I am having a problem getting the school nurse to follow doctors directions about my son’s diabetes management. I have written everything down for the school nurse, and I have had the doctor’s office send her the same thing I have given her, but she still doesn’t follow directions.

When I call my son’s doctor about it, they get disgusted with the nurse because the things I am expecting her to do is what the doctor has told me to do. Then, the office sends the nurse another note about what to do, when to do it, etc., but the nurse still doesn’t follow directions. Any suggestions on where I can go from here to try to get the school nurse to follow the doctor’s directions?

This is a difficult situation. Without knowing what care the doctor and you are asking of the school nurse, I cannot identify a problem or a solution. Sometimes, we forget that the school nurse must care for several hundred kids at once, and they cannot be expected to be a substitute for a practitioner who can provide one-on-one care day-in and day-out.

Do you have a Section 504 program agreement or other special education/student disability program established with the school? Have you discussed your concerns with the school principal or the school system central office? If you have already explored these solutions you could call the Iowa State Department of Education at 515-281-5294.

DSH
Additional comments from Shirley Goodman, diabetes nurse specialist:

It sounds like you’re in a frustrating situation! You didn’t mention whether you have sat down with your school administration and health office staff and written a plan of care (504 plan or IEP) for your child’s safety and diabetes care while at school. If you haven’t already, I would recommend that you meet, not only with the school nurse, but with the principal and staff before school starts, and outline your child’s needs and the care necessary while in school. Put this plan in writing and have it signed by everyone involved. Then, perhaps a couple of months into school, return, and review the written plan for any changes that may be necessary. Remember to include not only the testing and insulin needs, but how your school will handle substitute teachers, fire and tornado drills, field trips, and parties.

If the personnel at school are not adhering to a plan of care developed by you, your diabetes team and the school, going to the principal, then the superintendent, district administration and school board could be your next steps. Both your doctors/nurses and the American Diabetes Association can be helpful in helping you think of strategies to ensure that your child is receiving safe care while at school.

SG
Additional comments from Barb Schreiner, diabetes nurse specialist:

I would suggest moving up the administrative chain — speak with the school’s principal, then the region’s nursing director, if necessary. If you still have trouble, you might talk with your local American Diabetes Association advocacy group.

BS