Should a school nurse diagnose?

[luvsJack]

Or maybe the kid had the sore throat a few days before but was fine that day (as the OP said). Maybe he was getting cough drops for a cough. Since he had other cold symptoms and a sore throat that improves is often the first symptom of a cold....

Again, the nurse definitely should mention the white patches, let the parent know what she found. Saying that the child HAD strep and HAD to see a doctor what I have a problem with. The child did NOT have strep, she misdiagnosed. That's way different than mentioning, "little DS came to me for cough drops today and I noticed he had some white patches on his tonsils. That could be a sign for strep, it might be a good idea to bring him to be tested." Or if you want to go further, take a good history from the parent on other symptoms, family symptoms, etc, before making a diagnosis. I would be fine with that for my kid or any kid in the class. I would not be fine with sending everyone who visits the nurse for a cough drop to the doctor.

She hardly has time to get a medical history every time a kid comes to see her. That's what the dr. office is for.

She checked his throat for a reason. That's why I say he probably mentioned his throat hurting or itching or being uncomfortable in some way.

I am not a nurse nor have I ever tried to be one, but when I was a child care director, if a child mentioned a sore throat and had white spots--he/she went home until we got a dr. note. Plain and simple. Symptoms of strep or throat infection = contagious illness which equals a lot of sick kids.

You also have to remember that they have to have policies for ALL parents, including those that wouldn't have second thought about the nurse saying there were white patches. Some parents just are not going to take off and take their child to the dr. until they are made too. The policies of the school nurse have to be direct so that sick kids are not coming to school.

 

[Jaime4004]

She hardly has time to get a medical history every time a kid comes to see her. That's what the dr. office is for.

She checked his throat for a reason. That's why I say he probably mentioned his throat hurting or itching or being uncomfortable in some way.

I am not a nurse nor have I ever tried to be one, but when I was a child care director, if a child mentioned a sore throat and had white spots--he/she went home until we got a dr. note. Plain and simple. Symptoms of strep or throat infection = contagious illness which equals a lot of sick kids.

You also have to remember that they have to have policies for ALL parents, including those that wouldn't have second thought about the nurse saying there were white patches. Some parents just are not going to take off and take their child to the dr. until they are made too. The policies of the school nurse have to be direct so that sick kids are not coming to school.

If you (you in general, not you personally )are going to diagnose a child with anything, you better be taking a history. If you dont have the time to do it correctly, don't do it...

I'm definitely aware that policies are generally made to cover the more lazy parents. I would have to see the policy in writing that a kid with white patches and no sore throat needed to be sent home and see a doctor before returning to school. Then I would have to work to change that policy as it is an ignorant one. But my guess is that it is not a policy, just her opinion. I am a nurse, so I would have no problem disagreeing on her opinion.

Many doctors would not do a throat culture on someone who did not have a sore throat, regardless of what it looked like. (Again with my waste of time and money arguement). Particularly with someone showing cold symptoms, as the symptoms are likely viral. Many people are strep carriers and will test positive, never showing a symptom. They do not need to be treated. Yes, occasionally someone will have a cold or something else, and also develop a raging strep, but it is rare and strep with go away on it's own with or without antibiotics. The most common reason it's treated is the rare, but serious, complication of rheumatic heart disease. But really, you're more likely of dying from a secondary pneumonia after having the flu, than contracting rheumatic heart disease...

HHHMMmmn, i'd love to rant on soapbox, but DS4 just climbed in my lap, asking "how many more minutes til lunch? how many more? how many more MINUTES" Fun over.

 

[Pea-n-Me]

So - when a whole school gets infected with strep, or Norwalk virus runs rampant on a cruise ship (or WDW), now you now why.

 

[Beka]

It's not in our scope of practice as nurses to diagnose. Hope everyone is feeling better! I hope that nurse straightens herself out before the licensing board does.

 

[Pea-n-Me]

I hope that nurse straightens herself out before the licensing board does.

 

[badblackpug]

Actually, I am a nurse, and I have school-aged kids. The policy here, and in many school districts, is that if a child shows signs of a highly contagious illness, such as strep or conjunctivitis, that requires medication to treat, then they cannot return to school without clearance from a physician.

