Should a school nurse diagnose?

[dakcp2001]

My son went to the school nurse last week because his throat hurt. I picked him up, took him home, checked his throat, gave him some meds & waited. By that evening he was fine, but about two days later came down with a cold.

Today he went to the nurse to see about getting some cough drops (he has a cold, one that all three kids have had this week) & the nurse proceeded to check his throat & declared he had strep. Even though his throat doesn't hurt. She called me & said I have to pick him up, take him to the Dr & he can't return to school without a note from the Dr. She said he had white spots in his throat. She would not even let him go get his things from class.

I had his sister (thank God she was home today) take him to the Dr & the strep test is negative, just as I knew. There was also no sign of white spots. Even the Dr thought this was very extreme for the nurse to do. Needless to say after the time, money & him missing class over this I am a bit ticked off. I could understand if he had a fever, or was even complaining about his throat, but neither was the case. So yes I called her & let her know that he does not have strep & until she obtains an MD after her name she should not diagnose people.
At the beginning of the year my DD went to the nurse because her ear hurt. The nurse said she had severe ear wax & I needed to flush her ears out. I knew something was wrong since she never complains of her ears. Went to the Dr & sure enough she had an ear infection. The Dr said it was good that I did not flush her ears, it would have been extremely painful.

Congratulations on being "that parent".

The nurse is there to help your child, and also to protect the other children from catching what your child may or may not have. Did she TELL you your child had strep throat? Who did she "declare" it to? Is it possible she suggested it could be strep throat and your child gave that to you third hand and maybe phrased it differently? Big difference there, wouldn't you say?

And it sounds like your kid goes to the nurse a lot. If he had been sick over a week, like you mentioned, he saw her last week with a sore throat and then went again this week, I think it was reasonable for her to think he needed to see the Doctor.

As far as your comment, you owe her an apology. Perhaps you should have your kid call you when he needs cough drops.

 

[Eeyore'sthebest]

Nope. School nurses see a lot of stuff but they are not capable of diagnosing. Picked up DSD at school one day and was informed that her one lung was filled with fluid and I was a horrible step-mother for sending her to school. She had been coughing all morning. As DSD has asthma this was disconcerting to me and I took her immediately to the doctor's office. There was nothing wrong with her lungs. Did have an ear infection but she sat there and told me and the doctor that her ear didn't hurt. Turns out the coughing was due to the teacher spraying bug spray in a closed classroom with the class full of kids. Well hell, of course it set off her asthma and she was coughing. Yeah, that's all my fault.

 

[NaLisa]

I agree with PPs that your comment to the nurse was rude and that the conversation was probably slightly different than "Your child has strep." The nurses are there to protect the entire school population from infectious diseases and to recommend a doctor's treatment when deemed necessary. Sounds like that's what she did.

We're fortunate to have a wonderful school nurse, who's there 5 days a week in a school with 700 kids. A couple of years ago, DD8 had a boil that had opened and drained after we applied a warm compress. Put a bandaid on her and she was fine when I sent to to school in the morning, but the nurse called a couple of hours later to say the open boil was draining a dark-colored fluid and she thought I should take DD to the Dr. ASAP. Took DD straight to the doctor then an hour later across the street to the surgeon's office. Turns out DD had MRSA staph and required incision, drainage and antibiotic treatment, so she went to the children's hospital for outpatient surgery the next morning. It was quite scary but DD had no complications and the MRSA staph never returned. I called the nurse to let her know DD had MRSA staph and to thank her for spotting the seriousness of the situation, and she simply said "I was concerned it could be staph" after the fact.

This was a potentially life-threatening ailment that could have been much worse if it wasn't for my DD's school nurse. Thank goodness for great nurses!

 

[kirstenb1]

School nurses have a tough job. Damned if they do, damned if they don't. I think it was sufficient that she was notified your child didn't have strep. To rub her nose in it is a bit much.

 

[kimmyann]

I admit, I probably should have waited until tomorrow to call her regarding his results. It just bothered me the way she spoke to me when she called to pick him up, she was rude to me & did in fact say that he had strep. He went about cough drops because he now has a cold & has a cough, he even told her that his throat did not hurt.

