School nursed changed doctor\'s orders (who to report it to?)

Posted on: Sun, 09/10/2006 - 8:16am
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On Wendesday I found out the school nurse changed my son's doctor's treatment protocol. He hasn't been back to school since. I'm wondering who to report that to? The school director knows (I immed. complained to her) and she told me they have to follow the school nurse's orders.

I have an appt. with ds' doctor on Wed. and tomorrow I find out if ds gets into another school.

I think I should report this to someone but I'm not sure who.

Also, since it's not a given ds will get into another school do I send him to school even though they won't be following the doctor's orders regarding treatment? If I send him I'd stay but sending him sends a message to the school that I'm letting them get away with what they've done and contiue to do, I think.

What would you all do?

[This message has been edited by ~*Trace*~ (edited September 10, 2006).]

Posted on: Sun, 09/10/2006 - 8:18am
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sorry about the typo in the title but I can't figure out how to edit that part.

Posted on: Sun, 09/10/2006 - 8:24am
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I'm intrigued. what did she change? specifics please, route, time (circumstances), dose, medication, etc........

Posted on: Sun, 09/10/2006 - 8:29am
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Doctors orders for treatment were:
1) Epi Pens
2) Call 9-1-1
and the wording stated to use Epi Pens first before any anaphylactic symptoms.
The school nurse changed it to:
1) Use Benadryl
2) Use albuterol inhaler
3) Use Epi Pens
with symptoms listed at each number of treatment.
I have the papers out in the car in the med file but that is basically how it was changed.

Posted on: Sun, 09/10/2006 - 8:30am
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OH, I did call the doctor's office and they were outraged and said she had no right to do that.

Posted on: Sun, 09/10/2006 - 8:35am
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I'd call the CA Board of Registered Nursing to discuss anonymously first. Then probably file a complaint, and get doctor's office as support as needed.
[url="http://www.rn.ca.gov/enf/complaint.htm"]http://www.rn.ca.gov/enf/complaint.htm[/url]
That is completely outrageous!

Posted on: Sun, 09/10/2006 - 10:17am
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Maybe you need to have a chat with the superintendant of your school district. The superintendant needs to know what's going on at this school.
Cathy

Posted on: Sun, 09/10/2006 - 10:20am
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We already did that. She wasn't any help. She told me PB&J's are a staple of the Kindergarten diet so she couldn't make the room nut free. She also said she suffers from allergies too and understands where we're coming from *insert eyeroll here*.

Posted on: Sun, 09/10/2006 - 10:23am
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Quote:Originally posted by ~*Trace*~:
[b]Doctors orders for treatment were:
1) Epi Pens
2) Call 9-1-1
and the wording stated to use Epi Pens first before any anaphylactic symptoms.
[/b]
"treatment"
treatment for what?
a reaction?
what signs and symptoms did the physician state to be present to administer the epipen, if the epipen is to be administered [i]before an anaphylactic[/i] reaction. As a nurse, I would have at least expected standing orders to contain that. Does the "order" contain that?
side note:
completely unrelated, but if a physician orders me to give a medication (or administer an intervention) when it is inappropriate, or contraindicated, I can be held responsible for the consequences. Even if a physician ordered it. Not saying that is what is going on here, just something mentioned in the course of "signs and symptoms" and physician orders.

Posted on: Sun, 09/10/2006 - 11:13am
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I don't have his paperwork here with me (it's in the car) but basically he wants the Epi Pen to be used before anything else including Benadryl. He listed the signs of anaphylactic reactions.
I'm not using his terms in my posts here. As I said the paperwork is in the car. Basically the nurse took it upon herself to change the "treatment" (my words) protocol in the even of an allergic reaction to nuts.
It's not uncommon for a doctor to advise using the Epi first (over Benadryl) from what I understand. In light of ds reactions (to kicking nuts and licking one) the doctor said he wants the Epi to be used first.
Per the school nurse it's to be used 3rd (upon constriction of the throat).

Posted on: Sun, 09/10/2006 - 11:19am
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That really makes me mad. The line about using Albuterol inhaler before epi is especially dangerous. It is the reason that both Nathan Walters and Sabrina Shannon died, not to mention many others. FAAN is extremely clear that if you must use albuterol inhaler for a reaction, use epi first. The reason is that the albuterol may get rid of the cough and wheezing, but if it is an allergic reaction the other symptoms like the blood pressure dropping are still occurring. So the epi should always be used before the albuterol.
I would get the allergist to write a letter ASAP to the school. If it happened to us, our allergist would let me write it. He would make any necessary changes and sign it. It should be short and concise, something like:
"To _________
The purpose of this letter is to clarify instructions for the treatment of (child`s name) for the following symptoms (list symptoms)."
Then he would put the instructions step by step. For example,
1. Use epi first
2. Give Benadryl (quantity)
3. Albuterol (if your dr wants it, the epi would probably eliminate the need for albuterol, because it would treat the wheezing).
Then the doctor would add something like "Under no circumstances is this order to be changed."
Then the line I love that I always have my allergist put in with anyone who doesn`t get it is "Peanut allergy can be fatal".
Sorry, I know you are asking who to report it to, just wanted to mention getting your allergist to write a letter first as that is more pressing. You should report the nurse to whoever licenses nurses (the nursing board?). Do a google search and you can probably figure it out. Also, I wonder if OCR can help?
Also, when I had a problem with our school nurse teaching the epi incorrectly, there was some sort of dept of education nursing office in our state capital.

