Should a school nurse diagnose?

[tvguy]

I have to admit that I am shocked that your schools still have a nurse. They eliminated that position in the schools here. before my oldest started school 20 years ago. Budget cuts, and a move to cut liability since there were a few costly lawsuits due to questionable treatments. Now, the kids go to the office where the parents are called, and if the kid is ill enough, the call 9-1-1.

 

[kaytieeldr]

Really???

Almost sounds like you know the OP personally or something.

Who cares about your lack of trust in the OPs abilities to diagnose....why do you feel the need to trust her?

This thread is getting silly............

Nope, not at all. All I know of the OP is what she's posted here. I don't know the school nurse, either.

But the OP has questioned whether the school nurse (yup, just checked and the thread title hasn't changed) should diagnose... then herself proceeded to diagnose. We only get one version of an incident, and based on that I opt to remain skeptical, and to question.

 

[Pea-n-Me]

I'd really like to know how certain posters get away with being SO FREAKING NASTY on this board.

This thread is about nastiness.

katieeldr is spot on.

Funny how disagreement = nastiness yet it seems ok with some for OP to be nasty to the school nurse. Makes you go hmm.

 

[Pea-n-Me]

I agree with the three posters who say the OP owes the school nurse an apology.

But we know that will never happen.

I'm sure we'll also never know if the 48 hr throat culture comes back positive, either.

Nor will we know if the OP's son wolfed down a burger, fries and a drink on the way to the doctor's office for the rapid strep. (I know that's what my teen son usually wants to do in the car on the way anywhere. Remember, he wasn't sick nor in pain; heck, they didn't even need to be going there in the first place...)

OP, since your assertion is that the school nurse LIED about the white spots in your son's throat, why don't you just request seeing her documentation about the issue? Or talking to her about it? Why is it that it had to be she LIED?

 

[Nancyg56]

I have to admit that I am shocked that your schools still have a nurse. They eliminated that position in the schools here. before my oldest started school 20 years ago. Budget cuts, and a move to cut liability since there were a few costly lawsuits due to questionable treatments. Now, the kids go to the office where the parents are called, and if the kid is ill enough, the call 9-1-1.

I know that the school nurse position has been eliminated in many school systems so we are thankful that every school in our town has one. I know that because nurses are human there is always the chance that misunderstanding will occur but I would rather accept the mistakes in communication or policy than have the children have no one to go to when they are not feeling well.

When my DGD was in K through 2 she had an accident in school. The nurse was also the person who managed children's accidents and had an assortment of clothing for DGD to wear. The teacher and the nurse handled her with compassion so that with the exception of one little pal, no one knew she had that accident. The nurse can make mistakes but when the alternative is simply sending children to the office to call parents I will take chances with someone who has the ability to help in more practical ways.

 

[Boston Tea Party]

I have to admit that I am shocked that your schools still have a nurse. They eliminated that position in the schools here. before my oldest started school 20 years ago. Budget cuts, and a move to cut liability since there were a few costly lawsuits due to questionable treatments. Now, the kids go to the office where the parents are called, and if the kid is ill enough, the call 9-1-1.

It is a common belief in my state that California's education system is a mess as a result of rampant cuts resulting in a number of transplanted Californians in my school. Not having a school nurse is just another example.

That being said, I am thankful that we have a school nurse. She is the primary medical care for many of my students whose parents cannot or will not afford medical care and use the city's emergency rooms for treatment of such things as sore throats, fevers and ear aches.

 

[tvguy]

It is a common belief in my state that California's education system is a mess as a result of rampant cuts resulting in a number of transplanted Californians in my school. Not having a school nurse is just another example.

That being said, I am thankful that we have a school nurse. She is the primary medical care for many of my students whose parents cannot or will not afford medical care and use the city's emergency rooms for treatment of such things as sore throats, fevers and ear aches.

I argree California schools are a mess. That's why our kids went to private schools.....it also explains why my family car is 25 years old, and why the 33 year old carpet, with seams coming apart, isn't getting replaced anytime soon. Both kids ended up in public colleges, and were shocked how poorly their classmates from public schools were prepared for college. My daughter graduated from high school in 2009, and went to a California State University. The class entering in the fall of 2009 had the highest SAT, and ACT scores in the systems history....and the highest percentage of Freshman needing to take remedial english and math. Hmmm.

