School nurses

Christabelle · Jul 26, 2013

Quick question about school nurses since we didn't have nurses in my schools growing up.

If a student keeps a non-daily medication in the nurse's office, does the nurse notify the parents that the student has been to the office for his or her medication?

I can see it both ways, and if it matters, I'm wondering specifically about in a high school setting.

Hendo · Jul 26, 2013

That could be a heck of a lot of phone calls to make considering how many kids might need medication. I think it would be more likely that the nurse would call if the kid didn't show up to take their medication. (assuming it was scheduled and after making sure that they weren't absent) They may also consider calling if it's a non-daily med that the kid tries to take too often.

Christabelle · Jul 26, 2013

That makes sense.

As I mentioned, we didn't have school nurses in my district. Either our teachers or the principal's office handled medications. That could definitely lead to a lot of phone calls.

shakeysix · Jul 26, 2013

Our school is very small. I think our nurse does keep the parents informed--at least the grade schoolers. I think whatever it is, the policy would be set by the school board--s6

melindamusil · Jul 26, 2013

Former teacher here. I can't answer your question specifically but here are a few thoughts:

1. If a student keeps ANY medication at the nurses' office, chances are he'll have to fill out about twenty pages of doctors notes beforehand. ESPECIALLY if it's a nonprescription/nondaily medication - kind of ridiculous but all the zero tolerance programs are forcing this. (You could use this to your advantage - perhaps the doctors notes mandate that the doctor/parents be informed every time she takes the medicine.)

2. Is it a large high school or a small high school? In all high schools, but especially small high schools, rumors will be going wild. "Did you hear that Susie was in the nurses' office? I bet she's taking birth control pills again!" In other words, even if the nurse doesn't tell the parents, there's a fair chance that the rumor mill might inform them. (Either way you could use this to your advantage - maybe the parents don't find out but she's afraid they will.)

3. In a high school setting, many states will offer contraceptive and reproductive medication to students but can't inform parents due to privacy laws.

4. Especially if it's an OTC medicine, especially in a large high school, many students will bring the medicines themselves and never get caught.

5. If it's a really bad home situation, sometimes they'll bend the rules to protect the kid. It's more rare nowadays (again, the zero tolerance laws) but it still happens.

ULTRAGOTHA · Jul 26, 2013

Melidnamusil, I don't know how universally true that is.

Also, since every kid in the school who has a rescue inhaler or diabetes or any other maintenance drug troops in and out of the nurses office, I question how many birth control rumors would fly.

Hendo is correct that it's more likely the nurse would tell the parents if the kid did not show up to take medicine than if they did. If they did take the medicine why would the parent need to be informed of what should be happening?

Christabelle, My wife is a school nurse who has worked in high schools. I'll ask her when I get home. Or you can PM me.

What state is this in and what time period? That will make a big difference.

Also what will make a difference is what the medication is and why the student is taking it. OTCs are not the same as Formulary drugs. Analgesics are not the same as rescue inhalers. Taking blood sugars before and after lunch is not the same as any of the rest of it. Etc.

Nurses cannot, at least in this state, hand out any drugs at all unless a doctor orders it. Sometimes there is a general order for all kids (anyone may be given benadryl for allergic reactions, for example) but even for individual children, there needs to be some kind of doctor's order for the Nurse to administer.

ULTRAGOTHA · Jul 26, 2013

OK, ran this past the wife. As I suspected it depends on the circumstances.

PRN (as needed) ibuprofen for cramps? No.

PRN benedryl for allergic reactions? Probably.

PRN epi pen for anaphalactic shock? Absolutely.

My wife has been a school nurse in four states. In none of them did the parents have to fill out more than one piece of paper, with the doctor's signature, for a drug to be dispensed at school, either as a maintenance drug or PRN.

Schools that have on-campus clinics that dispense, for example, birth control pills are different than the nurse's office at the school. She's never administered BC pills in school. They're QD (once a day) so why would they need to be administered during school hours? The clinic won't administer them either, they'd prescribe them and they might dispense them; but they wouldn't administer them because they don't need to be taken during school hours.

In any setting doctors and nurses can't discuss, for legal reasons, a high school student's medical care with the parents without the permission of the student if the student is 18 or older. Google HIPPA Privacy laws.

melindamusil · Jul 26, 2013

ULTRAGOTHA said:
Also, since every kid in the school who has a rescue inhaler or diabetes or any other maintenance drug troops in and out of the nurses office, I question how many birth control rumors would fly.

High school students can be cruel, so I would say it's certainly not impossible that a bully might use a rumor to torment someone. But you're right, many kids have inhalers or something similar, so it's probably not as common. Whatever works best for your plot.

Christabelle, My wife is a school nurse who has worked in high schools. I'll ask her when I get home. Or you can PM me.