Now, the OPs son presented to the school nurse twice in two weeks with essentially the same complaints. Obviously the school nurse was to believe that the complaint was ongoing and checked her son. She saw white patches on his throat, which are indicative of strep, and required medical clearance to rule out strep before he could return to school. Also sore throat of that duration, too, can indicate strep. That is a fairly common school policy.

I doubt, seriously, if she said "your kid has strep." I have never even heard a doctor diagnose strep in absence of a positive culture. She may have said she thinks he has it, or might have it, or has symptoms of it. ...and the OP does not know what conversation her son had with the nurse. (and I, too, am surprised at a teen that would go to the nurse for cough drops, sounds, to me, like he wasn't too broken up about missing class. Surely some other kid had candy, gum, or mints)

The poor school nurse is damned if she does and damned if she doesn't. If she doesn't send the kid home then a million parents are gnashing there teeth and crying that a sick kid was allowed to remain at school and infect their kids. (I've seen those posts on the DIS) If she sends him back to class then mommy is mad because she didn't call and tell her that he felt sick. (I've seen those posts, too) If she does call then she is overreacting and inconveniencing the parent (this is one of those posts)

The bottom line is that the nurse is responsible for ALL the children in the school, not just yours, and if she sees symptoms of what is, potentially, a very contagious disease, then it is her responsibility to protect the other kids from getting it, too.

...and the follow up call was rude, condescending, childish, and unnecessary.

 

[ccgirl]

Actually, I am a nurse, and I have school-aged kids. The policy here, and in many school districts, is that if a child shows signs of a highly contagious illness, such as strep or conjunctivitis, that requires medication to treat, then they cannot return to school without clearance from a physician.

Now, the OPs son presented to the school nurse twice in two weeks with essentially the same complaints. Obviously the school nurse was to believe that the complaint was ongoing and checked her son. She saw white patches on his throat, which are indicative of strep, and required medical clearance to rule out strep before he could return to school. Also sore throat of that duration, too, can indicate strep. That is a fairly common school policy.

I doubt, seriously, if she said "your kid has strep." I have never even heard a doctor diagnose strep in absence of a positive culture. She may have said she thinks he has it, or might have it, or has symptoms of it. ...and the OP does not know what conversation her son had with the nurse. (and I, too, am surprised at a teen that would go to the nurse for cough drops, sounds, to me, like he wasn't too broken up about missing class. Surely some other kid had candy, gum, or mints)

The poor school nurse is damned if she does and damned if she doesn't. If she doesn't send the kid home then a million parents are gnashing there teeth and crying that a sick kid was allowed to remain at school and infect their kids. (I've seen those posts on the DIS) If she sends him back to class then mommy is mad because she didn't call and tell her that he felt sick. (I've seen those posts, too) If she does call then she is overreacting and inconveniencing the parent (this is one of those posts)

The bottom line is that the nurse is responsible for ALL the children in the school, not just yours, and if she sees symptoms of what is, potentially, a very contagious disease, then it is her responsibility to protect the other kids from getting it, too.

...and the follow up call was rude, condescending, childish, and unnecessary.

Fabulous post.

 

[NaLisa]

Actually, I am a nurse, and I have school-aged kids. The policy here, and in many school districts, is that if a child shows signs of a highly contagious illness, such as strep or conjunctivitis, that requires medication to treat, then they cannot return to school without clearance from a physician.

Now, the OPs son presented to the school nurse twice in two weeks with essentially the same complaints. Obviously the school nurse was to believe that the complaint was ongoing and checked her son. She saw white patches on his throat, which are indicative of strep, and required medical clearance to rule out strep before he could return to school. Also sore throat of that duration, too, can indicate strep. That is a fairly common school policy.

I doubt, seriously, if she said "your kid has strep." I have never even heard a doctor diagnose strep in absence of a positive culture. She may have said she thinks he has it, or might have it, or has symptoms of it. ...and the OP does not know what conversation her son had with the nurse. (and I, too, am surprised at a teen that would go to the nurse for cough drops, sounds, to me, like he wasn't too broken up about missing class. Surely some other kid had candy, gum, or mints)

The poor school nurse is damned if she does and damned if she doesn't. If she doesn't send the kid home then a million parents are gnashing there teeth and crying that a sick kid was allowed to remain at school and infect their kids. (I've seen those posts on the DIS) If she sends him back to class then mommy is mad because she didn't call and tell her that he felt sick. (I've seen those posts, too) If she does call then she is overreacting and inconveniencing the parent (this is one of those posts)

The bottom line is that the nurse is responsible for ALL the children in the school, not just yours, and if she sees symptoms of what is, potentially, a very contagious disease, then it is her responsibility to protect the other kids from getting it, too.