 

[Coconut36]

I have to admit that I am shocked that your schools still have a nurse. They eliminated that position in the schools here. before my oldest started school 20 years ago. Budget cuts, and a move to cut liability since there were a few costly lawsuits due to questionable treatments. Now, the kids go to the office where the parents are called, and if the kid is ill enough, the call 9-1-1.

It's hit or miss around here. I know one district where they have no nurses at all. The district my DH is in and my kids attend has nurses at all schools. Others have floating nurses..it really varies. Nurses however have been cut out of a lot of schools.

 

[fortwildernessishome]

Nope, not at all. All I know of the OP is what she's posted here. I don't know the school nurse, either.

But the OP has questioned whether the school nurse (yup, just checked and the thread title hasn't changed) should diagnose... then herself proceeded to diagnose. We only get one version of an incident, and based on that I opt to remain skeptical, and to question.

We only get ONE version of ANY incident here on the Dis. Thats nothing new. Posters may try to explain another persons perspective, but the reality is, we only EVER hear one side.

This thread is no different.

So I guess what you are saying is that you remain skeptical and have the need to question everyone that posts a thread on the Dis, because you are only getting one side.

I guess to each their own. Unless a thread is really super strange, I just take a posters statements at face value. I dont have a need to question and be skeptical, because it is only one side. One side is the nature of the beast here on the Dis.

 

[npmommie]

I agree I don't question people here, I just read the story for what it is.

and there is a big difference between a nurse in the school giving a medical diagnosis and a parent who knows their child feeling that they know what is wrong. as moms we don't need a medical degree to "diagnose" our kids

I think I would have been annoyed with the way it was presented. If I didn't feel my child had to go to the doctor yes I would have been annoyed that I had to take him. unnecessary trips to the doctors office waste time.

but on the other hand, I would want to be sure it was or was not strep. the only way to know for sure is a culture.

I used to get so annoyed with the receptionist at the internal med practice when I worked there. She would take calls for urgent care patients and say
"oh come in at 2pm, npmommie will see you, you probably have pneumonia and she will order a chest xray" or " you must have strep throat she will do a throat culture"
so I would get people coming in who already knew what they had because Donna at the front desk told them

and yes, after it happened a couple times I had a conversation with her, and she stopped.

 

[Mickey&Mouse]

To the OP, first I feel your concern with this nurse. It must have been incredibly frustrating to have to go through this, and I can certainly relate given that our family has had our share of similar circumstances with various school nurses over the years. From what you’ve described though, she has a pattern of overstepping. The situation with your daughter and the ear wax was irresponsible to say the least. It was good that you did not flush your daughter’s ears.

Bottom line, she is not a doctor. She should not be diagnosing children at the school, or recommending any treatment. That’s what doctors are for. She knows her job description, and so does the school. As far as what you said to her, I don’t think you went far enough. You stated truthfully that until she obtains an MD after her name that she should not be diagnosing people.

This is a true, and I would argue non-offensive statement in the grand scheme of things. Offensive to me would have been an obscenity-laced tirade, not a true and factual statement about not being a doctor. Actually, what she did both times with your children was much more offensive IMO. Further, it should be stressed to her about what a danger she poses by overstepping into a doctor’s territory.

Additionally, I would suggest filing a formal complaint with the school. Not only for your son’s encounter with her, but your daughter’s previous one as well. It shows a clear pattern of disregarding her job description. You also have your doctor’s opinions to back you up. According to your doctor, the nurse’s actions with your son were “extreme”, and with your daughter her recommendation would have caused an “extremely painful” experience. Both warrant a written complaint with the school, and a follow-up later down the line. Who knows how many other children have been exposed to this dangerous pattern already, or how many will continue to be.

The comments about “Dr. Mom” reminded me of our wonderful family doctor who passed away a couple of years ago after a heart-wrenching battle with pancreatic cancer. He was an old-fashioned doctor, the likes of which are rare these days. He would even make house calls when needed. He was a wonderful person with a gentle soul. Anyway, one of the qualities that drew me to him was his acknowledgment of “Dr. Mom”. When I brought one of the kids in to him, he would always ask what I thought- what my “Mom” instincts were telling me. He had such respect and kindness for me as the Mom, and he was never condescending like so many doctors (and nurses) routinely are. It felt like a collaborative effort going into his office. He is sorely missed by our whole family.

 

[badblackpug]

To the OP, first I feel your concern with this nurse. It must have been incredibly frustrating to have to go through this, and I can certainly relate given that our family has had our share of similar circumstances with various school nurses over the years. From what you’ve described though, she has a pattern of overstepping. The situation with your daughter and the ear wax was irresponsible to say the least. It was good that you did not flush your daughter’s ears.

