Should a school nurse diagnose?

[peacelover]

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.

Schools have changed a lot over the years. Kids here are not allowed to have anything that is not prescribed, and then it has to be kept in the nurses office.

 

[Hannathy]

I understand the "cough" drop not being allowed -as stupid as it is- I guess I'm just surprised a high schooler would waste time going to the nurse for one. I would think by that age they wouldn't be wasting the nurses time for that and would just find some gum or candy and that the teachers let them. That's all.

 

[Coconut36]

I understand the "cough" drop not being allowed -as stupid as it is- I guess I'm just surprised a high schooler would waste time going to the nurse for one. I would think by that age they wouldn't be wasting the nurses time for that and would just find some gum or candy and that the teachers let them. That's all.

Wasting time is one of the top past times for teens A trip to the nurses off is time out of class.

 

[shellybaxter]

I direct a preschool - so no money for a nurse in our budget. We require children to be seen by a Dr. a lot because we suspect on illness may be contagious. We just went through a bout of pink eye. One parent was so uncooperative it was frustrating. We have an infant room and her little guy woke up with green crusties in his eyes. We wipes them and cleaned him up and 20 mins later - more goop. This is a classic sign of an eye infection - or possibly just a "eye cold". Since the pink eye was going around we asked her to take him to the Dr. and get him checked to make sure he wasn't contangious. She refused and said it was just a cold. She kept him out for a week, but that doesn't help us to make sure the others are safe or let the mom's know if their children have been exposed. It is really important for moms to cooperate with school requests when it comes to medical issues. We don't just make them for fun - or to make your life harder

 

[mhsjax]

I understand the "cough" drop not being allowed -as stupid as it is- I guess I'm just surprised a high schooler would waste time going to the nurse for one. I would think by that age they wouldn't be wasting the nurses time for that and would just find some gum or candy and that the teachers let them. That's all.

Sounds good in theory, but I don't know if a teacher would have candy or gum and if they did they probably wouldn't give it to the student. My allergies are in full swing right now, pollen is insane, and if I am not drinking something or sucking on candy all I do is cough due to sinus drainage. Not something kids and teachers want to here all day, so I am not sure that going to get a cough drop is such a waste of time. I know if it was me, they would be begin me to go and get one. I cough until I start gagging.

 

[aprilgail2]

In my DD's school the nurse can't even give out cough drops without a prescription.

The kids are not allowed to have cough drops on them here, nor any type of medicine, even tylenol. If you are caught with it the punishment is not different than if you were caught with a joint.

I have had ups and downs with our school nurse- one time my daughter was in kindergarten and she went to the nurse not feeling well, the nurse didn't even take her temp and said she was fine and sent her back to her class where she spend the next 3 1/2 hours with her head down on the desk. By the time she got off the school bus her temp was almost 105 and I had to end up taking her to an emergancy place since her Dr was closed. If the nurse had called me about it I would have left work and came and got her to her own Dr while they were still open. At that point I told the nurse that anytime my child went to her office she was to call me and I would decide if I was going to come and get her, not her!

When she was in 5th grade I had H1N1 and called the school nurse to let them know in case my daughter came down with it- sure enough 5 days later my daughter was down at the nurse with a fever, the nurse knew and put a mask on her and they moved the kids to a new classroom and cleaned the one she was in. I was actually taking her temp every morning before school just in case but she ended up getting a fever around noon. I drove there but didn't want to go in the school since I was sick too, no sense spreading more germs there, so I called the nurse when I got there and she walked my daughter out to the car.

 

[Nancyg56]

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.

I would not want that job! Strep does not always mean sore throat and little white dots. My DGD vomits and has a little rash on her cheek. IF the nurse was worried she was within her right to suggest a Dr appointment. Maybe she needed to work on how she discussed the issue with the OP but I would cut her some slack, she is darned if she does, darned if she does not.

DD has a friend who will routinely send her child to school, dance, or anything else planned no matter how ill the little girl is. DD has offered to care for the child but was told she was okay for school.This parent is a school psychologist so she knows how these illnesses fly through the school system but does not care.

I think that it is important that when a nurse discusses a child they use a little common sense. My DS was nervous with the nurse when he was little and as a result he failed a hearing test. The nurse called to tell me DS was deaf His pediatrician was appalled, kid was fine! I did talk to the nurse and explained that she really gave me a scare.

 

[luvsJack]

DD gets strep a couple of times a year, or at least she used to. It doesn't always show up the same way. Sometimes she runs fever, sometimes she doesn't. Sometimes the sore throat is so bad, she can hardly swallow, sometimes not.

The nurse saw symptoms that could be strep and maybe its going around. She was certainly within her job to say that with those symptoms, your child needed to be seen by a dr. to get the strep test.

I can't believe you said something as rude as you did to someone just doing their job!