...and the follow up call was rude, condescending, childish, and unnecessary.

 

[Coconut36]

Actually, I am a nurse, and I have school-aged kids. The policy here, and in many school districts, is that if a child shows signs of a highly contagious illness, such as strep or conjunctivitis, that requires medication to treat, then they cannot return to school without clearance from a physician.

Now, the OPs son presented to the school nurse twice in two weeks with essentially the same complaints. Obviously the school nurse was to believe that the complaint was ongoing and checked her son. She saw white patches on his throat, which are indicative of strep, and required medical clearance to rule out strep before he could return to school. Also sore throat of that duration, too, can indicate strep. That is a fairly common school policy.

I doubt, seriously, if she said "your kid has strep." I have never even heard a doctor diagnose strep in absence of a positive culture. She may have said she thinks he has it, or might have it, or has symptoms of it. ...and the OP does not know what conversation her son had with the nurse. (and I, too, am surprised at a teen that would go to the nurse for cough drops, sounds, to me, like he wasn't too broken up about missing class. Surely some other kid had candy, gum, or mints)

The poor school nurse is damned if she does and damned if she doesn't. If she doesn't send the kid home then a million parents are gnashing there teeth and crying that a sick kid was allowed to remain at school and infect their kids. (I've seen those posts on the DIS) If she sends him back to class then mommy is mad because she didn't call and tell her that he felt sick. (I've seen those posts, too) If she does call then she is overreacting and inconveniencing the parent (this is one of those posts)

The bottom line is that the nurse is responsible for ALL the children in the school, not just yours, and if she sees symptoms of what is, potentially, a very contagious disease, then it is her responsibility to protect the other kids from getting it, too.

...and the follow up call was rude, condescending, childish, and unnecessary.

Great post!

 

[honeydiane1953]

I would be THANKFUL the school has one!!! We didn't, my kids didn't and now my grand kids don't!!! GOD BLESS THE SCHOOL NURSE!!!!!

 

[kaytieeldr]

I'm definitely aware that policies are generally made to cover the more lazy parents.

It appears we're not reading the same thread
Everything I've read in this thread demonstrates that [related] policies are generally made to protect the students.

 

[Nancyg56]

::yes:

Actually, I am a nurse, and I have school-aged kids. The policy here, and in many school districts, is that if a child shows signs of a highly contagious illness, such as strep or conjunctivitis, that requires medication to treat, then they cannot return to school without clearance from a physician.

Now, the OPs son presented to the school nurse twice in two weeks with essentially the same complaints. Obviously the school nurse was to believe that the complaint was ongoing and checked her son. She saw white patches on his throat, which are indicative of strep, and required medical clearance to rule out strep before he could return to school. Also sore throat of that duration, too, can indicate strep. That is a fairly common school policy.

I doubt, seriously, if she said "your kid has strep." I have never even heard a doctor diagnose strep in absence of a positive culture. She may have said she thinks he has it, or might have it, or has symptoms of it. ...and the OP does not know what conversation her son had with the nurse. (and I, too, am surprised at a teen that would go to the nurse for cough drops, sounds, to me, like he wasn't too broken up about missing class. Surely some other kid had candy, gum, or mints)

The poor school nurse is damned if she does and damned if she doesn't. If she doesn't send the kid home then a million parents are gnashing there teeth and crying that a sick kid was allowed to remain at school and infect their kids. (I've seen those posts on the DIS) If she sends him back to class then mommy is mad because she didn't call and tell her that he felt sick. (I've seen those posts, too) If she does call then she is overreacting and inconveniencing the parent (this is one of those posts)

The bottom line is that the nurse is responsible for ALL the children in the school, not just yours, and if she sees symptoms of what is, potentially, a very contagious disease, then it is her responsibility to protect the other kids from getting it, too.