Bottom line, she is not a doctor. She should not be diagnosing children at the school, or recommending any treatment. That’s what doctors are for. She knows her job description, and so does the school. As far as what you said to her, I don’t think you went far enough. You stated truthfully that until she obtains an MD after her name that she should not be diagnosing people.

This is a true, and I would argue non-offensive statement in the grand scheme of things. Offensive to me would have been an obscenity-laced tirade, not a true and factual statement about not being a doctor. Actually, what she did both times with your children was much more offensive IMO. Further, it should be stressed to her about what a danger she poses by overstepping into a doctor’s territory.

Additionally, I would suggest filing a formal complaint with the school. Not only for your son’s encounter with her, but your daughter’s previous one as well. It shows a clear pattern of disregarding her job description. You also have your doctor’s opinions to back you up. According to your doctor, the nurse’s actions with your son were “extreme”, and with your daughter her recommendation would have caused an “extremely painful” experience. Both warrant a written complaint with the school, and a follow-up later down the line. Who knows how many other children have been exposed to this dangerous pattern already, or how many will continue to be.

The comments about “Dr. Mom” reminded me of our wonderful family doctor who passed away a couple of years ago after a heart-wrenching battle with pancreatic cancer. He was an old-fashioned doctor, the likes of which are rare these days. He would even make house calls when needed. He was a wonderful person with a gentle soul. Anyway, one of the qualities that drew me to him was his acknowledgment of “Dr. Mom”. When I brought one of the kids in to him, he would always ask what I thought- what my “Mom” instincts were telling me. He had such respect and kindness for me as the Mom, and he was never condescending like so many doctors (and nurses) routinely are. It felt like a collaborative effort going into his office. He is sorely missed by our whole family.

The bottom line is without definitive testing one cannot diagnose or rule out an illness, and being a nurse and a mom I will tell you the "Dr. Mom" stuff is mess. My own 2 year old son walked around a week with pneumonia (BTW my husband is a doctor) because he had no fever, he was happy, playful and acting like his normal self. I figured he had the same cold the other 3 had had. Whoops! Nope, he didn't. I have seen parents downplay illnesses and injuries and I have seen them overplay them, too. Just because you "think" something is so doesn't make it so.

After many years in healthcare I will tell you that a lot of people hear what they want to hear, whether it is good or bad.

Again, the OP's son is a teen, he presented to the nurse 2 times in a week with similar complaints. Something was said over the course of the 2 visits to prompt her to check his throat. (and I have a teen, I am not naive or foolish enough to believe that that I always get the whole story) The nurse saw white patches which can indicate strep. She said the child needed to be tested and/or treated before he could return to school. This is a very, very common school policy. If the nurse suspects something infectious the child must have medical clearance from a Dr. before returning, lest that child infect other children.

As I have said before and I will say again, this is a no-win situation for the nurse. Had she ignored the boy's complaint and sent him back to class and he did have strep, mommy would have been calling her yelling at her that he was sick and how dare she send him back to class without calling her. All the other moms would have been calling screaming because their child was exposed to an infectious illness and now THEY have to take time off from work to take their kid to the doctor and their kid is missing school. If she calls mommy and tells her the kid has been in the office twice in a week for the same complaint and needs medical clearance to return to school, then she is overstepping and has no right to say that or decide that because mommy always knows best.

The nurse erred on the side of caution. Better one mother is mad and insulting her than 20.

 

[Mickey&Mouse]

The bottom line is without definitive testing one cannot diagnose or rule out an illness, and being a nurse and a mom I will tell you the "Dr. Mom" stuff is mess. My own 2 year old son walked around a week with pneumonia (BTW my husband is a doctor) because he had no fever, he was happy, playful and acting like his normal self. I figured he had the same cold the other 3 had had. Whoops! Nope, he didn't. I have seen parents downplay illnesses and injuries and I have seen them overplay them, too. Just because you "think" something is so doesn't make it so.

After many years in healthcare I will tell you that a lot of people hear what they want to hear, whether it is good or bad.

Again, the OP's son is a teen, he presented to the nurse 2 times in a week with similar complaints. Something was said over the course of the 2 visits to prompt her to check his throat. (and I have a teen, I am not naive or foolish enough to believe that that I always get the whole story) The nurse saw white patches which can indicate strep. She said the child needed to be tested and/or treated before he could return to school. This is a very, very common school policy. If the nurse suspects something infectious the child must have medical clearance from a Dr. before returning, lest that child infect other children.

