drugs: the solution to all things in America.

Unrelated to unhealthiness, I came into work today to find a lovely gift on my desk of stationery and a candle, as well as a thank you card wishing me a Happy Nurse's Week. Belated or not, it was a good way to start a Monday.

National School Nurse Day

That's today! For you non-nurses wondering when we'll stop showering ourselves with appreciation, Nurses Week ends on Saturday, Florence Nightengale's birthday (look her up if that name doesn't ring a bell). In the school environment, today and this week is hugely overshadowed by Teacher Appreciation Week, but I don't mind: the PTO takes good care of our teachers, and I consider myself entitled to every breakfast and luncheon and "thanks" they're providing to the teachers. I did get one thank-you note from our dedicated noon duty at my middle school, and I'll happily take that one recognition.

Other random musings:
I had the usual conversation with my diabetic today:
Me: Okay, you ready to wash your hands? [After a very long 15 minutes waiting for her blood sugar to go up after I found her shaky and a BG of 64 at lunchtime.]
Her: No.
Me: I don't care, go wash your hands.
Her: "You sound like my MOM!"

I've also concluded the best way to get some kids out of my office is to make it miserable:
Not-really-injured kid: What's she doing in here? [Pointing at a not-really-sick kid.]
Me, the nurse tired of an over-crowded office: We do not talk about other people when we're in here. We can talk about you though, should we do that?
She narrowed her eyes at me and pouted. Suddenly, I heard, "I'm feeling better" and she ran away from me as fast as she could.

Last, it's link time:
Electronic health records in schools. If my district was this organized and awesome...well, that would just be too great for words.
First grader saves friend. Yay for learning life-saving techniques on the Disney channel!
Obesity continues. And we have decided pizza sauce is a vegetable.

Happy Nurses Week!

(And many other things we are never thanked for!)

Happy Nurses Week! Yay us! 

Timeline of a school nurse:

August-September: Crazy mad chaos as the school year begins. Health alerts, unhappy teachers, demanding parents, medication issues, and the always embarrassing moment when you discover two months into the school year you didn't realize you had an epileptic student on board...that sort of thing.
October-November: Hearing and vision screenings all over the place. Mail out referrals that will either be ignored or returned to sender. IEPs and other paperwork.
December-January: Christmas break! Listen to teacher's complain about so-and-so who still can't see the board.
February-March: Morale sinks as the budget proposals and kinks are worked out.
April: No one in education is happy as next year's changes are finalized (e.g. school closings) and state testing approaches. Spring break is a brief, but only brief, respite from the unhappiness.
May-June: Coast into summer. Clean up the medication cabinets, realize with some embarrassment that you've let some expire, or never actually got the right medication authorization paperwork, and breathe a sigh of relief at the epi-pens that went unused. Testing is over, teachers are nicer, parents trust you, and you have two months vacation approaching. The insanity that has happened over the last  9 months is forgotten, and life is good.

It's been a long year, but we're coasting into break now (particularly with that lice policy off my plate). Happy Friday!

Judgement Day:

The short version: an agreement was reached!

 

The long version: My proposed updated policy was passed around to all the nurses at our monthly nurse's meeting yesterday, along with position statements that I used to write the policy, including the one by the Public Health Department. There were uneasy glances exchanged as I described the major change from a no-nit to no-lice policy, but eventually, grumbling agreement. The coordinator, who had previously agreed with me about when to send kids home (taken directly from Public Health, my stance was the unpopular one, that they would be allowed to remain in class with lice; after immediate notification of the parents, they will be excluded by the end of the day at the latest) became a stellar politician and before my very eyes, flip-flopped on that agreement to the more popular one, which is to send them home (thereby humiliating the student) immediately. To say I was upset about this change of heart would be an understatement: she was my sole supporter of this whole project, and if I didn't have hers, I didn't have anybody's.

 

I knew I wouldn't rest at night unless I did all that I could, so I spoke up and provided my reasoning (again, reading directly from the official statements that we base all of our other practices on), only to be met with disgusted looks. But...stubborn people make change! I calmed my nerves and approached another nurse after the meeting, one I have had very little contact with ever, but knows her stuff. She is extremely "by the book," which I certainly can't claim to be, and I knew if I didn't win over her support, I wasn't going to get this approved. Conversely, I knew if I had her support, this would get approved: she can argue a point as well as I can, and if we aren't arguing the same position, we're at a stalemate forever.

 

Turns out I work well with people I don't think I get along with. She is actively involved in the union, school nurse organization, etc., and she commended my enthusiasm and perserverance on something so mundane to most people in education, as well as the fact that I was even involving myself in policy-writing. We worked together to re-write the sentence I was stuck on, adding in the phrase that she suggested: "or at the discretion of the school nurse or designee." Power to the nurses! It didn't take long for us to both be happy with it and given we are the two loudest nurses (who aren't flip-floppers) in regards to policies, I feel good that I've done what I can on this issue. There's no saying anything will become of it, because it still needs to be sent to the board, etc., which will take eons, but I can sleep well at night knowing I've done what I can to save my kids from unnecessary humiliation and needless absences. Phew.