At the end of the day I can sit here & look at both sides. This nurse has no idea if I'm a good parent or a neglectful one, therefore she sided with what she probably runs into a lot. I know my kids pretty well, have dealt with illnesses many times (strep included) over the past 20 years & when I see typical cold symptoms & siblings with the same thing then I'm pretty confident with what it is. I also know when the boy can go out with his friends to hang out everyday & is fine at the end of the day (after school) then he is not really sick.

I'm usually a pretty passive person, but I think with the combo of her attitude, my son going to her in the first place, & her forcing me to take him to a doctor (in which I feel I would know if he needed one) just about did it for me today. I could have understood if he was indeed sick, but he was not. No fever, no white spots (dr confirmed & myself) & all he wanted was some freaking cough drops for his cough & congestion. But like I stated, she doesn't know me or my household so for all she knows I'm just a mother who doesn't really care. But I am not, so I will just leave it at that.

I also wanted to make sure it is understood that this in no way implies anything about nurses in general. You guys do an awesome job & in my personal experience do & know more than the doctors many times.

 

[sookie]

Whether or not she can "diagnose" here is kind of a moot point.

Yes, it's the title of the thread and the OP's impression that she "diagnosed", but most of us here know what she really did was refer for diagnosis, or rule out strep.

(Of course, npmommie can diagnose because she's a licensed NP. )

To clarify the difference between what MD's do and what RNs do (although they often overlap), MDs diagnose illness and RNs diagnose response to illness. There is such a thing as nursing diagnosis which is used to plan the care of the patient. It is different from, but related, to a medical diagnosis.

I actually worked as a Nurse Practitioner at a boarding / residential school. So some school nurses can diagnose... I actually ran into a couple other school based Nurse Practitioners, so I know I wasn't the only one in the US (but there are not many). So, I did both roles - I had to diagnose and treat the kids. If they had strep, I knew it because I ran the rapid test or I sent off the culture and got the result back (and had them in sick bay in the meantime). But then I also gave them their meds and notified their parents what they were getting, because they didn't live with their parents.
Anyway, OP, I'm sorry you had a bad experience. Yes, in general, a school nurse should be very careful of her wording. Their main job is to run crowd control, to run basic first aid, and to notify you (the parent) when someone might potentially be sick and let you make the decisions to get treatment from there. A better way might have been "Johnny has a sore throat, and I'm concerned because we have had strep going around school. I would like him to have been cleared by a physician before returning to class".
I'm not sure that she could even technically exclude him based upon just her own exam of his throat - unless with the illness he was running a high fever that was also documented. But that might be a policy district thing. And in some places, with a documented fever, the student just has to be out 48-72 hours max without a physician note and then can return (and can return sooner with the note). Each district seems to have their own criteria for "fever" and what they want students and parents to do with that.
But I'm rusty - because I was the prescriber, I was usually able to grant clearance back to class quickly or keep kids in my sick bay when needed without much trouble.
Sorry you had such troubles! I think 99% of the nurses in our profession are great, but I have had my own school nurse troubles (my daughter, at 5, literally had a wood chip in her eye, walked into the office 3 times, and I had to go pick her up only to flush it out myself. She should have received emergency eye care the first time she walked in). I think there are good ones and bad ones.

 

[castleview]

My son went to the school nurse last week because his throat hurt. I picked him up, took him home, checked his throat, gave him some meds & waited. By that evening he was fine, but about two days later came down with a cold.

Today he went to the nurse to see about getting some cough drops (he has a cold, one that all three kids have had this week) & the nurse proceeded to check his throat & declared he had strep. Even though his throat doesn't hurt. She called me & said I have to pick him up, take him to the Dr & he can't return to school without a note from the Dr. She said he had white spots in his throat. She would not even let him go get his things from class.