As I have said before and I will say again, this is a no-win situation for the nurse. Had she ignored the boy's complaint and sent him back to class and he did have strep, mommy would have been calling her yelling at her that he was sick and how dare she send him back to class without calling her. All the other moms would have been calling screaming because their child was exposed to an infectious illness and now THEY have to take time off from work to take their kid to the doctor and their kid is missing school. If she calls mommy and tells her the kid has been in the office twice in a week for the same complaint and needs medical clearance to return to school, then she is overstepping and has no right to say that or decide that because mommy always knows best.

The nurse erred on the side of caution. Better one mother is mad and insulting her than 20.

True, without definitive testing an illness should not be diagnosed- which is exactly what the school nurse in this case was doing. To the OP’s original question, “Should a school nurse diagnose?”- the answer is an emphatic NO. It’s irresponsible and dangerous, and NOT in her job description. She was definitely overstepping in not just the OP’s son’s case, but also in her daughter’s case a few months ago. This demonstrates a pattern of behavior, not just a one time deal.

Whether or not some parents downplay or overplay their children’s health issues is irrelevant to this particular situation. The nurse should not be diagnosing strep throat ever, nor should she be recommending an ear flush for a child’s ears. That is not her job. From what the OP said, the nurse told her DIRECTLY (not just through the child with a possible misquoting by the child) that he had strep throat. Not that she suspected it, not that she thought that he might have strep and needed to be tested- she said to the OP that he HAD strep throat. That sounds like a diagnosis to me, and she was shamefully irresponsible in giving any diagnosis for anything.

We can certainly play the “what if” game to no end; however, I would never presume to know what the OP’s reaction would have been if the nurse sent her son back to class and he ended up being really sick. Coming up with hypothetical scenarios serves no purpose here. The OP asked a specific question, and then laid out the specifics of her situation and her very specific reaction. Speculating beyond that could go on and on forever.

This situation was more than “insulting” one mother or a school nurse erring on the side of caution; it was a continuation of a dangerous pattern that really should be brought to the attention of the school. Otherwise a future child could also be in danger if this pattern of behavior is not addressed.

 

[fortwildernessishome]

True, without definitive testing an illness should not be diagnosed- which is exactly what the school nurse in this case was doing. To the OP’s original question, “Should a school nurse diagnose?”- the answer is an emphatic NO. It’s irresponsible and dangerous, and NOT in her job description. She was definitely overstepping in not just the OP’s son’s case, but also in her daughter’s case a few months ago. This demonstrates a pattern of behavior, not just a one time deal.

Whether or not some parents downplay or overplay their children’s health issues is irrelevant to this particular situation. The nurse should not be diagnosing strep throat ever, nor should she be recommending an ear flush for a child’s ears. That is not her job. From what the OP said, the nurse told her DIRECTLY (not just through the child with a possible misquoting by the child) that he had strep throat. Not that she suspected it, not that she thought that he might have strep and needed to be tested- she said to the OP that he HAD strep throat. That sounds like a diagnosis to me, and she was shamefully irresponsible in giving any diagnosis for anything.

We can certainly play the “what if” game to no end; however, I would never presume to know what the OP’s reaction would have been if the nurse sent her son back to class and he ended up being really sick. Coming up with hypothetical scenarios serves no purpose here. The OP asked a specific question, and then laid out the specifics of her situation and her very specific reaction. Speculating beyond that could go on and on forever.

This situation was more than “insulting” one mother or a school nurse erring on the side of caution; it was a continuation of a dangerous pattern that really should be brought to the attention of the school. Otherwise a future child could also be in danger if this pattern of behavior is not addressed.

Exactly! Well said!

 

[luvsJack]

She said the kid needed to be checked by the doctor. She didn't try to give him meds or anything! However she said it, the result would be the same: The kid had to be checked by the doctor.

Whether she said "you HAVE strep and need to go to the doctor" or she said "you MIGHT have strep and need to go to the doctor" then end result was the same. He needed to be checked and he was. She did her job.

 

[kaytieeldr]

Whether or not some parents downplay or overplay their children’s health issues is irrelevant to this particular situation. The nurse should not be diagnosing strep throat ever, nor should she be recommending an ear flush for a child’s ears. That is not her job. From what the OP said, the nurse told her DIRECTLY (not just through the child with a possible misquoting by the child) that he had strep throat. Not that she suspected it, not that she thought that he might have strep and needed to be tested- she said to the OP that he HAD strep throat.