We have 5 nurses on staff on our campus (all instructors, we don't have an actual "school nurse") And I trust their opinions completely. And have asked them many times about things going on with dd or with others in my family. As nurses, they have seen it all and do know what they are talking about. No, they don't have "MD" behind their name but that doesn't mean they can't look at symptoms and tell you what it might mean. And it doesn't mean they don't know what they are talking about.

Besides, the thing that tells whether you have strep is a throat swab that goes to the lab tech. So, to be completely technical its the LAB TECH that tells you if you have strep, not the dr. He just orders the test.

 

[Jaime4004]

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.

I agree with being a little ticked, though your response could have been a little better.
As you posted, it didn't sound like your DS had the symptoms of strep (white spots does not mean strep) but did have cold symptoms. I would have been really aggravated if I was told that he had strep and couldn't come back to school without a doctor's note. I don't take my kids to doctors for colds. It's a waste of time and money. I personally would have refused, just nicely stating his symptoms and the facts, and sent him to school anyway. (Assuming he was acting perfectly fine, no fever, etc). I have to pay doctors visits and lab tests at 100% until our high deductible is met.

 

[luvsJack]

I agree with being a little ticked, though your response could have been a little better.
As you posted, it didn't sound like your DS had the symptoms of strep (white spots does not mean strep) but did have cold symptoms. I would have been really aggravated if I was told that he had strep and couldn't come back to school without a doctor's note. I don't take my kids to doctors for colds. It's a waste of time and money. I personally would have refused, just nicely stating his symptoms and the facts, and sent him to school anyway. (Assuming he was acting perfectly fine, no fever, etc). I have to pay doctors visits and lab tests at 100% until our high deductible is met.

But white spots CAN mean strep. Not having high fever doesn't necessarily mean you don't have strep, nor does having a less than painful sore throat.

If the nurse thought that strep was a possiblity it was not her job to worry about whether the parent "wastes" time and money going to the dr. Its her/his job to make sure that a child with a contagious illness is not in school infecting other children.

 

[ols386]

I agree with being a little ticked, though your response could have been a little better.
As you posted, it didn't sound like your DS had the symptoms of strep (white spots does not mean strep) but did have cold symptoms. I would have been really aggravated if I was told that he had strep and couldn't come back to school without a doctor's note. I don't take my kids to doctors for colds. It's a waste of time and money. I personally would have refused, just nicely stating his symptoms and the facts, and sent him to school anyway. (Assuming he was acting perfectly fine, no fever, etc). I have to pay doctors visits and lab tests at 100% until our high deductible is met.

Depending on the school policy, you may not be able to do that.

 

[luvmy3]

I agree with being a little ticked, though your response could have been a little better.
As you posted, it didn't sound like your DS had the symptoms of strep (white spots does not mean strep) but did have cold symptoms. I would have been really aggravated if I was told that he had strep and couldn't come back to school without a doctor's note. I don't take my kids to doctors for colds. It's a waste of time and money. I personally would have refused, just nicely stating his symptoms and the facts, and sent him to school anyway. (Assuming he was acting perfectly fine, no fever, etc). I have to pay doctors visits and lab tests at 100% until our high deductible is met.

In the last few years my dd has come down with strep alot. Sometimes she has typical strep symptoms, fever, spots, sore throat but sometimes she has simple cold symptoms and it turns out to be strep. I don't take my kids ti doctors for colds either, and I have ignored her symptoms before, only for her to get progressively worse. I would never think of making sure she doesn't have strep as a waste of time and money.

 

[Hannathy]

But white spots CAN mean strep. Not having high fever doesn't necessarily mean you don't have strep, nor does having a less than painful sore throat.

If the nurse thought that strep was a possiblity it was not her job to worry about whether the parent "wastes" time and money going to the dr. Its her/his job to make sure that a child with a contagious illness is not in school infecting other children.

Agree. She is protecting the entire school community and has to act on her best judgement of a situation, and not base it on whether it inconveniences you.

 

[Jaime4004]

Depending on the school policy, you may not be able to do that.

our policy is a fever greater than 100, the OPs son did not have a fever

 

[Jaime4004]

In the last few years my dd has come down with strep alot. Sometimes she has typical strep symptoms, fever, spots, sore throat but sometimes she has simple cold symptoms and it turns out to be strep. I don't take my kids ti doctors for colds either, and I have ignored her symptoms before, only for her to get progressively worse. I would never think of making sure she doesn't have strep as a waste of time and money.

It is a waste of time and money if the OP (you know, the parent.. who knows the child well... knows the other symptoms going on in the rest of the family) does not believe it is strep. That's why I totally agree with the nurse suggesting her impression that it MAY be strep and suggesting maybe the child should see a doctor. Saying that it is strep and the child MUST see a doctor is unprofessional.

