Another Richmond-area School Reaction

[Macabre]

http://www.wtvr.com/news/wtvr-school-nurse-uses-epipen-to-help-fifth-grade-student-20120214,0,2056654.story

[Macabre]

The first article seems more accurate than this one, since it seems it was at lunch and not a snack time---unless it was a class Valentine's Day party with pizza.

www.wric.com/story/16939893/local-student-saved-by-epipen

[CMdeux]

I'm glad this had a happy ending.  Certainly more things seem "right" here than in the case that preceded it.

But still-- an allergic reaction is in progress in a child with a peanut allergy, and the school nurse calls THE PARENT??

NO, NO, NO.   

That's the kind of thing I'd expect a school secretary or classroom teacher to do.  Someone who felt out of his/her depth.  Unsure.  That should NOT be the case with a school nurse.  Sure hope that was not actually what went on here.     Because if it was, then this school district has missed learning one VERY important lesson from that little one's death.

[Macabre]

According to one story, the symptoms were still one body system. That would call for a call to us according to our plan unless that one system is mouth or throat GI Tract.

According to that story, the nurse saw the escalation, called the mom and told her she was going to epi. Now you're right--if the nurse has determined it's what needs to be done epi first, call 911 them call mom.

But I think overall this went well, although I hope the kid had a buddy go with him to the office. Or should have adminnes the epi there and then called the nurse if he self carries. As we know, being on the feet is not a good thing to do, but this child recognized what was going on and did something about it. His mom should be proud.

[CMdeux]

Except that this was a suspected PN ingestion, yes?  Hard to know what symptoms were, exactly, since the two stories are somewhat conflicting.   I'm not sure that "itchy" head, shoulders and neck is just hives-- or that the administrator reporting it is entirely correct.  The other story seemed to indicate that the child realized pretty much immediately that he'd eaten something that contained pn-- which almost certainly means oral symptoms.

In most kids with PA, that kind of actual/suspected ingestion calls for epinephrine administration-- period.  I guess not in someone without anaphylaxis Hx, though it seems unlikely that a child with that kind of history would have the training and presence of mind to do what this boy did.  It's hard to know.

Good for this child for knowing what to do.       You're right, Mac-- his parents should be very proud of him.   

It makes me pretty grumpy to know that this was probably the direct result of unsafe candy being handed out willy-nilly for Valentine's day, though.   A fair number of 5th graders are not yet capable enough to determine safety, particularly when you add in the mix-ups of lookalikes and size/packaging quirks in holiday candies.  Ugh.

[Arkadia]

Oh, you both are so overshooting the temperment of even a "good" school nurse.  A certified one even. School nurses just don't "do" time sensitive emergent field work. If you're a nurse, and you do have both the temperment and skill set to handle emergent situations or continuously manage an unstable patient (and I DO mean in the healthcare sense of classification) then that's where you'll find work if your license is worth the watermark it's printed.) School nurse pay isn't A THIRD of what even the surliest barely english speaking import with reciprocity can earn in ER, Surgery, Cath Lab, or a Critical Care open heart unit. That and a school nurse is minimal daily hours and probably not five days a week even.

It's not their primary function. If it were, they'd have equipment on hand to start at least an iv.... But they don't. Nor will they ever. It's a trick bag. For a number of reasons.

but I digress. 

what you're asking for is someone for whom it's second nature.

You're not going to get that when 99.9 % of their time their primary function is submitting eye exam paperwork or going over dental hygiene with kindergarteners.

Just two days ago, the sub nurse called me at home to come pick my daughter up because her eczema was "itching" and her eyes were red. Um.....I told her if I was going to take her home for that.....get ready to pay for summer school and a homebound instructor. I went over anyway, washed the tempera paint off her little mittens with her favorite soapless body rinse, patted them dry, and applied a prescription moisturizer. her eyes were a tad red at the outer lower lid, but skin intact and in general just looked like "allergy shiners".

In the meantime she was sounding flustered when her personal cell phone rang and she blurted out to the person on the other end:  "I can't talk now, my office has FIFTY people in it."

Oh, f***, princess, your office had THREE children in it, ONE of which was mine that I took off your hands, and the ONE seemed to be managing himself after you loudly complained we were using the bathroom (to wash the paint off my daughters hands) he typically used for whatever it was you wanted us out of there for. The other you addressed as "my diabetic" to me when you dismissed my inquiry if she could head back to lunch (after I gave her a little personal attention and some mommy love----you are SO not the nurse she was expecting for her daily jaunt/large motor break to the nurses office to shoot the breeze a few minutes during lunch).

that's like me telling someone who wants me to come see their family member:  "I can't, I have to do "x" for my "small bowel obstruction". 