Posted on: Sun, 09/10/2006 - 11:23am
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We were posting at the same time. Our instructions also are to use epi first. Maybe your allergist could add in a line saying that delaying the epi can cause a fatality.

Posted on: Sun, 09/10/2006 - 12:01pm
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Boy this stinks! THe only person being hurt here is your child who is missing out on his education. I hope you can come to a quick resolution on this. I wouldn't wait until a Drs. appt...I woudl call and have them FAX over something.

Posted on: Sun, 09/10/2006 - 12:06pm
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Edit
[This message has been edited by NicoleinNH (edited June 09, 2007).]

Posted on: Sun, 09/10/2006 - 12:42pm
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Why would you want the school to use the epi-pen before any reaction is witnessed? I'm confused...
Yes, epi is generally safe, but I wouldn't want some over zealous administrator giving my kid epi with no signs of a reactions ie, tingling mouth, hives or swelling, etc..Did I miss something?
------------------
mom to Ari(6) - severe nut allergies, asthma, you name it - and Maya (9), mild excema

Posted on: Sun, 09/10/2006 - 12:46pm
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Are you in the USA?
Each state has a licensing board for nurses.
This should be reported. A NURSE can not change a doctor's orders.
I see articles in the papers in Iowa all the time where nurses are reprimanded or lose their license for stuff like this.

Posted on: Sun, 09/10/2006 - 12:49pm
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Trace, I did not realize you were in California. So am I. Feel free to email me if you want [email]elyssa95@comcast.net[/email]
[This message has been edited by Carefulmom (edited September 10, 2006).]

Posted on: Sun, 09/10/2006 - 12:54pm
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Thank you for the name and phone number. I will call her tomorrow ((( HUGS )))

Posted on: Sun, 09/10/2006 - 1:03pm
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Quote:Originally posted by ~*Trace*~:
[b]I don't have his paperwork here with me (it's in the car) but basically he wants the Epi Pen to be used before anything else including Benadryl. He listed the signs of anaphylactic reactions.
[/b]
this is the part of your post I am referring to:
"[b]and the wording stated to use Epi Pens first before any anaphylactic symptoms. [/b]"
I'm confused. Does he want it used before anaphylactic symptoms or after?
[This message has been edited by MommaBear (edited September 10, 2006).]

Posted on: Sun, 09/10/2006 - 1:51pm
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Thank you, I will email you.

Posted on: Sun, 09/10/2006 - 2:32pm
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I'm sorry mamabear I don't have the exact wording handy and at this point my concern is that the school nurse had no right to change the doctor's orders. If she had any questions or concerns she should have called the doctor's office (she didn't, I checked) and she should have called me. I have never met nor spoken with her.
The doctor is not advising them to admin the epi willy nilly. It had specifics (symptoms and what to do) on his orders and one was that Epi was to be the first thing/treatment or whatever you want to call it. Not Bendadryl, then albuterol inhaler and then Epi.

Posted on: Sun, 09/10/2006 - 3:48pm
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Quote:Originally posted by that'smetrying:
[b]Why would you want the school to use the epi-pen before any reaction is witnessed? I'm confused...
Yes, epi is generally safe, but I wouldn't want some over zealous administrator giving my kid epi with no signs of a reactions ie, tingling mouth, hives or swelling, etc..Did I miss something?
[/b]
This is frequently advised for kids like mine-- who have experienced very rapid descent into grade 4 anaphylaxis from ultra-trace amounts. The thinking is that [i]if there is a known ingestion of pn[/i] there is probably not enough time to "wait and see" what kind of symptoms will appear. Treat first and hope you are quick enough.
(Having seen DD's two grade 4 rxns, I'm a believer.)

Posted on: Sun, 09/10/2006 - 11:03pm
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Our allergist ordered Epi first (as taken from the "checklist" of symptoms from FAAN's emergency action plan sheet), except for one symptom (don't have it in front of me). I was surprised about that. He said that the protocol that *I* would follow may be different than what he wants the school to follow due to the "wait & see" approach that the school might take.

Posted on: Sun, 09/10/2006 - 11:48pm
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Quote:Originally posted by ~*Trace*~:
[b]I'm sorry mamabear I don't have the exact wording handy and at this point my concern is that the school nurse had no right to change the doctor's orders.
[/b]
Never said she did. Just trying to figure out what didn't "click" with her. Ya know? She might have jumped the gun if faced with an order she [i]couldn't[/i] follow. Of course, rewriting "dr's orders" isn't permissible, and is the "wrong way" to handle something like that.....just trying to see [i]what happened[/i].
If indeed, she did "rewrite" doctors orders.
It's just not something I frequently encounter, [i]even from school nurses[/i]. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] As a matter of fact, that's not the group of nurses I'd find suspect of such an offense. KWIM?

Posted on: Mon, 09/11/2006 - 1:25am
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How did you realize that the school nurse changed the orders?
Once I turn in the paperwork for medication, I never see it again.
I would report it to the person in charge of school nurses at the state level.
Did you ask her why she amended the doctors protocol? This is very scary.

Posted on: Mon, 09/11/2006 - 2:40am
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Edit
[This message has been edited by NicoleinNH (edited June 09, 2007).]