It's been a few years since I worked in a public school, so it's certainly changed somewhat. Listen to UltraGotha over me.

wendymarlowe · Jul 26, 2013

ULTRAGOTHA said:
Google HIPPA Privacy laws.

Common typo - it's HIPAA (Health Insurance Portability and Accountability Act). More at http://www.hhs.gov/ocr/privacy.

ULTRAGOTHA · Jul 26, 2013

I know that, darn it. I work in insurance.
:rant:

wendymarlowe · Jul 26, 2013

The sad thing is, "HIPPA" actually gets about a third more google hits than "HIPAA" does :-\

Christabelle · Jul 26, 2013

All of you guys have great suggestions!

What state is this in and what time period? That will make a big difference.

The story I'm working on is contemporary and takes place in Colorado. The high school is fairly large, in a fictional suburb of Denver.

My character in question is a 16-year-old guy with hemophilia. He self-infuses his medication at home, but he would keep extra at school for emergencies. I know plenty about the treatment plans and forms he'd have on file at school, but I'm wondering if it would be school policy - or perhaps something his parents would likely ask for - to have the nurse inform the parents if he had a bleed.

His visit to the nurse's office arises a nosebleed rather than a fight or anything that would raise alarm. He's my MC's brother, and while not essential to the story, whether or not his parents find out would raise the conflict level between the two characters.

Hope that gives more insight into what I'm trying to figure out. Thanks!!

ULTRAGOTHA · Jul 26, 2013

She absolutely would call the parents.

Factor VIII is bloody damned expensive. Like, $50,000 per insurance claim from the pharmacy. !!

Christabelle · Jul 27, 2013

ULTRAGOTHA said:
She absolutely would call the parents.

Factor VIII is bloody damned expensive. Like, $50,000 per insurance claim from the pharmacy. !!

Yeah, it's extremely expensive, but I hadn't taken cost into consideration for her calling. Makes sense.

ULTRAGOTHA · Jul 27, 2013

Oh, no. The cost wouldn't be a consideration. I was just exclaiming in general at the cost (we price those claims at work). !!!

No, she'd call the parents because their hemophiliac son had a bleed. It's information they need to know. If he was infused at school he may need less factor at home this evening. They might need to follow up at home, or with his treatment center or with his doctor. Also, they now need to send in replacement Factor VIII or IX.

At Sixteen years old, and if you really need to for your plot, it's conceivable the school nurse might write a note to the parents instead of making an actual call. Especially if she tried to call and couldn't get hold of them. The kid is self-infusing at home and could know enough to re-calculate his dose that night, and take another vial in a cold pack to school the next day. But as a reader in the health care industry with a school nurse in the family, suspending my disbelief that she wouldn't call the parents would be an uphill road for the writer.

ETA: You may already know this, but for infusion: Alcohol wipe, followed by infusion of saline, followed by alcohol wipe, followed by infusion of Factor VIII, followed by alcohol wipe, followed by infusion of saline (and in this case, definitely NOT followed by another alcohol wipe and an infusion of of heparin.)

Christabelle · Jul 27, 2013

ULTRAGOTHA said:
At Sixteen years old, and if you really need to for your plot, it's conceivable the school nurse might write a note to the parents instead of making an actual call. Especially if she tried to call and couldn't get hold of them. The kid is self-infusing at home and could know enough to re-calculate his dose that night, and take another vial in a cold pack to school the next day. But as a reader in the health care industry with a school nurse in the family, suspending my disbelief that she wouldn't call the parents would be an uphill road for the writer.

ETA: You may already know this, but for infusion: Alcohol wipe, followed by infusion of saline, followed by alcohol wipe, followed by infusion of Factor VIII, followed by alcohol wipe, followed by infusion of saline (and in this case, definitely NOT followed by another alcohol wipe and an infusion of of heparin.)

Excellent points, Ultragotha. Thanks for checking with your wife and for your insights as someone in the health care industry. I'm hoping my story doesn't require too much suspension of disbelief.

I'm not sure why I got hung up on this point. It's not a major plot point, but between the kid trying to assert his independence and the MC sister being angry at him for other things, it worked its way in. A call from the nurse will be good enough for a "told you so" moment between siblings.

I'm not arguing, but for most people I've observed, the infusion is pretty much a one injection process. Mix the factor, clean the site with alcohol, infuse, and then pressure over site. No need to do the saline flush. (My computer isn't letting me insert a link but there are some videos on YouTube.) Were you possibly thinking of accessing a port? No worries either way.

I appreciate any and all thoughts and suggestions!