I had his sister (thank God she was home today) take him to the Dr & the strep test is negative, just as I knew. There was also no sign of white spots. Even the Dr thought this was very extreme for the nurse to do. Needless to say after the time, money & him missing class over this I am a bit ticked off. I could understand if he had a fever, or was even complaining about his throat, but neither was the case. So yes I called her & let her know that he does not have strep & until she obtains an MD after her name she should not diagnose people.

At the beginning of the year my DD went to the nurse because her ear hurt. The nurse said she had severe ear wax & I needed to flush her ears out. I knew something was wrong since she never complains of her ears. Went to the Dr & sure enough she had an ear infection. The Dr said it was good that I did not flush her ears, it would have been extremely painful.

Your taking your child's word on that one. She could have said that it looks like strep and he may have seen that as a declaration. As for the second bolded part, well I hope you feel better for demeaning her. Seriously, that was ridiculous and pathetic.

 

[Ceila]

Your taking your child's word on that one. She could have said that it looks like strep and he may have seen that as a declaration. As for the second bolded part, well I hope you feel better for demeaning her. Seriously, that was ridiculous and pathetic.

Did you miss the part where the OP said that she talked to the school nurse directly? And did you also miss the OP's update above?

It sounds like the nurse didn't handle this well, and being frazzled, neither did the OP. I can see where the OP is coming from, though, because I've had a very similar experience with a school nurse. She's a good person, but I really didn't like how she handled something once.

 

[mamacatnv]

OP I likely would have done and said the same thing.
She told you what you as a parent had to do when your child did not have any symptons to indicate that she should even be looking in his throat.

Regardless of whether or not he could have strep is not the point. The point to me is that she told you the parent, what you MUST do and that is where it crossed a line. She doesn't know your kids medical history and while I have a ton of respect for nurses, she is not a Dr nor is she your son's primary health care provider.

A call to say "Mom, your DS was here with a cough, I looked in his throat and I see suspicious stuff, keep an eye on him for sign of fever" etc.... is one thing. A call telling you what you must do where there are no established symptoms went over the line.

 

[Goofycampers]

School nurses have a tough job. Damned if they do, damned if they don't. I think it was sufficient that she was notified your child didn't have strep. To rub her nose in it is a bit much.

Boy you're not kidding. I wouldn't be a school nurse, thought about it but decided against it. They have soo much responsibility and get paid very poorly, usually less than what a new teacher makes, regardless of the experience of the nurse. A coworker of mine was a school nurse and she got burnt out from parents chewing her out when she would call them to pick up their kid. I mean kids with fevers, vomiting, etc. The parent would say "deal with it I'm not leaving work. " Instead of berrating your school nurse you should be thanking her.

 

[Frye7127]

I have had the same thing happen. My child has reactive airway disease, have been dealing with it nearly his entire life. I know what is wrong and how to treat. She has known him 7 months. The first time, she swore it was strep, kept taking his temperature, and listening to his lungs. I knew he didn't have strep, has never had it, but took him to be sure becuase i would have felt awful if by chance he had it.

The second episode is going on now and she calls me to check on him since i kept him home today and tells me that he has pertussis -(HA!). I know he doesn't. Took him to his new ped for steroids, antibiotics, and a new puffer. He is much better today. It is allergies.

I appreciate her concern, but I know him and she doesn't know me. But, what I find worse is the Walgreen's pharmacist who recently diagnosed my son's cough as Tourette's. I am sorry, but completely out of line. She knew nothing about him other than his cough and told me it was a tic, and he had Tourette's. I saw red!

 

[Hannathy]

The school nurse is charged with keeping it a safe environment for all kids not just yours. If she thinks a child has a contagious disease she is within her rights and actually her responsibility to ask for a DR's note before allowing the child back in contact with the rest of the school population. And Strep is a serious infection.

I can just see the righteous indignation on here if a school nurse would send a child back to the class with pink eye for example because she can't diagnose or ask for a DR's note to confirm or clear the child and the Dis'ers child caught it.

Oh it would be why didn't she do her job, how stupid is she that she didn't know it was pink eye, why didn't she ask for a DR to see it.

She obviously felt your son showed signs of Strep and she was protecting the rest of the school. I'm still trying to figure out why a high schooler is bothering the nurse for cough drops.