Posted on: Mon, 09/11/2006 - 2:50am
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Quote:Originally posted by NicoleinNH:
[b]Mommabear and others-It is not uncommon for allergists to prescribe Epi prior to any symptoms for kids who have already shown quick anaphylactic reactions. My daughter's care plan written by her physicians (pediatrician and pediatric allergist) states the school staff is to administer Epinephrine if they know my daughter ingested peanut (before she shows any symptoms--but I doubt the school would "know" she had ingested it because they can't/don't watch her constantly). [/b]
that's my point. I don't see where "treatment" was for [i]known ingestion[/i]. I'd like to know what signs and symptoms the physican prescribed epi for [i]before an anaphylactic reaction.[/i]
I mean, when dealing with the [i]unknown[/i]. Not knowing if anything has been ingested. Just looking at "signs and symptoms".

Posted on: Mon, 09/11/2006 - 3:44am
Anonymous's picture
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Edited because after reading the entire thread, my question was already answered.
Apologies.
[This message has been edited by AnnaMarie (edited September 11, 2006).]

Posted on: Mon, 09/11/2006 - 7:38am
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Thanks everyone for your suggestions, advice and concern. We took ds to school to day and were met by the school director who wanted to have a meeting with us. She apologized that the nurse changed the doctors orders (said the nurse was confused by the doctor's notes) and that she (the school director) called the doctor's office on Friday to get clarification.
Here are his orders (since I have them sitting right here I won't be omitting key words this time, lol!~)
"I apologize again for the confusion and resulting concern with our nursing plan yesterday. In order to better clarify our responsibiliy to R, I called the nurse ad the doctor's office (names omitted). We reviewed, once again, the current doctor's orders. The following is my understanding of my discussion with the nurse and what the current orders state we must do if ingestion or contact with ANY type of tree nut or peanut is suspected or known:
1 Admin EpiPen
2. Admin Albuterol MDI - 2 puffs w/spacer
3. Administer Benadryl- 3.5 tsp
4. Call 9-1-1
5. Call parents
(4&5 should be done immediately by another staff member)
Symptoms: Hives, rash, itching, itching/swelling of the lips/tongue/mouth/throat, nausea, abdominal cramping, diarrhea and or vomiting, shortness of breath, repetitive coughing, wheezing "thready" pulse, passing out.
And they notated the "accomodations" they've made.
I took the letter to the doctor's office who approved it and said they're impressed that the school seems to be finally "getting it".
The reason I know the nurse changed the orders is because I took the doctor's orders to the school and made copies for me, the school director and for the med bag. When I picked ds up from school on Wed. on of the class aids was telling me about their epipen training class and that now she knows that if any symptoms show then to admin. Benadryl. I immed opened the med bag to find the copy of the doctor's orders gone and found the nurses orders in the bag.
The nurse changed things from the order above to:
Benadryl
Albuterol inhaler
EpiPen
The symptoms were listed as well. Specific symtoms for the Benadryl and certain symptoms for the inhaler and certain (the most severe) symptoms for the EpiPen.
As soon as I saw the nurses paperwork I went straight to the school director, had her pull her copy from the doctor and showed her the difference. While she agreed the difference was huge she said they have to go by what the school nurse says. I kept ds out of school both Thurs and Fri (telling the school director that's what I was doing due to these orders being changed) and then she called the doctor's office on Friday.
When I saw the nurse (at the doctor's office) today she told me that she told the school director that the school nurse had no right to change the orders and in fact the doctor will be calling the school nurse.
In today's meeting the school director told me she has been in contact w/the district's special ed director and that she's requested a 504 meeting.
So, all of that went well, I think. However, his teacher is very negative and overwhelmed and stressed and quite frankly I'm not sure what to do about it. She told us again today she's got 20 other kids to worry about and ds isn't her only concern. She also is very unclear of when or why to give the epi. (She asked me why I didn't give ds the epi when he woke up throwing up at school the day he got the concussion!) We are feeling like we're on a roller coaster ride. You know the one step forward and two steps back sort of thing? We felt very good after our meeting today and then when we spoke w/the teacher we felt we should grab ds and run far and fast, ugh!
Maybe too I shouldn't harbor on the fact she referred to ds as a "problem". "He's not my problem once he leaves my classroom" didn't sit well with me after going through so much, kwim?
In all seriousness the teacher most definitely needs some one and one training with the school nurse or even my ds doctor. I hate though that I can tell she'd rather he just go away.
Oh, the school director did say "you know, if you're so concerned w/his safety there are other options. You could homeschool him". I told her that I get concerned when I think everything is planned out and then the school nurses changes doctor's orders. That's what worries me". She said, she understoood.
[This message has been edited by ~*Trace*~ (edited September 11, 2006).]

Posted on: Mon, 09/11/2006 - 8:16am
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I would give the teacher the FAAN video "It Only Takes One Bite" and meet one on one with her to practice the epipen until she is comfortable. If you have any expired ones, you can have her practice into an orange. It is very helpful. I really think it is best for the parent to meet one on one with the teacher if the teacher seems confused. My dd is 11 and I always meet with the teachers on my own anyhow, even if the nurse meets with them too. I always want to be sure they really get it. Glad to hear the change of orders got straightened out at least!

