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Re: [IPp] First week of school & @#$#$#@^%#@ Nurses!

Alllison, take
 off that fire resistant cloak--------it's too hot for that!!!   LOL
It was still 92 here at 9PM.

<<If your doctor signed the IHCP then they are considered doctor's orders.
school doesn't need something separate from that. We have our endo sign our
504 plan each year.>>

We didn't go into the IEP with a Dr. signed HCP.    What we presented to
them was the plan we (Zach, us, and ENDO/CDE) wanted implemented (sp?)
for this school year to avoid last years semester long absence.     We'd
just been to the hospital in July and discussed this with his Diabetes Team.
We all felt that Zach's having as minimal amount of contact with the school
nurses would eliminate or decrease his anxiety and "Nurse Phobia".   Plus,
they'd been wanting him to test in class for the past 2 years and it had
been denied as against District policy.

They said to attend the meeting,  present our proposed plan  (which would
replace the ridiculous/offensive plan the nurses created against my wishes
last year),  get their approval or start the battle.    If approved, they
said to
fax final version to them for signatures.    So naturally, since all was
once again by nurse staff at meeting,  we were walking in on Monday AM
without a policy in place.

I had contacted the Endo over the weekend,  told her of the meeting,
told her what was in the plan,  and we agreed to proceed as if they'd agreed.
I faxed orders to her office (she was out of town when we spoke)  and
she promised to have them signed and faxed back as soon as they got
in on Monday  (unfortunately this would be one hour after start of school
day----thus no orders sitting there when son came into their office.)

<<  IMHO, based on what you have written (I wasn't there), it doesn't seem
the nurse was out of line. She doesn't deal with diabetes every day and it's
your job to educate (not berate) her on a daily basis and help her see what
is right for your son.>>

You do however, reach a point where you are fed up!    This nurse refused
to listen to his Endo or CDE last year when they would try to explain
what they wanted or why they wanted it.    And it's not like she is new to
treating Diabetics.    She's been there for over 6 years that I know of,  and
during that time she's had 2-5 diabetics per year.    Six years ago she had
her first student go on a pump.    She attended an 8 hour seminar on
insulin pumping.     She's had numerous students on pumps since.   Matter
of fact,  she came to our elementary at the end of his 5th grade and INSISTED
that we get him on a pump over the summer so his Diabetes would quit
being a problem before he got to her.    That year she'd had 3 on a pump.
He wasn't ready and she was furious and spent the entire first semester
last year telling him he would have his current problem of the moment if he'd
gone on a pump like she'd requested.

<< I don't disagree with a little more control by the school the first week
or two
of classes. Our kids are going to be high and low the first couple of weeks.
Your going to be doing basal/ratio changes due to the new schedule. Things
are going
to be changing alot the first couple of weeks.>>

I did give in on this the other day, but with the stipulation that it only
for the first two weeks, not the first few months as they had decided after
his first moment of confusion/request for assistance.    So far we've not
any adjustments to his basals/ratios this week.    I'm waiting to see if the
stress decreases first.    If he's fine this weekend and then back high again
next week, I'll be changing them for the school days until he destresses.

<<The schools have to protect themselves legally. <snip>  If your 504/IHCP
says he tests at 8:30, then they are going to want him to test at 8:30 every

Last years nurse created health care plan (not the one in his IEP) said he
had to test at 8:30 AM,  lunch,  and 2PM each day.    The 8:30 testing was
because they knew he'd already had two seizures since he'd started pumping
and both had been 1-1 1/2 hours post breakfast and they wanted to be assured
he was within okay numbers.  This new health care plan I presented to them
and had faxed to them that day says that suggested times would be in the AM
around 8:15-8:30 (until he was settled into the school pattern and then he'd
replace that with one around 10:15-10:30 since lunch is so late he might need

a snack),  lunch,  and 2PM each day (to decide if  they felt comfy putting
on a bus),  pre-academic tests, and whenever he deems necessary.

<<  Does your son have a watch with alarms? If not, I highly recommend one.>>

He did in 5th grade, but the teacher confiscated it and threw it out on a
as she didn't like hearing it beep (to remind him to go to nurse 10 minutes
before lunch).    I've thought about saving up some money and getting him
one of the watches discussed on the list.  I'll re-read some of those posts
to try to figure out which one was best.