 

[Boston Tea Party]

Did she actually say to you, "He has strep" or is this hearsay from a child?

 

[HelenePA]

Last week two teachers told my 9 yr old she had strep throat with out even looking in her mouth *shrugs* She had a scratchy throat just like the other 5 of us here. We all came down with the same bug and its NOT strep. I told her to ignore her teachers she didn't have strep, she didn't even have a fever, and she was going to school the next day.

 

[teacherforhi]

Boy you're not kidding. I wouldn't be a school nurse, thought about it but decided against it. They have soo much responsibility and get paid very poorly, usually less than what a new teacher makes, regardless of the experience of the nurse. A coworker of mine was a school nurse and she got burnt out from parents chewing her out when she would call them to pick up their kid. I mean kids with fevers, vomiting, etc. The parent would say "deal with it I'm not leaving work. " Instead of berrating your school nurse you should be thanking her.

I'm a teacher, not a nurse, but you're not kidding about parents that don't seem to care about their kids being dick at school. Several years ago, we had a flu epidemic going on...think 100 kids absent a day. I had a student arrive to school so sick he could barely move. According to the child, mom made him come to school because she had to work.

I call mom and she says she can't take off work because too many people called out due to their sick kids. Duh! You have one too! She actually asked if there was a place we could keep him. I was furious. I managed to explain (and not scream) that we were not a babysitting service and that she needed to have someone come get her child.

Apparently, she tried to get her mother to come get the child. Except grandma was sick with the flu as well. Mom called me back and just proclaimed there was nothing she could do. Then I did something horrible. I told her that if she wasn't there in 15 minutes I was calling DSS and reporting her for neglect. Since her child had a disability, I knew they would be all over her. She showed up in 10 and he was absent for the next week.

I fully expected her to file a complaint and that I would be fired, but she never said anything. At the time, I was a new teacher and was shocked that a parent would send a sick child to school and really not care.

 

[HelenePA]

She obviously felt your son showed signs of Strep and she was protecting the rest of the school. I'm still trying to figure out why a high schooler is bothering the nurse for cough drops.

in my school your NOT allowed to carry cough drops with out a dr's note and then they must be kept in the office because they have the word "medicated" on them.. no joke.. even chapstick that says Medicated is not allowed because its a "medicine". Gotta keep the schools "drug free" no tolerance gotta love it. I am not sure what happens if you get caught with any of this stuff but I'm sure it will involve some sort of punishment beyond what what is necessary... god forbid you have tylenol and give one to your friend.. that right there is drug distribution and you will have the cops called on you...

 

[Nolcrest]

To me a cold, cough, congestion plus needing cough drops = sick. I'd rather err on the side of caution. If in fact he did have strep I'm sure you would have wanted it treated. Gosh I hope the OP didn't speak to the nurse like that in front of the son. Be a role model even in adverse situations.

 

[Bungle]

I'm a teacher, not a nurse, but you're not kidding about parents that don't seem to care about their kids being dick at school.

That seems like an entirely different issue

Even if your nurse was incorrect she was just doing her job. If you didn't like the way she handled it then you really could have handled it like and adult and responded in a way that less condescending. If the nurse gives us a call I usually go get it investigated just in case because I'm not a doctor either.

 

[Coconut36]

I'm still trying to figure out why a high schooler is bothering the nurse for cough drops.

In a lot of schools they are required to do so. I believe our district policy is that kids must go to the nurse for medications and they specifically include cough drops in that list. Kids can't carry them around themselves so if they feel like they need them they have to get them from the nurse.

 

[peacelover]

I think the nurse used very poor judgement.
Telling a parent to flush out a child's ear is dangerous if you do not know the correct procedure.
Telling a parent that her child has strep when there is no fever / rash/ malaise, etc. is irresponsible
Kids get colds/ viruses all the time. A parent usually knows their child well enough to know when they need to see a doctor.
I would say that unless she is a practitioner,, she has no business diagnosing, and I would say maybe in violation of the nurse practice act.
Nurses, just like doctors, are not infallible,