Posted on: Mon, 09/11/2006 - 8:33am
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We talked today and the teacher said "Oh, I know how to use the epi pen I'm comfortable with that". She doesn't seem to know under what circumstances to use it. I have tried talking one and one with her (several times) and each time she gets more closed off and tells me she's very stressed about it all and then she reminds me this is a "big deal" and she's got 20 other kids to worry about.

Posted on: Mon, 09/11/2006 - 9:44am
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Sounds like the school was doing a
C.Y.A. (Cover Your A--)

Posted on: Mon, 09/11/2006 - 11:11am
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Could you approach the teacher in a more conciliatory fashion? (By gritting your teeth and smiling, a few shots of whiskey in the parking lot first, you know, whatever it takes to be pleasant about it at this poit... [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img] )
She sounds like someone who is shutting down because she is truly overwhelmed. Maybe you could approach her [i]with concern for HER perspective[/i] in mind... tell her you'd like to meet with her to answer any questions she might have and reassure her about how simple it really is-- though it can seem overwhelming and complicated. It is truly hard to miss a child in anaphylaxis, though some early warning signs can be subtle.
Let her know that you intend to be there as a resource [i]at her disposal[/i].... and that you [i]appreciate her willingness to allow DS to feel unafraid in her room[/i] (this may [i]really[/i] require some teeth-gritting, huh?)
I just can't think that any teacher of young children would ever want any of them to come to harm. Every one I've ever known loves children dearly.
But some of those teachers can get emotionally overwhelmed and shut down before they can really absorb the information. I know that you've needed to be rather assertive thus far, but can you try a little more sugar with the teacher? I mean, if you don't get anywhere, you aren't any worse off than before, right?
[img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Posted on: Mon, 09/11/2006 - 12:06pm
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I do need to try that again. At the end of the first week of school I gave her a plant of mini-roses w/ a note thanking her for helping keep ds safe. I have tried to reassure her that "we're all on a learning curve here and it will get easier" but it seems the more she learns about the allergy and her "responsibilities" the more she well, freaks out. Anyway, I will try again.
We did check out the school in the other district. There are two and the one we wanted is full but we checked out the other and spoke with the Principal too. She was a lovely woman and asked questions and was very positive. The school is a lot larger but the Kindy class is separated from the other classes. The only class they have open is the pm class. I worry about my 2nd grader. That school was SO MUCH LARGER, lol! Though she kept saying "Can I go here??" so we're setting up a meeting with the Kindy teacher and we'll make our decision from there.

Posted on: Wed, 09/13/2006 - 12:27am
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I probably have an unpopular opinion, but if it were *me* I'd stop talking to the teacher altogether on this topic. . . for the time being. This isn't a matter of softening the teacher into 'liking you' so that she'll do what needs to happen. I'd be very businesslike in my demeanor. This teacher needs to be instructed by a superior as to her responsibilities, and you (any parent) aren't the proper person to do that. Someone, most likely the building principal, has the responsibility to make sure the school is 504 compliant, and to whom the teacher has accountability.
I think a 504 meeting is the correct solution so that individual responsibilities are identified/clarified. If the teacher needs assistance in the classroom to address student needs, then make a case for the district to acquire a classroom aide.
There was a time when I tried to fill in the gaps and shortcomings at my DD's elementary school regarding the proper management of her PA. In my situation, I was just doomed for failure until the school accepted that the success managing children with PA was of responsibility of the school [i]system[/i] and can't solely be dependent on a/the parent.
So maybe at the 504 meeting you can remember to ask often, [i]"So who is responsible for that?" [/i] And hold back on any inclination to offer up your volunteerism until they process it a bit and figure out how *they* should be addressing it without you enabling a broken system. I'd ask, who is the 'case manager" for your son's 504? And who is the building compliance officer? These are important lines of responsibility that they may not even be aware of.
And, on the subject of "home schooling" (totally inappropriate), if the principal brings this up at the 504 meeting ask her if she is recommending that your child receive services under a "home [b]bound[/b]" option. Ask her if she has the forms to fill out for "home bound." (This is where the School District provides instruction to your child in your home.) That should quiet her down.
Just my opinion.

Posted on: Wed, 09/13/2006 - 12:32am
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Quote:Originally posted by Corvallis Mom:
[b]Could you approach the teacher in a more conciliatory fashion? [/b]
LOL! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] You mean like bearing gifts and softly pleading, [i]"Please, oh please, with sugar on top, would you please do your job?" [/i]

Posted on: Wed, 09/13/2006 - 3:23am
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lol Gail, but you beckon me back to the "do your job" side of the fence once again.
[i]with my own words, even[/i].
yes, let's be done with [i]ingratiating[/i] ourselves to people who need to realize [i]what their job is[/i].
~Or need get out of Dodge.
It only serves to encourage them. It makes me part of the [i]problem[/i], rather than the solution.
Too much time in Off Topic has made me lose my focus...