ULTRAGOTHA · Jul 27, 2013

Granted I was working from IV infusions. Teach me to guess! Bad ULTRAGOTHA, no biscuit!

areteus · Jul 28, 2013

May not be relevant here but in my time in schools (mainly in the UK I have to admit) I have noticed that there are less and less actual named school nurses anymore. More likely there will be a designated first aider, usually a member of the admin team, who has the training to deal with these issues but they will not be 'a nurse'. There will also usually be a series of photos on the staffroom wall showing kids with specific issues so any staff member can recognise those who may need special attention (i.e. if they collapse in one of their classes) as well as the online register system recording any special needs. In some schools, they also issue either notes or cards to kids with special needs that may require them to leave the class in a hurry. For example, if they have a kidney or bladder problem permission to go to the toilet has to be automatic or if they have diabetes they may have to eat something. Haemophillia may also require a system like this because if they get injured in anyway it becomes imperative that they get their Factor VIII injection as soon as possible and if there is a supply teacher in the room instead of their normal teacher (who would likely see the injury happen and respond immediately by sending them to the office to get their treatment) they will need to be convinced the claim is real (yeah, as a Supply teacher I have had kids with genuine medical issues and also kids trying it on... a simple card signed by the head with a 'this child needs...' on it makes life a hell of a lot easier...).

Christabelle · Jul 28, 2013

ULTRAGOTHA said:
Granted I was working from IV infusions. Teach me to guess! Bad ULTRAGOTHA, no biscuit!

You can still have a biscuit. :e2coffee:

Still an IV injection, just not the IV drip.

Areteus, great points about sharing the nurses. That happens here also. They can have five or more schools in their care. I don't know how they manage!

FWIW, my character is more familiar with the office staff and nurse than he'd like to be. Whether the nurse were on duty or some office lady, he would be allowed to stay and take care of whatever he needed to do (infuse, ice his ankle, call his parents, get his nosebleed under control, etc.).

ULTRAGOTHA · Jul 28, 2013

Even if there isn't a full time nurse at the school (a more and more common occurrence, alas) his parents, if they're involved with their local treatment center, probably have a ... 509...? treatment plan with the school to cover whatever he needs to have done re his hemophilia.

I didn't mean an IV drip. Some people who need temporary infusions have an IV put in and get a push infusion via syringes. For those, it's saline, drug, saline and sometimes heparin. People on 10 days of IV antibiotics getting home infusion, for example. So I thought a port would be the same. THAT'S why no biscuit.

ETA:

areteus said:
... if there is a supply teacher in the room instead of their normal teacher (who would likely see the injury happen and respond immediately by sending them to the office to get their treatment) they will need to be convinced the claim is real (yeah, as a Supply teacher I have had kids with genuine medical issues and also kids trying it on... a simple card signed by the head with a 'this child needs...' on it makes life a hell of a lot easier...).

Supply teacher = Substitute teacher? In other words, a teacher hired by the school district to come in for a day or longer to temporarily replace a teacher that can't be there for some reason?

areteus · Jul 29, 2013

Yes, a supply teacher is what you would call a substitute. Usually hired by an agency the school call first thing in the morning as soon as they know there is an absence they need to cover.

And I don't think IV is what you meant... I think what you were talking about was a cannula - a needle inserted into a vein for a period to allow easier injection of IV drugs, usually while in hospital but I have known some have them outside of there. Not aware of these being long term as they are an infection risk and can cause damage to the veins. These are usually fitted to the back of the hand.

Some diabetics have an insulin pump which has a needle fixed into their skin (but not a vein, as far as I am aware... insulin only needs to be a sc not iv injection).

Christabelle · Jul 29, 2013

areteus said:
And I don't think IV is what you meant... I think what you were talking about was a cannula - a needle inserted into a vein for a period to allow easier injection of IV drugs, usually while in hospital but I have known some have them outside of there. Not aware of these being long term as they are an infection risk and can cause damage to the veins. These are usually fitted to the back of the hand.

Some diabetics have an insulin pump which has a needle fixed into their skin (but not a vein, as far as I am aware... insulin only needs to be a sc not iv injection).

Most hemophiliacs with decent veins are taught to self-infuse into their own veins. They don't need a port or a PICC line (I think that might be like the cannula you mentioned) - both of which are prone to infections. They can give themselves their factor almost anywhere. Younger kids, especially those on 2-3+ times per week treatment, often have a port because their veins are more difficult to hit on a regular basis.

ULTRAGOTHA, I see what you mean about the IV, but since many hemophiliacs have to infuse several times per week for their entire lives, it's healthier to prevent infection if they don't have an outside line. Did that make sense?

I'm sure my character would have a 509 plan to work from at school.

I hope I'm making sense!

areteus · Jul 29, 2013

As I understand it, cannulation is a general technique for which there are many different variants depending on what you are using it for... so yes.

School nurses

Christabelle

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