According to the OP (and yes, whoever said it yesterday, I realize we pretty much always get only one side of the story here... where's Paul Harvey when you need him?).

Several people tried pointing out it's human nature to hear what we want to hear - not necessarily what's being said. They were all ignored by the OP. We weren't there, but it's entirely possible the nurse said, "I think your son has strep throat" and the OP didn't register the first words.

It's also entirely possible the nurse said exactly what the OP says she said. We don't know, we weren't there. The nurse does seem to have more medical training than the OP (who hasn't claimed any) and she is responsible for all the students (plus staff/faculty), not just the OP's children.

 

[Pea-n-Me]

However she said it, the result would be the same: The kid had to be checked by the doctor.

Yeah. What a menace.

 

[kaligal]

If she diagnosed and/or prescribed treatment, she was practicing medicine without a license.

Although this is routinely done on the DIS, lol, it is frowned upon when it comes to nurses. It's not only wrong; it's illegal.

But is it possible that she said it could be x, y or z and the kid should go to the doctor?

 

[kaytieeldr]

I fount this http://www.educationworld.com/a_admin/admin/admin146.shtml interesting article on school nurse duties. Granted, it's twelve years old - but it describes how much school nurse responsibilities had increased over the previous twenty years.

Especially appropriate to this thread is the section that states:
A recent New York Times article, For School Nurses, More Than Tummy Tending, reported that, in interviews conducted around the country, "school nurses uniformly said their jobs were changing because American life has changed." The article refers to "a growing public sense that a school is, in part, a health-care provider."
As Gerri Harvey explained to Education World: "There is definitely a shift in expectations from parents, who expect the school to assume responsibility for many aspects of a child's physical, social, and emotional well-being, things families and medical providers were once expected to provide."

"Sometimes I think I'm the only medical professional some of these children ever see," Van Camp said. "Some days there will be a line of children waiting outside of my office at school, some with their parents."

It's not unusual for parents to ask the school nurse to look at their child's ears or throat and advise whether the child needs to see a doctor. For immigrant families, particularly if the parents don't speak much English, a child's school nurse may be the point of entry into the health-care and social-services systems.
I don't mean to give the impression the above article applies to the OP. It doesn't.

 

[Pea-n-Me]

From the National Association of School Nurses

Infectious Disease Management in the School Setting

It is the position of the National Association of School Nurses that a primary role of the school nurse is the prevention and control of infectious disease. School nurses have the professional knowledge and public health perspective to provide leadership in designing and implementing programs targeting infectious diseases. Key components of school-based infectious disease programming includes the promotion of vaccines; individual and schoolwide infection control measures; and how to contain, manage and prevent further spread of infectious diseases. The school nurse also plays a role in disease surveillance and reporting, providing a vital link between the school and public health community.

School nurse knowledge about the epidemiology of infectious diseases provides the evidence base to direct surveillance for and intervention to control the spread of disease, as highlighted in the case of the 2009 H1N1 influenza outbreak (Garcia, Bergren, Butler, & Bobo, 2009). The school nurse role in the school is an extension of public health, creating a natural partnership with the public health community at the local and state levels enforcing laws, regulations, and policies that protect the health of the school community.

School-age children are a population at risk for contracting and spreading infectious diseases due to their inconsistent use of proper hand hygiene, cough etiquette and social distancing from others who may be displaying signs and symptoms of infection. Local and global communities must deal with on-going emerging and resurging infectious diseases that continue to threaten the well-being of children and youth. School nurses are highly qualified to identify symptomatic trends, prevent and manage infectious disease in the school setting, and access and interpret public health information.

http://www.nasn.org/PolicyAdvocacy/...Management-in-the-School-Setting-Revised-2011

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

From the US National Library of Medicine National Institutes of Health

Clearly a widespread problem recognized and supported by the medical community.

Prediction of streptococcal pharyngitis: an option for school nurses?

The authors address the dilemma confronting school nurses in determining whether or not to counsel parents about seeking medical care for a child with a sore throat. The use of a clinical scorecard in the school setting as an aid in predicting streptococcal pharyngitis is investigated. The authors conclude that the only valid solution to the dilemma is the availability of the throat culture to schools. Using the culture as an additional assessment tool augments those already proven over time--the stethoscope, scoliosis and vision screening, and the otoscope.

http://www.ncbi.nlm.nih.gov/pubmed/3528665