...and the follow up call was rude, condescending, childish, and unnecessary.

 

[Goofycampers]

I'd be willing to bet money that nurse didn't say the kid had strep but rather the kid may have strep or had signs of strep. I'm a nurse (not a school nurse) and I can't tell you how many times patients will misquote what I tell them. I'll say to them " you have symptoms of pneumonia (or whatever), I'd like you to go to the er and be checked by a Dr. The Pt will get on the phone to a relative and say "the nurse says I have pneumonia and I need to go to the er". Happens all the time. OP I know you were upset, but that nurse deserved more respect than that, in mhi you owe her an apology.

 

[kimmyann]

She hardly has time to get a medical history every time a kid comes to see her. That's what the dr. office is for.

She checked his throat for a reason. That's why I say he probably mentioned his throat hurting or itching or being uncomfortable in some way.

I am not a nurse nor have I ever tried to be one, but when I was a child care director, if a child mentioned a sore throat and had white spots--he/she went home until we got a dr. note. Plain and simple. Symptoms of strep or throat infection = contagious illness which equals a lot of sick kids.

You also have to remember that they have to have policies for ALL parents, including those that wouldn't have second thought about the nurse saying there were white patches. Some parents just are not going to take off and take their child to the dr. until they are made too. The policies of the school nurse have to be direct so that sick kids are not coming to school.

He had a cold, it started with a sore throat that then turned into a cold. When he went to the nurse the second time (about the cough drops) he did NOT have a sore throat & even told the nurse this. He also did NOT have white spots in his throat. She checked his throat again because of when he was in there the Friday before, this was Thursday which is less than a week & typical of the common cold. He did not have strep & I as his mother knew it.

Actually, I am a nurse, and I have school-aged kids. The policy here, and in many school districts, is that if a child shows signs of a highly contagious illness, such as strep or conjunctivitis, that requires medication to treat, then they cannot return to school without clearance from a physician.

Now, the OPs son presented to the school nurse twice in two weeks with essentially the same complaints. Obviously the school nurse was to believe that the complaint was ongoing and checked her son. She saw white patches on his throat, which are indicative of strep, and required medical clearance to rule out strep before he could return to school. Also sore throat of that duration, too, can indicate strep. That is a fairly common school policy.

I doubt, seriously, if she said "your kid has strep." I have never even heard a doctor diagnose strep in absence of a positive culture. She may have said she thinks he has it, or might have it, or has symptoms of it. ...and the OP does not know what conversation her son had with the nurse. (and I, too, am surprised at a teen that would go to the nurse for cough drops, sounds, to me, like he wasn't too broken up about missing class. Surely some other kid had candy, gum, or mints)

The poor school nurse is damned if she does and damned if she doesn't. If she doesn't send the kid home then a million parents are gnashing there teeth and crying that a sick kid was allowed to remain at school and infect their kids. (I've seen those posts on the DIS) If she sends him back to class then mommy is mad because she didn't call and tell her that he felt sick. (I've seen those posts, too) If she does call then she is overreacting and inconveniencing the parent (this is one of those posts)

The bottom line is that the nurse is responsible for ALL the children in the school, not just yours, and if she sees symptoms of what is, potentially, a very contagious disease, then it is her responsibility to protect the other kids from getting it, too.

...and the follow up call was rude, condescending, childish, and unnecessary.

The nurse did in fact say he had strep, so I'm not sure why you seem to think you know what she said when I am the one who spoke to her. Like I said before, she was very rude to me initially, so yes when the results of the forced test was negative (which I knew it would be) I was not calling her to thank her for the doctor visit that was not needed.

I could understand if he actually had symptoms besides that of the common cold, I have no issue taking my kids to a doctor if they are sick.
http://www.webmd.com/oral-health/tc/strep-throat-symptoms

Would also like to emphasize, he did not have white spots in his throat. She was wrong.

 

[Hannathy]

Would also like to emphasize, he did not have white spots in his throat. She was wrong.

You mean he did not have white spots by the time the DR say him. He very well may have had white spots when she looked at him.

The last time my DS had strep I would have bet he didn't have it either, you can't tell. Sometimes for the betterment of the whole school it is better safe than sorry.