Posted on: Wed, 09/13/2006 - 5:08am
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I didn't think this was about her offering to do the teacher's job for her (or anyone else's either) but rather in doing what she could to de-escalate the deteriorating situation with this particular teacher. Positive reinforcement as a training aid, if you will.
The teacher is a human being. She was obviously feeling both totally overwhelmed and probably totally unappreciated for the effort she was making. (Probably wondering, [i]"good nightshirt!! What will ever be enough??"[/i])
All I was advocating was a way to let the teacher know that her efforts were not being wasted and that learning about PA [i]is[/i] a stressful adjustment-- just simple good communication skills, folks. NOT conceding a thing. [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img] I wouldn't have suggested it in a situation where the teacher was seeming grumpy and uncooperative. This one seemed... overwhelmed.
While I agree that the school should be doing more to prevent situations like this from happening in the first place, making the teacher understand that you don't regard her as "the enemy" seems a pretty innocuous thing!
In other words, "I know you can do it!" or even,"We can make this work as a team," is quite different from "If that's too much, I can do it." (Which I have never, nor will ever say when I fully believe it is their JOB to be doing it.)
Once things are going more smoothly, it may be a more powerful engine of change to have BOTH of them suggest ways for such rancor to [i]never[/i] develop during a 504 process again.
[img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] Points for style, ladies.... there are points for style.
ETA: (But I agree wholeheartedly about asking [i]many[/i] questions about whose responsibility things are!!! You've seen some red flags that warn you this is a problem with the school.)
Linking:
[url="http://uumor.pair.com/nutalle2/peanutallergy/Forum7/HTML/002528.html"]http://uumor.pair.com/nutalle2/peanutallergy/Forum7/HTML/002528.html[/url]
[This message has been edited by Corvallis Mom (edited September 13, 2006).]

Posted on: Wed, 09/13/2006 - 8:27am
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Quote:Originally posted by Corvallis Mom:
[b]
While I agree that the school should be doing more to prevent situations like this from happening in the first place, making the teacher understand that you don't regard her as "the enemy" seems a pretty innocuous thing!
In other words, "I know you can do it!" or even,"We can make this work as a team," is quite different from "If that's too much, I can do it." (Which I have never, nor will ever say when I fully believe it is their JOB to be doing it.)
Once things are going more smoothly, it may be a more powerful engine of change to have BOTH of them suggest ways for such rancor to [i]never[/i] develop during a 504 process again.
[img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] Points for style, ladies.... there are points for style.
[/b]
Just don't come across as thanking them [i]for doing you a favor[/i]. Sorry, but that's the way it seems to me when we "sweeten the deal". Sugar is addictive. What makes the coffee palatable today, might not placate tomorrow.
I'm back to setting [i]boundaries[/i]. Recent "sweetness" has resulted in a rapid spiral downward, human nature being what it is. My school district has been "swamped", and you know what they say about squeaky wheels. I don't remember anything about "sugar coated" wheels. Just squeaky ones.

Posted on: Wed, 09/13/2006 - 8:31am
Gail W's picture
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Quote:Originally posted by Corvallis Mom:
[b]I didn't think this was about her offering to do the teacher's job for her (or anyone else's either) but rather in doing what she could to de-escalate the deteriorating situation with this particular teacher. Positive reinforcement as a training aid, if you will.
The teacher is a human being. She was obviously feeling both totally overwhelmed and probably totally unappreciated for the effort she was making. [/b]
Point taken. There is a human component here that shouldn't be overlooked. Nothing is more [i]personal[/i] to me than my girls. I certainly have needed a *connection* sometimes with a teacher, especially when I was uncertain, fearful and/or stressed out. Good communication, positive and reassuring words, *a hug* are all ways that I've connected with those caring for my DD. There were times I would have been lost without it, and I'm sure the reverse is true too.
I'm sure the one thing that both ~*Trace*~ and the teacher have in common is that they are both afraid. That primal human emotion: fear. I'd be afraid too if I were in [i]either[/i] of their shoes.
~*Trace*~ 's situation is probably polar opposite of mine right now. We're in our 4th week of school and I haven't met a single one of Mariah's teachers. Not one. I'll meet them for the first time tonight at Open House, just like all the other parents. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
I don't have any fears because the system is working as it should now. (The School Counselor administers the 504 and the School Nurse administers the IHP).
Wasn't it the [b]Superintendent[/b] who has a "PA" who stated that she [i]couldn't [/i]restrict PB? ~*Trace*~ is a victim of a broken system and so is the teacher. I hope that they can see what they have in common and work together to address the broken system as a whole. Otherwise, it's as MommaBear says:
Quote:Originally posted by MommaBear:
[b]yes, let's be done with ingratiating ourselves to people who need to realize what their job is.
~Or need get out of Dodge.
It only serves to encourage them. It makes me part of the problem, rather than the solution.[/b]
[This message has been edited by Gail W (edited September 13, 2006).]

Posted on: Wed, 09/13/2006 - 8:51am
Corvallis Mom's picture
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Nothing says you can't be squeaky [i]while[/i] you're being sweet. [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img]
Right?
I think Gail is right on target-- this is definitely a situation to inspire considerable fear in both parents and teacher. But that being the case, they need to be able to work [i]together[/i] against a what has turned out to be a common enemy. Put yourself in this teacher's shoes-- she's been told [i]SEVERAL[/i] different things by different "authority figures", right? (And the rules evidently keep changing as fast as she can keep up!) She knows that making a mistake could cost a child his life. I'd be terrified.

