Another Richmond-area School Reaction

[Arkadia]

CM--it may not have been in the child's plan to epi upon rcns from known ingestion.

plans don't supercede good practice. Or scope of practice, for that matter.  Even when there is a physician's name attached to them.

ask me how I know. 

And Ark--some people do a job because they love doing it. Not because they are mercenaries.

that's a lovely notion, but the field I work in you not only have to love, but  KNOW WHAT YOU ARE DOING.  Good intentions and a touchy feely "I just LOVE helping people" attitude doesn't cut it.

Actually, it doesn't even have to be your first career choice. Nursing is littered with folks who decided they needed a job that they not only could tolerate and were good at, but paid the mortgage, too.

Just because the setting is a school doesn't mean that school nurse is any less qualified than one with the same credentials as one in a hospital. Or that a hospital nurse is better.

Survey saaaaays:  you're wrong.

http://books.google.com/books?hl=en&lr=&id=ighVBJY_y7AC&oi=fnd&pg=PA247&dq=floating+nurses+guidelines&ots=PJXz1NJ-GS&sig=pE582WlYC5986j9R5DZ8ZfEnk8E#v=onepage&q=floating%20nurses%20guidelines&f=false

Even critical care nurses won't float to Labor and Delivery or an Oncology floor. At least not nurses who have a speck of sense. Not unless they have EXPERIENCE in that field, and EXPERIENCE in the LAST YEAR. It's a rapidly evolving field all the way around. Or would you want a nurse who hadn't worked in Labor and Delivery in five years monitoring you and your unborn child/administering treatments while you were in labor?

Not only is experience tantamount to defining the scope of a nurse's practice, lawsuits are PREDICATED on it. You aren't invited to practice in emergency medicine without the credentialling or three month orientation. (minimum) I'm continually having to get recertified and inserviced in my field. We may hire new grads, but we require them to work side by side with another experienced nurse for three months minimum, full time, and then, we don't assign them patients who need a more experienced nurse. Sit in at bed/board and you'd know that.

Fresh hearts don't go to just any critical care nurse, they go to one who is open heart certified.

Our Houston area elementary a school nurse was an RN, sharp as a tack, and an unbelievable advocate for DS. And she recognized as a rxn these symptoms: falling asleep on play ground after lunch and a lower blood pressure. She rocked. She'd worked in an allergist office but loved getting to know the students anda having holidays and summers with her kids.

Ya don't say?  Nice change to hear around these boards...but I bet she had more background/experience than an office nurse in her previous life. Maybe even more pay or moonlighted in an ER.  Our jr. high nurse was a retired navy nurse, and while she might not have  minded the pay, she probably was collecting a retirement stipend on top of it. but see, that's something I know, as an insider in the field. I associate people who care about the $$ they trade their skills for in order to provide for their family with high quality nursing care. I don't want some mope caring for my loved one, YK?

Just because you plant epi in the school nurse office, don't expect the incidence of death to decrease, unless steps are taken to ensure your school nurse is not only comfortable using it in her scope of practice, but understands the BIG PICTURE. She needs to understand the pharmalogical kinetics, pathophys, and aftercare. She needs to understand her ROLE. She needs EXPERIENCE. And also, a community that respects that degree of AUTONOMY. Even if that culture is one District Nurse. I mean, have you ever had ONE paramedic arrive on a scene? NONSENSE. There are always TWO, if not THREE. Peer review/collaberation is a BIG DEAL in emergency medicine.

Things will need to change regarding school nurse recruitment if you want the situation to improve.

[Arkadia]

The fact of the matter is that school nurses NEED to be more adept at handing these types of emergencies. 

you aren't going to attract anyone "adept" with 14-17 dollars an hour in a field where new grads can be mentored in a hospital setting and their practice enriched with valuable experience starting at 32-40 an hour. Experienced nurses working registry tack on another 8 an hour + differentials. Don't even ask me about agency. It's obscene.

The entry standard is already a Bachelors degree, unofficially. Expect it to be official in the near future, nationwide. People who invest in a four year degree, in a healthcare career, eventually want their masters, if not to become a Nursing Practitioner. They want EXPERIENCE, because that's what gets them into those slots. It not only ENRICHES their practice, it's a requirement for an advanced degree.

Most of the people you deal with in offices aren't even RN's at this point. They usually keep one on hand to administer medications and treatments that need one, by state requirement, to administer. But really, it's not where you'll find them, unless they are a Nurse Practitioner seeing patients in a physician's place. 

[Arkadia]

Experience makes a nurse....a better nurse.

[Mfamom]

Experience makes a nurse....a better nurse.

experience makes most people better at most things, don't you think? 

[Arkadia]

Experience makes a nurse....a better nurse.

experience makes most people better at most things, don't you think?

apparently, to a most of the school community, nurses aren't those people. LOL!

[rainbow]

In some states there are ancillary benefits for being a school nurse. Like great benefits, summers off, tenure, and pension.

[Arkadia]

School nurses generally DON'T have a background managing emergent situations let alone it being second nature. Their assessment skills aren't anywhere near those of a well seasoned critical care career professional. Again, a major influence in attracting that level of care is $$. Sure, you'll run across an occassional anomoly, but hands down, it's not the skill set you'll find in the RN office of a school building. 