 

[kimmyann]

You mean he did not have white spots by the time the DR say him. He very well may have had white spots when she looked at him.

The last time my DS had strep I would have bet he didn't have it either, you can't tell. Sometimes for the betterment of the whole school it is better safe than sorry.

He saw the doctor within an hour of being picked up from school.

 

[kaytieeldr]

I'd be willing to bet money that nurse didn't say the kid had strep but rather the kid may have strep or had signs of strep. I'm a nurse (not a school nurse) and I can't tell you how many times patients will misquote what I tell them. I'll say to them " you have symptoms of pneumonia (or whatever), I'd like you to go to the er and be checked by a Dr. The Pt will get on the phone to a relative and say "the nurse says I have pneumonia and I need to go to the er". Happens all the time. OP I know you were upset, but that nurse deserved more respect than that, in mhi you owe her an apology.

More than once, I've called my PCP's office, described my symptoms to one of the nurses, and been told, "it sounds like strep". No mention of white spots, since she can't see my throat over the phone and I never thought to look.

 

[kaytieeldr]

He had a cold, it started with a sore throat that then turned into a cold. When he went to the nurse the second time (about the cough drops) he did NOT have a sore throat & even told the nurse this. He also did NOT have white spots in his throat.

So it sounds like cough drops weren't required, and hard candy would have sufficed. Given your feelings about the school nurse, you might want to investigate ways to keep your son out of her office.

She checked his throat again because of when he was in there the Friday before, this was Thursday which is less than a week & typical of the common cold. He did not have strep & I as his mother knew it.

You know "Doctor Mom" is an advertising fallacy, right? Where did you get your medical training and certification?

The nurse did in fact say he had strep, so I'm not sure why you seem to think you know what she said when I am the one who spoke to her.

You keep saying that, while a number of other posters keep saying we hear what we want to hear. My experience, above, was the nurse telling me it sounds like strep based on my description. It's entirely likely that's what the school nurse said to you (or "he may have..." or "...think he has..") and you only heard/registered "has strep".

Like I said before, she was very rude to me initially, so yes when the results of the forced test was negative (which I knew it would be) I was not calling her to thank her for the doctor visit that was not needed.

Why call her at all? How old are you? You took your son to the doctor, got the test - on which you may want to follow up, given the possibility of false negative results from the apparent quick test they did - and got the note requested, right? Why did you feel the need to also call the nurse and insult her? Did you stop to think maybe the 'rude' treatment you were getting from her initially was a reflection of how you were treating her?

I could understand if he actually had symptoms besides that of the common cold, I have no issue taking my kids to a doctor if they are sick.
http://www.webmd.com/oral-health/tc/strep-throat-symptoms

Would also like to emphasize, he did not have white spots in his throat. She was wrong.

Again - your medical training and certification come from what institution? Anyway, the ultra-respected Mayo Clinic website http://www.mayoclinic.com/health/strep-throat/ds00260/dsection=symptoms - I've highlighted a couple of bits of information that struck me as pertinent to this thread:
In general, signs and symptoms of strep throat include:

Throat pain
Difficulty swallowing
Red and swollen tonsils, sometimes with white patches or streaks of pus
Tiny red spots on the soft or hard palate — the area at the back of the roof of the mouth
Swollen, tender lymph glands (nodes) in your neck
Fever
Headache
Rash
Stomachache and sometimes vomiting, especially in younger children
Fatigue
It's possible for you or your child to have many of these signs and symptoms, but not have strep throat. The cause of these signs and symptoms could be a viral infection or some other kind of illness. That's why your doctor generally tests specifically for strep throat.

It's also possible to have the bacteria that can cause strep in your throat without having a sore throat. Some people are carriers of strep, which means they can pass the bacteria on to others, but the bacteria are not currently making them sick.

 

[Hannathy]

He saw the doctor within an hour of being picked up from school.

Again I will say he may have had them when she looked at him. An hour is a long time. He may have gotten a drink or sucked on the cough drop he had to have.

It is very believable that by the time he got to the DR the spots were gone, heck I have seen things in patients that are gone by the time I would get the DR to come back into the exam area.


Why would she lie about seeing white spots? Because that is what you are saying she did.

 

[kimmyann]

Never mind, it's just not worth my time.