 

[Jaime4004]

But white spots CAN mean strep. Not having high fever doesn't necessarily mean you don't have strep, nor does having a less than painful sore throat.

If the nurse thought that strep was a possiblity it was not her job to worry about whether the parent "wastes" time and money going to the dr. Its her/his job to make sure that a child with a contagious illness is not in school infecting other children.

Totally disagree. Strep is a possibility for many, many different symptoms. The only symptom may be a cranky child or a decreased appetite. Are you going to send all cranky kids or ones not eating much that day to the doctor? My DD would be there daily then... You need to look at the whole picture, not take one symptom. Someone looking for a cough drop and having "white patches?" Not necessarily immediate MD need and removal from school.

Yes, i know, many kids have strep and show no symptoms. Again, are we going to test every kid everyday, just in case some kids have it, show no signs, and are infecting the school? Of course not, you know your child best and how they appear when ill.

Sorry for the multiple posts, I'm not talented enough to quote multiple posters in one post.

 

[luvsJack]

Totally disagree. Strep is a possibility for many, many different symptoms. The only symptom may be a cranky child or a decreased appetite. Are you going to send all cranky kids or ones not eating much that day to the doctor? My DD would be there daily then... You need to look at the whole picture, not take one symptom. Someone looking for a cough drop and having "white patches?" Not necessarily immediate MD need and removal from school.

Yes, i know, many kids have strep and show no symptoms. Again, are we going to test every kid everyday, just in case some kids have it, show no signs, and are infecting the school? Of course not, you know your child best and how they appear when ill.

Sorry for the multiple posts, I'm not talented enough to quote multiple posters in one post.

No, of course you don't test everyone every day. That is ridiculous.

But this kid was showing signs of illness (hence the need for a cough drop), perhaps she asked why he needed it and he said his throat hurt??

She is a professional, and can probably spot strep before a lot of dr.s can. Maybe she was aware that strep was going around.

I just don't believe that a parent should consider it a waste of time and money if a medical professional tells them that the child needs to be checked. Its safer to know that the symptoms are NOT strep than it is to ignore them and it turn out to be strep. A lot better for the other kids in school too.

How would the OP have felt if another kid went in to see the nurse, had white patches, the nurse does nothing and 10 days later her child and the rest of the class comes down with strep? I am guessing that if that was the case we would be hearing how the nurse didn't do her job.

 

[Coconut36]

It is a waste of time and money if the OP (you know, the parent.. who knows the child well... knows the other symptoms going on in the rest of the family) does not believe it is strep. That's why I totally agree with the nurse suggesting her impression that it MAY be strep and suggesting maybe the child should see a doctor. Saying that it is strep and the child MUST see a doctor is unprofessional.

Not in the slightest bit unprofessional. The nurse saw classic symptoms of strep. It is part of her job to protect other students from contagious diseases and strep is a big one. She was extremely professional and well within her rights to require Dr verification before the child returns to school. Unless the parent is the child's treating Dr and runs a strep test they don't get to decide what it is (in this instance where there were warning signs) and send the kid back to possibly expose others. Strep as others have pointed out can present with classic and less than classic symptoms. My ODS got a cold once..seemed fine but when we went in it turned out he had a raging case of strep. Spots and red inflamed throat but no fever or any other signs and to him the throat didn't hurt that bad.

 

[Jaime4004]

No, of course you don't test everyone every day. That is ridiculous.

But this kid was showing signs of illness (hence the need for a cough drop), perhaps she asked why he needed it and he said his throat hurt??

She is a professional, and can probably spot strep before a lot of dr.s can. Maybe she was aware that strep was going around.

I just don't believe that a parent should consider it a waste of time and money if a medical professional tells them that the child needs to be checked. Its safer to know that the symptoms are NOT strep than it is to ignore them and it turn out to be strep. A lot better for the other kids in school too.

How would the OP have felt if another kid went in to see the nurse, had white patches, the nurse does nothing and 10 days later her child and the rest of the class comes down with strep? I am guessing that if that was the case we would be hearing how the nurse didn't do her job.

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.

 

[Jaime4004]

Not in the slightest bit unprofessional. The nurse saw classic symptoms of strep. It is part of her job to protect other students from contagious diseases and strep is a big one. She was extremely professional and well within her rights to require Dr verification before the child returns to school. Unless the parent is the child's treating Dr and runs a strep test they don't get to decide what it is (in this instance where there were warning signs) and send the kid back to possibly expose others. Strep as others have pointed out can present with classic and less than classic symptoms. My ODS got a cold once..seemed fine but when we went in it turned out he had a raging case of strep. Spots and red inflamed throat but no fever or any other signs and to him the throat didn't hurt that bad.

She is within her rights if the child is showing "classic" signs of strep, which he was not.
Do you now bring your child to the doctor with every cold symptom because she once had strep with it?