Posted on: Wed, 09/13/2006 - 9:51am
MommaBear's picture
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Quote:Originally posted by Corvallis Mom:
[b]Nothing says you can't be squeaky [i]while[/i] you're being sweet. [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img]
[/b]
Nothing says that being squeaky is anything less than appropriate. People who interpret someone pointing out what *should* be, what is *supposed* to be, are [i]suspect[/i] in my book. [b]Guilty[/b].
I've never had a problem with people who have concerns, or complaints for that matter. If it takes someone "outside" the system to see where the problem lies, to make a fuss, then [i]shame on those[/i] [b]inside the system[/b]. It just should never happen.
[i]shame, shame, shame.[/i]
If a problem gets referred to my [i]superior[/i] that I was a direct variable in, that I had an obligation in, then hey, it was probably [i]staring me right in the face[/i] at one point or another. Probably several times.
[This message has been edited by MommaBear (edited September 13, 2006).]

Posted on: Wed, 09/13/2006 - 12:43pm
Gail W's picture
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Quote:Originally posted by Corvallis Mom:
[b]Put yourself in this teacher's shoes-- she's been told [i]SEVERAL[/i] different things by different "authority figures", right? (And the rules evidently keep changing as fast as she can keep up!) She knows that making a mistake could cost a child his life. I'd be terrified.[/b]
Exactly.
But this is what I find most terrifying: on top of all that, sometimes teachers and school nurses also [i]fear for their job[/i]. I've seen and experienced it personally. Others here have also posted about it (thinking of bandbmom, Drew's mom). When push comes to shove, most teachers are going to do what s/he is told to do by the superior who evaluates him/her. It's [i]self-preservation. [/i]
I'll always remember the conversation I had with the school nurse before Mariah's 504 eligibility meeting. She essentially [i]apologized[/i] to me before the meeting because she didn't know what the outcome would be and wanted me to know that that she would have to 'fall in line' with whatever her supervisor ruled. She [i]knew[/i] it would be wrong to deny Mariah a 504 designation, but she knew that she couldn't risk losing her job by disagreeing with ~defying~ her supervisor or the Super if that was his decision. She was basically asking me for my understanding and forgiveness if that's how things would have gone. (That was one of those conversations that included a lot of human emotion, including fear, and also involved *a hug*.)
[This message has been edited by Gail W (edited September 13, 2006).]

Posted on: Wed, 09/13/2006 - 12:59pm
Corvallis Mom's picture
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You make a great point, actually, MB... better still when combined with the other one...
Common enemy.... staring in the face, several times.
Best to have [i]as many squeaky wheels as possible in that case, wouldn't you say?[/i] [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img] The enemy of my enemy and all that. If you can be nice enough to reach beyond someone's fear of the situation they find themselves in, they may be willing to become an ally in a mutual [i]cause.[/i] The cause of defeating beauracratic inertia/institutional flaws. KWIM?
This is [i]always[/i] my strategy, by the way-- and it pays HUGE dividends. Regularly.
Glad this came up, actually-- it is something I have been searching for a way to say for a long time.
[img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Posted on: Wed, 09/13/2006 - 11:13pm
Rosemary S's picture
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NicoleinNH,
I

Posted on: Wed, 09/13/2006 - 11:25pm
MommaBear's picture
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Quote:Originally posted by Corvallis Mom:
[b]You make a great point, actually, MB... better still when combined with the other one...
Common enemy.... staring in the face, several times.
Best to have [i]as many squeaky wheels as possible in that case, wouldn't you say?[/i] [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img] The enemy of my enemy and all that. If you can be nice enough to reach beyond someone's fear of the situation they find themselves in, they may be willing to become an ally in a mutual [i]cause.[/i] The cause of defeating beauracratic inertia/institutional flaws. KWIM?
This is [i]always[/i] my strategy, by the way-- and it pays HUGE dividends. Regularly.
[/b]
Your strategy assumes people [i]care[/i].
I mean, other than what happens to their own backside.
It's a dangerous assumption.

Posted on: Wed, 09/13/2006 - 11:30pm
MommaBear's picture
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repeating......
Quote:Originally posted by Gail W:
[b] Exactly.
But this is what I find most terrifying: on top of all that, sometimes teachers and school nurses also [i]fear for their job[/i]. I've seen and experienced it personally. Others here have also posted about it (thinking of bandbmom, Drew's mom). When push comes to shove, most teachers are going to do what s/he is told to do by the superior who evaluates him/her. It's [i]self-preservation. [/i]
[/b]
My biggest flaw is my aptitude for [i]tunnel vision[/i]. Assuming everyone looks at things the way I do. It was a huge step for me to finally realize that even some of the most cuddly, drippy sweet, [i]pleasant[/i] people involved in my cubs care put [i]Numero Uno[/i] above someone else's life. Were more worried about [i]getting in trouble[/i], than [i]doing the right thing[/i].
It's a realization you have to learn to make. I've had to practice restraint....
Discerning which of those *nice* (or even not so nice) people will do the *right* thing is not a luxury I can afford now. Actually, I never could afford it. I've just been [i]lucky[/i]. Or so I have been told.....but I digress.
Anywhoooo. Looking back, it's probably the old [i]battle axes[/i], the seemingly unfriendly, the [i]prickly[/i] people, that have done me the greatest good. [img]http://uumor.pair.com/nutalle2/peanutallergy/cool.gif[/img]
Not the gooey ones.
This may be a backbone issue.
[This message has been edited by MommaBear (edited September 14, 2006).]