It's knowledge and skill you NEVER get from an inservice.

from the link:

Increasingly, legal opinion has indicated that nursing should be viewed as a profession, like medicine, with distinct specialties. 8,9 As Regan 10 has noted, "Indiscriminate floating in hospitals reflects an administrative mentality that still subscribes to the hackneyed notion that a license to practice nursing is a license to do anything within the legal definition of professional nursing."

Italics/bold added.

[Arkadia]

Overwhelmingly....I read account after account HERE, on these boards of people who fail to administer, to their own child or themselves, and horrifyingly wait a reaction out. (eek)

Don't expect your school nurse to do any better. If they do, count yourself lucky.

[Mfamom]

here's a news video naming the School Nurse a Hero.
It also says the reaction occured during a vd party.

The solution in their eyes is to have epi pens in all VA schools, but alongside that, how about removing food from the classrooms and non food parties.  anyone think of THAT?   
As someone else mentioned, I'd love to know if anyone escorted the child to the nurse etc.  Funny, our plan in elem called for the nurse to come to my ds for known ingestion.  (along with laying him down, feet raised, all kids cleared from room.)

She says as soon as she saw the symptoms, she administered the epi pen. 

I'm happy for the positive ending, but really it seems like every time there is an incident like this, the districts cannot seem to put together a balanced plan for preventing in the future.  In this case, they want to be sure all schools have epi pens.  Great start, but not enough! 
(emergency plans, elimination of food in classrooms, etc)

[Arkadia]

Hey, it's cool to see y'all loving up nurses for a change, but again (and I've been saying it for TEN effing years) school nurses need to ATTEND formal 504/IEP meetings for a healthcare need as THE PERSON MEDIATING/LEADING/DIRECTING IT.  Generally it's a social worker or school psychologist for developmental needs.

This whole "I don't need to be there" bs has to end. They will better realize their role when they are the one's conducting the meeting.

[Mfamom]

here's a news video naming the School Nurse a Hero.
It also says the reaction occured during a vd party.

The solution in their eyes is to have epi pens in all VA schools, but alongside that, how about removing food from the classrooms and non food parties.  anyone think of THAT?   
As someone else mentioned, I'd love to know if anyone escorted the child to the nurse etc.  Funny, our plan in elem called for the nurse to come to my ds for known ingestion.  (along with laying him down, feet raised, all kids cleared from room.)

She says as soon as she saw the symptoms, she administered the epi pen. 

I'm happy for the positive ending, but really it seems like every time there is an incident like this, the districts cannot seem to put together a balanced plan for preventing in the future.  In this case, they want to be sure all schools have epi pens.  Great start, but not enough! 
(emergency plans, elimination of food in classrooms, etc)

Shoot!  forgot to post the link to the video.  BRB
http://www.wric.com/global/Category.asp?c=190525&clipId=6747025&topVideoCatNo=92150&autoStart=true

[CMdeux]

Well, that is certainly not entirely in keeping with the earliest reports, but I'm glad that the nurse acted quickly in any case, and VERY glad that this story had a good outcome.

Still, I had the same sense that you did, Mfamom; that this was mostly about "we're just repsonsible for treating kids if they have a problem" and "we can't know what we can't know" rather than any kind of ownership that most of these "problems" are avoidable to begin with in kids with known allergies. 

Total disconnect on prevention.  Bummer.

And no, I do not think that most school nurses (or nurses, in general) have a CLUE when it comes to that side of this equation.  Treatment?  Absolutely, I think that a competent school nurse ought to be taking the lead.  Sounds like this one may have (though I'm still troubled by the "call mom and dad" in light of a possible ingestion of pn and a reaction in progress), but that neglects preventative measures like not having the allergen present in the child's classroom during a break in daily routine.   

[Mfamom]

I'm so curious what the candy was and who provided it?   Wonder if it was an outright nutty candy like valentine snickers or something?   
Wonder if there's a class mom or two taking it all in and feeling lucky their vd party didn't kill someone.?

[rainbow]

Since Tuesday was Valentines Day this does sound like it occurred during the classroom party during "snack time".  The reporter could have been more thorough there!  Reporters or FAAN, if you're reading -- please look into that.  Many schools no longer allow food attached to Valentines.  This said it was a "candy" so that is what it sounds like.  Shared food at celebrations must be safe for the children in the class with LTFA, and attaching candy is just not safe -- "regular" parents (those not having a child with LTFA) cannot safely pick out safe candy (hence my child getting snickers, milky way, and other chocolates on his valentines in Kindergarten!).  PTO class moms can get crazy with this stuff, and many teachers are not assertive.

Candy should not be allowed, because parents do not understand food allergies and risk.  All it takes is one bite of the wrong candy.  These are little kids that cannot be expected to know not to eat it, as these candies are usually unlabeled, parties are chaotic, and there is peer pressure to be like your peers and enjoy the party food.

There have been quite a few reactions lately resulting in death, comas, and lucky cases like this one with a severe reaction and good outcome, thanks to the Epipen (which doesn't always work this well!). I hope schools are getting the message.  PREVENTION and eliminating risk via non-food celebrations is the key to avoiding reactions at school.

[Scout]

our district nurse comes to my 504 meetings and she gets it, the school nurse (every day person) gets it but not as happily......I think she rolls her eyes behind my back hahahaha.....not really

but she is not warm and fuzzy, but she is smart as a whip and competant....