But yeah, only TWO kids there she had to do anything with and the one seemed to be waiting for someone to pick them up.

Egads. MY LUNCH BREAK IS BUSIER, if I get one.

"FIFTY".

fifty.

[Arkadia]

fwiw, I obtained permission for my daughter to go back to lunch from the office secretary. 

[CMdeux]

... but truly, in that case, Ark-- why is having school nurses in buildings "essential" if managing emergent care isn't something that the average one is any more capable of than, say, a cool-headed kindergarten teacher?


(That's a serious question, by the way.  I'm definitely not disagreeing with your observations, since I've seen that myself too many times to discount it.)

[Arkadia]

... but truly, in that case, Ark-- why is having school nurses in buildings "essential" if managing emergent care isn't something that the average one is any more capable of than, say, a cool-headed kindergarten teacher?

you've answered your own question because that whole mindset is what ends up clustering core/fundamental rejects into the school nurse slots.

when the pay is commensurate with the expectation, then you'll see change. when "essential" is defined as "every day, each day, all day, in every school building" and not "Tues, Wed, Friday, every other week, you'll see nurses tripping each other on the way to the interview. When a school nurse doesn't tell me to my face:  "my boss told me I wasn't involved with the marching band, it's an extracurricular", you might get a set of nurses HIRED in the first place who wouldn't dare let a principal dictate their scope of practice. When practice, not politics, is held in regard, expect change.

But yeah, I'm not counting on it any time soon in the current economy, but "essential" is defined more often than not by budgets. 

[Arkadia]

the best school nurse I ever had the pleasure of having a school relationship with was in 8th grade:  Retired Navy Nurse. 

She's now the district nurse (in a little over two years in the district). She's so COOL!!

Regular kinder nurse is full time and pretty adept, but I wouldn't want her walking into a ccu unit and titrating cardiac gtts, mixing amniodorone, pushing etomidate and succinycholine, or administering Mannitol, YK?

[Arkadia]

truthfully, I think everyschool should have TWO nurses daily as peer oversight is a pretty good motivator. There's a lot to be said for brainstorming in a crisis. It works. 

but yeah, TWO nurses, not one. It's too easy for the casual RN to slink off to a corner.

[CMdeux]

the best school nurse I ever had the pleasure of having a school relationship with was in 8th grade:  Retired Navy Nurse. 

She's now the district nurse (in a little over two years in the district). She's so COOL!!

Regular kinder nurse is full time and pretty adept, but I wouldn't want her walking into a ccu unit and titrating cardiac gtts, mixing amniodorone, pushing etomidate and succinycholine, or administering Mannitol, YK?

Of course not...

but shouldn't a school nurse in possession of epinephrine, glucagon, and insulin be adept at evaluation and management for both bG and anaphylaxis??  At the very least, I mean. 

It just really troubles me that school staffers are basically expecting PARENTS to make an over-the-phone evaluation when a child is in distress during an allergic reaction.  It's far too often a feature in fatalites, speaking bluntly, and it delays proper care.  Personally, I consider it the #1 reason why I'd never give a school permission to speak with a child's doc; I'm afraid that they'd try to call him, too, instead of relying on protocol and EMS.   

[Macabre]

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

And Ark--some people do a job because they love doing it. Not because they are mercenaries. It's why people go into education in the first place. 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.

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.

[Mfamom]

Yeah, the fact that they called the parent when they saw the reaction escalating just irks me to no end. 

WHY??  if your house is on fire do you call your momma?  No, you call for qualified help.  What is the mom going to do?  She's not there!  OH it drives me crazy.  Give the epi pen, call for emergency help.  That way, if the epi pen doesn't help or reaction continues, help is on the way. 

[Mfamom]

... but truly, in that case, Ark-- why is having school nurses in buildings "essential" if managing emergent care isn't something that the average one is any more capable of than, say, a cool-headed kindergarten teacher?


(That's a serious question, by the way.  I'm definitely not disagreeing with your observations, since I've seen that myself too many times to discount it.)

I agree. 
The fact of the matter is that school nurses NEED to be more adept at handing these types of emergencies.  Because as we see, they are becoming more and more likely. 

And, with the many stories of reactions AND deaths in the school setting, if you're a school nurse and not up to date on exactly how to handle a situation like this, you'd better figure it out.