Posted on: Thu, 09/14/2006 - 12:18am
mommyofmatt's picture
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Quote:Originally posted by Rosemary S:
[b]NicoleinNH,
This requirement is not a state law, but is in the State

Posted on: Thu, 09/14/2006 - 6:24am
Corvallis Mom's picture
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Quote:
Your strategy assumes people care.
I mean, other than what happens to their own backside.
Not at all-- I am quite possibly the world's biggest cynic.
I [i]never[/i] assume such a thing. Because I agree that this is a dangerous thing to do. I assume that people in general will [i]always[/i] do [b]what is in thier personal best interests.[/b] If I can make them aware that helping ME is not incompatible with that and that [i]I do not pose a danger to them[/i] then they can pleasantly surprise me. And they do. (But count on it-- never.)
This is why I may be very nice, but I'm not especially forthcoming with information they don't need to have.
I always come loaded for bear-- but I don't start by shooting at the chipmunks. The chipmunks, you see, are afraid of the bear too--and the bear is utterly indifferent to the chipmunks. Once in a while, one of the chipmunks decides they've had enough of that bear. I'll take advantage of that any time I can-- it may only be an annoyance to the bear, but it gives me a chance to [i]reload.[/i] The chipmunks are always surprised that I turn out to have that gun...
[img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img]
I don't know if it works for everyone, though. My DH is utterly tone-deaf to political stuff too. To make my method work very well, I think you have to be able to read people very well and be able know what individual people are afraid of...empathy bordering on ESP, in other words. DH ain't got it. He tends to use your approach, MB. (With great success, I might add... picture[i] DH chases the bear out the back of the china shop, turns as he crashes through the back wall, shouting "Don't worry-- I'll pay for that later!!"[/i])
He is simply in awe of what I can accomplish by seemingly NEVER even demanding anything. Yoda. That's what he calls me in my element. (Of course, he calls it "That taoist cr@p" otherwise...) His method works better when you are dealing with all bears and don't have time for the set up. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] On the flip side, there is a communication/thinking style (emotive, non-assertive) common in educators that simply doesn't [i]allow[/i] them to really listen to you unless they feel they can "relate" to you or like you. DH figures he can just stomp them out of the way. I figure... I can take a shower later. [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img] (In other words, [i]yes[/i] it is a little like selling them something. But they can't hear you otherwise.)
All I'm saying is that there is more than one highly effective communication style. But probably only one [i]per person.[/i] My DH's style isn't one I can weild effectively, so I don't try. (And dare I say-- vice versa.)

Posted on: Thu, 09/14/2006 - 6:54am
MommaBear's picture
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Joined: 09/23/2002 - 09:00

Quote:Originally posted by Corvallis Mom:
Not at all-- I am quite possibly the world's biggest cynic.
I [i]never[/i] assume such a thing. Because I agree that this is a dangerous thing to do. I assume that people in general will [i]always[/i] do [b]what is in thier personal best interests.[/b] If I can make them aware that helping ME is not incompatible with that and that [i]I do not pose a danger to them[/i] then they can pleasantly surprise me. And they do. (But count on it-- never.)
This is why I may be very nice, but I'm not especially forthcoming with information they don't need to have.
I always come loaded for bear-- but I don't start by shooting at the chipmunks. The chipmunks, you see, are afraid of the bear too--and the bear is utterly indifferent to the chipmunks. Once in a while, one of the chipmunks decides they've had enough of that bear. I'll take advantage of that any time I can-- it may only be an annoyance to the bear, but it gives me a chance to [i]reload.[/i] The chipmunks are always surprised that I turn out to have that gun...
[img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img]
I don't know if it works for everyone, though. My DH is utterly tone-deaf to political stuff too. To make my method work very well, I think you have to be able to read people very well and be able know what individual people are afraid of...empathy bordering on ESP, in other words. DH ain't got it. He tends to use your approach, MB. (With great success, I might add... picture[i] DH chases the bear out the back of the china shop, turns as he crashes through the back wall, shouting "Don't worry-- I'll pay for that later!!"[/i])
He is simply in awe of what I can accomplish by seemingly NEVER even demanding anything. Yoda. That's what he calls me in my element. (Of course, he calls it "That taoist cr@p" otherwise...) His method works better when you are dealing with all bears and don't have time for the set up. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] On the flip side, there is a communication/thinking style (emotive, non-assertive) common in educators that simply doesn't [i]allow[/i] them to really listen to you unless they feel they can "relate" to you or like you. DH figures he can just stomp them out of the way. I figure... I can take a shower later. [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img] (In other words, [i]yes[/i] it is a little like selling them something. But they can't hear you otherwise.)
All I'm saying is that there is more than one highly effective communication style. But probably only one [i]per person.[/i] My DH's style isn't one I can weild effectively, so I don't try. (And dare I say-- vice versa.)
Now your assuming everyone has the ability, the intellect, the um....[i]flexibility[/i], the [i]ESP[/i] to do that. Your assuming I can hold my breath that long.
But.....EWWWWWWW........I don't want my head that far up.....
Honestly? people respond better to [i]bluntness[/i] and [i]logic[/i] and [i]reason[/i] better than you may imagine. Probably a lot better than when they feel indebted to you. You ought to at least try it. [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img] Besides, a lot of chipmunks have tenure. [img]http://uumor.pair.com/nutalle2/peanutallergy/tongue.gif[/img]
Clean, Neat, Surgical. Logic. [i]Be the Vulcan.[/i]
Give your hubby a "high five" from me too. [img]http://uumor.pair.com/nutalle2/peanutallergy/cool.gif[/img]
I don't remember Spock ever saying: "I'll pay for it later." [img]http://uumor.pair.com/nutalle2/peanutallergy/tongue.gif[/img]
Oh, what was it (tapping keyboard) someone posted once:
[b]Be the change you want to see.[/b] [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img]
I'd like to see people do what they *should*. [i]Their job.[/i]

