Monday, May 18, 2009

AWOL Nurse?

Two weeks ago, Ashley was injured at school. The teacher called me and said she was going to keep Neosporin in the cuts on Ashley’s hand and that she had tried putting a bandage on also, but Ashley would not keep it on.

Ashley still deals with sensory defensiveness, most likely related to the fact that she is deafblind, and she will not wear a bandage unless she is sedated.

I assumed that the injury was not too bad since the teacher didn’t mention taking Ashley to the school nurse. But, when she arrived home from school that same afternoon, I realized that assumption was incorrect.

The cuts on Ashley’s hands were dirty, red and swollen. I immediately took her to the pediatrician, and he prescribed a 14 day course of antibiotics.

I sent a note in the school the next day advising the teacher of the doctor’s treatment, and also asked why Ashley was not taken to the school nurse. The answer shocked me.

The school nurse was off the day that Ashley was injured. And, there was no substitute or backup nurse.

Besides the fact that there are several children in the school with significant disabilities, and who like Ashley are prone to seizures, any child in that school could be injured at any time. There could be accidents in gym class – there could be an onset of serious illness – there could be an injury in chemistry class – etc. etc. But on this particular day, and who knows how many other days – no licensed medical personnel were present.

So I invoked my rights as a citizen under the Freedom of Information Act, and asked for a copy of any policies or procedures relating to school nurse coverage for my county’s school. And here is the answer I received from the school’s attorney on Friday:

Please be advised that this office has no records responsive to your request. A document containing a specific policy or procedure that addresses school nurse coverage and backup school nurse coverage does not exist and has not been created.

And just for the record, I live in one of the wealthiest counties in my state. They can’t make sure that our children do not receive the care of a licensed healthcare provider during the school day?

Many words come to mind, but the ones I will share here are appalled, alarmed, frightened and angry.


a Tonggu Momma said...

At the Tongginator's kindergarten orientation last week, we learned that - starting next year - our school nurse will only be part-time due to budget cuts. A health aide is available during the other times. Appalling, isn't it?

Ashley's Mom said...

It is appalling and unfortunately it is probably going to take a serious injury or illness to affect a change.

I don't know about your school district, but in mine, clinic attendants (health aide) are not what my child with epilepsy needs.

little.birdy said...

Who gives out meds on days when the school nurse is gone?

Ashley's Mom said...

Little Birdy, that's a really good question. Ashley, for instance, has to take 2 seizure meds during the school day, and just a slight variation of 1 ml can be devastating for her.

I'm guessing it's the teacher, and in our particular instance, that's a really scary thought.

Sandi said...

Appalling and unacceptable! And unfortunately, with all the budget cuts, will probably get even worse.

Michelle Morgan-Coole said...

I have always found it interesting that American schools have nurses. Ours don't. Or at least none of the schools where I grew up (Sask) or where I live now (Nova Scotia) do. Actually it amazes me that the US still has them; I'm surprised that they weren't cut long ago due to cost.

So I have a child with epilepsy. And another with asthma (although admittedly it's mild). But there have been kids in their schools with severe asthma, bad peanut alleregies, who need to check their blood sugar regularly throughout the day (and know what to do when it's too high or too low) and one student with a severe heart condition. Come to think of it, we use have to watch the Blue Jay for severe low sugar episides when she was on the ketogenic diet. And no nurses.

Who handles these situations, you ask? Many kids are assigned aide time just because of the medical conditions. Then the aides help other kids in the classroom with the academics because the child with the medical problems often doesn't need any help with their learning.

Frankly, I don't think we do a good enough job for kids with severe medical conditions at school here. And yet, I kind of feel that a nurse in every school is overkill. I suppose I feel that way because I see the vast majority of medically-related issues handled well by schools here. But it's the kids who are more complicated, who have more complex medical needs, those are the ones I worry about. I suppose if I ran the world (now there's a scary thought!) I would only assign nurses to schools with medically complex students. But that's just me.

Anonymous said...

I share your concern about school nurses. There are times that we are w/o one at our school and the school secretary is on call. Now she's a nice woman and all that but she knows nothing at all about first aid and specifically the needs of our medically fragile kids. If/when parents say anything it is pointed out to them that most of the kids live in homes that do not have a nurse on site. Well, yes, but they have parents or guardians that are fully up to speed on the nuances of the child's medical issues and they are not looking after several hundred kids. Our school nurses are really quite wonderful and nothing replaces them when they are not there. We went all five weeks of summer school last year with no nurse. Don't even get me started on that one.

Ashley's Mom said...

MMC, the only problem with assigning a nurse to only those schools with medically fragile children is that children will then be assigned to those schools rather than having the ability to attend their neighborhood schools. And, that is just another step towards segregation, imho.

Michelle Morgan-Coole said...

That's a good point. But it seems to me that it should be easily gotten around by providing that if but for the nurse issue a particular child would go to their neighbourhood school, then they go to that school. The nurse issue should never be allowed to tip the scale for the exact reason you mention.

It's different here, all kids go to their neighbourhood schools, period. It's pretty well the only option. Heck, I wanted the Blue Jay to go to a different school for high school because they have a way better "intensive resource" (read life skills) program but so many parents want their kids there that they are absolutely refusing all out of district transfers.

And as soon as a I get a minute I really want to respond to your Crystal Ball post around those issues. :D

The Gang's Momma! said...

That is appalling. One of my little guys had an accident in gym class several years ago and the pt nurse on duty thought it might be a concussion. She was so busy handling all the kids herself that I wasn't notified till the end of the day, when he was already on the bus on the way home. Precious time that could have and maybe should have been used to get him to the pediatrician. I was livid. But after reading this, I'm so grateful that "all" it was was a concussion!

Queenbuv3 said...

When my son had his first seizure 2 1/2 years ago at a pool the kids swam at weekly I thank God that the school nurse was there. He wouldn't stop seizing and she knew it was time to call 911. They had to give him medication on the ambulance to stop it. He was hospitalized overnight and diagnosed with Epilepsy.

She has to have a new protocol every year and is the only one allowed to administer Diastat if needed. She or another nurse MUST go on all outings and field trips with his class. The only time he is without a nurse or the Diastat is on his bus ride to and from school but there is a protocol on each bus and in his folder.

This nurse was at his birth when she worked for the hospital he was born in. What a coincedence!

My son sometimes bites himself very badly on his hands or other body parts and these injuries need immediate attention and careful cleaning to prevent infection.

My daughter who is in a regular classroom but has Asthma, GERD, ADD possible ADHD has frequent trips to the nurse because of injury on the playground, stomachaches, headaces, respiratory infections due to her Asthma that require her to use her Albuterol inhaler at school. Speaking of that, every single time the nurse gave her the inhaler, she primed it and wasted 4 puffs of medication until Olivia told me what she was doing and I wrote a note telling her not to. She is frequently sick with strep or pneumonia or some other illness.

Schools need nurses. Some kids with no prior health issues can get injured or have a heart attack, allergic reaction or some other sudden emergency health issue.

wannabe said...

My school (elem, middle, high) never had a school nurse. one of the teachers was trained as a EMT and we always had the health (PE) teachers to go to if it was a female/male thing. the school secretary gave motrin/tylenol as needed, but i kept my meds in a backpack on me and doled them out to friends as needed - motrin, tylenol, benadryl for reactions, etc.