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. 

Pop pop pop

Sometimes even I forget what kinds of neighborhoods I work in. Today, there was a shooting across the street from one of my sites, 45 minutes before the students were to be released for the day. We first found out not from the police department, but from the principal who heard it herself while she was outside, three distinct pops. The kids were brought in, and the secretary called the police to question why we weren't on lockdown. (Apparently only the police department can decide when a school is on lockdown.) For whatever reason, they didn't put the school on lockdown immediately, so at the secretary's urging, I walked out with the principal and drove away to pick my baby up from daycare before I got stuck in a lockdown for the rest of the day. Just another day in paradise...

Arachnaphobia

I received an email from a teacher requesting me to talk to a fifth grade student of his that was refusing to use the school bathroom. (Not exactly a nursing issue one may argue, but I took it anyway. The teacher was male, the student female; I can't blame him for sending her to me.) A timid little girl came into my office, and looked petrified as I asked her to shut the door behind her for privacy. I assured her everything was okay and told her I just wanted to talk to her real quick:
Me: So...Your teacher mentioned you aren't using the bathroom here at school and I just want to find out why. Is everything okay?
Girl: Yes...
Me: So no one is teasing you or anything, there's not another student doing something that makes you not want to use the bathroom?
Girl [laughing]: No, no, it's not that.
Me: I've never used the bathrooms here, but if they're anything like where I went to school, I bet they're gross. Are they gross?
Girl [laughing]: Yes! They are so gross!

It turned out that what was gross about them to her was that she saw a spider in one once, and, in her words, she's "terrified" of spiders. Poor thing. I told her I'd talk with the janitor, and a secretary came up with a plan for her to get a buddy to scope the bathroom out for spiders before she uses it.

It's a shame this isn't a performance-based gig, because I think I am way better at this thing than some of the other ladies I work with. (I'm thinking of one in particular who turns her desk so that kids cannot walk up behind her or next to her, they can only approach her head on.) Oh well...I'll just give myself a pat on the back for this one.

Late already

I have so much to write, and so little time to write it. In an effort to continue breastfeeding as long as I can, I squeeze in pumping sessions between my diabetic rounds. So, in a typical day, I start at one school, pump, check diabetics at one school, pump, check diabetics at my middle school, pump, and return to my first school. This all takes from about 10:30-1:30, leaving me just a short time period in the morning and afternoon to get everything done at my school sites. (Then I race home to see my baby, hang with her until she goes to bed, then eat/shower/pack for the next day/sleep.) Needless to say, the days are passing by quickly, and I've been neglecting this blog.

Last week was the first full week of school. I could do without the administrative staff at my middle school, but all in all, I have a pretty decent assignment. A sampling of last week's activities:

1) Active lice in a middle school girl's hair. The poor thing was nearly in tears about it in my office, explaining that she got it from a cousin's house in a recent visit to Pakistan. We had a good little chat about it though, and she seemed cool and collected again as she left my office.

2) A hole the size of Texas in a 4th grader's molar. I wanted to strangle his mother for allowing it to develop, but I didn't. Instead, I asked the secretary to call home and tell his parents that the nurse will not be allowing him to come back to school until we have a note from a dentist certifying that he is being treated.

3) My daughter's first week of daycare...She did just fine, but boy, did it suck, to put it plainly, dropping her off that first morning. She's in a perfectly nice home daycare just two blocks away from us, but I still didn't want to leave her with, essentially, strangers.

More to come!

New Assignments

Classes started on Wednesday, and I am back to the usual nuttiness that seems to breed in my school district. I have three new schools this year, in addition to one I've had since I first started in 2010 (2010!), which means this year will certainly be more interesting than last year. An overview:

Wackyworld Elementary School: I actually had this school my very first year of school nursing, and had a couple of memorable experiences there, including this one: Being right never felt so bad. Yup...It's the weed cookie school. That incident pretty much sums up the clientele in the area. Lockdown isn't a rarity here, and I've been told specifically to not buy gas at the gas station across the street; it's too dangerous. Get in, take care of the kids, and get out. I like this kind of school; the kids need me, and I can make a difference. 

Disneyland: I've had this school every year since I started, and it's just a good place to be. Like Wackyworld, the kids need me, and the principal and secretaries make it a good place to work. I rely heavily on the Spanish speaking secretaries to contact the parents here. There are some high maintenance teachers here that I could do without, but again, I like this kind of school. The kids know me now too; kids I met as kindergartners are now in 4th grade and wave at me every chance they get.

Unknown Elementary School: I know nothing about this school. It's another elementary school with grades K-8, and a similar student population to Disneyland and Wackyworld. I have two 8th grade diabetics, one girl totally competent, and the other a boy who I'd heard had compliance issues. Sure enough, on day one, he didn't show up to the nurse's office. I had a lunch lady track him down, introduced myself, and told him in the future that he would need to make it to my office on his own. I think he got the impression; the next day, he had dropped off the doctor's orders I'd asked him to bring, and showed up promptly at lunchtime. He'll be a good kid to work with.  

Middle School: By no coincidence, I have been assigned Spitfire's middle school. I have two other diabetics here, including Mr. High Maintenance. I'm taking over this school from a woman twice my age who had been there for years, and for now, the staff is suspicious. I'll admit to being a little suspicious myself, as rumor has it the principal pulls the race card whenever she can. I hope to focus on the diabetics and other students in need, and forget the moody school staff best I can. 

To sum up: 3 new schools, including a middle school, and five diabetics. Spitfire was SO happy to see me on the first day of class that she ran through the gate past the secretary to give me a hug. It felt good to be back. 

A Waste of My Breath

I've been back all of one day and already have had to listen to an irate parent tell me, "You are a waste of my breath." This was in response to her being turned away when attempting to pick up her child's schedule  because she somehow missed the zillions of phone calls and letters that have been sent out warning future 7th grade parents that their children must have proof of a Tdap shot to start school.

The beginning of the school year always feels like being thrown into a hurricane, and this year particularly so after being essentially off for four months tending to full time motherhood duties. Oof. Here we go for another year!