<<I know I'm being the devil's advocate here, but you will get further with
school (who sounds like they are more than willing to make accommodations)
by being THEIR advocate as well. Helping them help you, rather than fighting
them and being rude ("repeatedly requesting the she please shut up"). >>

Actually, I don't even tell my kids to "shut up".   I was venting in my
and was saying what I was thinking not what was actually said.  On the phone
I was thinking "Just shut up please!"  but what I was actually saying was
"Debbie please just put Zach on the phone!" and  "Let me speak with my
son!"     I went out of my way last year first semester to be nice and polite
to her even though she was already verbally mistreating him.    I didn't
even get rude till late in the 2nd semester when I'd gotten fed up with her
keeping him out of school.     And that was when I started to use the
system to fight for his rights.

I wasn't rude at the meeting last week.    I simply stated and explained
our proposed plan.   When she went balistic and said it was impossible
and against policy and wouldn't be done as we requested,   I simply
FIRMLY restated what we would be doing,  how it was being done in
the District,  what rights he has that allows him to test, etc.    She was
the rude one banging her fist on the table,  I was the calm one restating
what we would be doing.

And once she was and her assistant had fled the room to put on their
battle armor,  I calmly re-explained to his 7 teachers, the guidance
counselor and the assistant principal,  what we were expecting,  why
we were expecting it,  and how I could best help them help Zachary.
They were all accepting and supportive (well accept the principal who said
she was supportive of the concept, but was wanting to see District approval
before getting too excited.)     Teachers wanted to see him test his blood,
show them the pump,  show them how it was connected and explain how
it worked.     Without the nurses, it would have been the perfect meeting  :)

<< I am surprised that the school accepted the liability to calculate the
Not many schools (districts) will do that.>>

Last year we wanted him to have an aid assigned to follow him through
the lunch line,  watch him add up his carbs on a calculator using a card
with the foods and carb grams on it,  watch him do the formula and then
make sure he punched the answer into the pump.

They decided,  that an aid couldn't be responsible for this and it would have
to be one of the nurses since it involved administering medicine.

<<I agree with the nurse here. Again, it's a liability issue. Whenever you
> son's bolus ratio's or corrections (times and ratios) change, you will need
> to either change the IHCP or an easier method, to add an addendum with the
> change, signed by the doctor. I know that we make these kinds of decisions
> every day, we change basals, we adjust bolus ratios, correction ratios,
> determine what times our kids should test, etc. But this is not the job of
> the school nurse. And she (the nurse) can only do what the 504/IHCP says
> she
> can do. If you IHCP says correct over 250, that is what she is legally
> allowed to do. Make her like easier by keeping your 504/IHCP up-to-date.
Actually the new 504 (well we've just turned in a newer one today)  had the
correction formula currently used as well as a range within which that
formula could be moved.   (i.e.   we are currently taking blood sugar -100
divided by 100.     But the range says I can say we are currently dividing
by anything from 60-120.      It says the range of acceptable insulin per
carb unit can be anywhere from   .5 to 1.5 and how lunch is currently   .8.

It said to only do correction boluses at meal time (she attempted to do one
last year an hour after breakfast.)     It didn't say at what number to start
doing them.   Was just contained in the hyperglycemia section.

Today's version (already signed by Dr. and dropped off at school)  says
we can also do a correction bolus as early as 10:30 (4 hrs past breakfast)
if he is  high rather than waiting till lunch to do it.    It also now says
do correction bolus for blood sugar readings (at those times) for numbers
starting at 150.

Whenever I make a change of the correction formula or insulin to carb
dosage,  I have to sign a new medication letter.   Dr. doesn't need to sign
as long as I'm within range.  (I have a stack of these blank forms.)

<<  Try to work with the school rather than fighting with the school and you
will have a much easier time of it.  >>

I'm really trying to work with the school.    I tried to work with the nurses
last year.   Matter of fact, I was so polite and allowing that I enabled them
their nonsence to keep him out of school for a whole semester.

<<Take a deep breath and remind yourself that you have accommodations for
your son. Your son IS allowed to test in the classroom. Your school nurse is
willing to calculate corrections and basals. You have SOOOOO much more than
many parents do. Your glass looks half full (not half empty) from over here.

I am thankful for any cooperation I get from the school, as well as any
accomodations we get.    I just ALSO want to make sure that his rights
to an education are no longer being denied as they were last year.

And now I'm also ready to play advocate for all the other diabetic children
in this district who are still being denied their rights because of lack of
education about  changes, policies,  presedents, etc.    I will be working to
see that the District writes and implements a policy for working with
If they can have a 4 page one for asthma, they can have one for caring for


Barbara A. Petzoldt - Pump Mama to Zachary (12),  Dx 2/93, 508 2/02.
Jennifer (20), Allison (17), Rachel (6)
Fenton, MO
email @ redacted
Independent Kitchen Consultant for The Pampered Chef.
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