Posted on: Thu, 09/14/2006 - 1:37pm
anonymous's picture
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A recap and update:
Last Wed. I found that the school nurse changed the doctor's orders so Reece didn't go to school on Thurs or Friday. On Monday we took him with the intent of staying with him. The school director met us at said she'd like to speak with us. The first thing she said was "I called your doctor and now I they can't talk to me??" she was pretty upset. I had called the doctor's office telling them I didn't want any medical info. given out beyond the doctor's orders for the school. So, I told the school director that I didn't just say she couldn't have access but that nobody could. She calmed down.
Then, she handed us a typwritten letter stating she apologizes for the misunderstanding with the nurses orders and that she called Reece's nurse and confirmed orders and had them typed out. The letter also stated the "accomodations" they've made to keep Reece safe. So, I took that letter up to Reece's nurse to look over before signing it and she said it was great.
Anyway, I had a 2 hour appt. with Reece's Allergist and nurse yesterday. (Well, saw the nurse for most of that time and the dr. for about 15 minutes ). We went over all the paperwork and got things very worked out and cleared up.
She rewrote the orders several times because each time she wrote them we found something that was confusing. It's because of the forms they use, lol! (They're going to revise them now thanks to us ) The school director asked me if I'd take a few questions to the nurse/doctor so the nurse and doctor answered those too.
One thing that bothered me is the nurse assumed I was "on guard" and that I was overbearing to the school which is not the case at all. I told her for every one of those "accomodations" I've had to fight but it only got that way after being told "NO" for everything. That sort of bothered me but I didn't let it get me stressed, kwim?
Oh, this nurse isn't the one who has been dealing with the school but she and the other nurse and the doctor had a meeting about Reece's case prior to our appt.
We got the orders clear and I think the school is going to feel a lot better with everything. What was tripping everyone up was the word "symptoms" and "anaphylactic symptoms". Plus their form was very confusing! Even the nurse got confused at one point and said "Wow, even I'm confused!!".
So, the orders are:
If facial hives or facial swelling develop OR ingestion/contact (with any nuts or "may contain traces" of nuts is suspected or known:
Administer Benadryl 3.5 tsp
Observe patient closely (I'm supposed to tell them this means having an adult sit with Reece and watching him the entire time)
Administer Epi Pen if further *symptoms occur
Call 9-1-1- and transport to ER
*symptoms:
Itching and swelling of the lips, tongue or mouth
Hives, itchy rash, and or swelling about face or extremities
Itching and or sense of tightness in the throat, hoarseness, hacking cough
Nausea, abdominal cramps, vomiting and or diarrhea
Shortness of breath, repetive coughing and or wheezing
"Thready pulse", passing out, feeling impending doom
I think if the school gets confused about anything it will be this part: "If facial hives or facial swelling develop"..... I need to let them know that means if he breaks out in hives but they have no idea if he's eaten or been around nuts. (Meaning not suspected or known)
The questions from the school were good questions. (I understand they had a meeting and these questions were asked in the meeting) One was if they give Reece the Epi and he didn;t really need it what would happen. The answer is that there may be no effect, he may feel antsy, increased heart rate. Another question they asked is if the give him the Epi and 911 arrives and they say he's fine should they still call us to pick him up. Umm. . . **** yes Doctor's order was nicer.. he said "Yes, Epi can wear off and symptoms may return". Normally 9-1-1 would transport to an ER anyway. Another good one was that if Reece is out in the yard or at PE and gets shortness of breath could they try the inhaler first (due to his asthma). The doctor answered yes as long and he hasn't ingested any nuts.
They asked a few more questions but those were the good ones, I thought.
I can tell the school director has been given some direction in how she's handling things because things are so formal now. Letters, signatures and etc. Also, we have our 504 meeting on Monday afternoon.
Yesterday morning before the doctor's appt. I had a meeting with my friend's friend who knows school systems and 504's inside and out. (The one with all the degrees that I mentioned earlier in another post). She spent an hour with me going over the paperwork and etc. She gave me some good points for the 504 meeting (one thing she suggested is state that I want to be present for all the meetings and training classes concerning Reece's allergies and etc. I had thought of that too and had written it down in my journal I'm keeping. I was glad she mentioned it. Made me feel like I was on the right track. ) She said there's no way they're going to deny the 504. (I'm worried they might as I've read a lot of schools try that) She said it's in the school's best interest to have one on file for liability reasons (both sides) so hopefully she's right.
I have all my paperwork lined up and ready to go and so I'm ready for the meeting.
I want to talk with the school director about the doctor's orders (that I got yesterday) so that she fully understands them. (Since everything has been so difficult with this school it wouldn't surprise me if there is still some confusion about something). Plus there are some things I'm supposed to tell them. I want to set up a meeting with the staff so we can all go over it together. Oh, the woman (school 504 guru) I spoke with yesterday told me to always find out who "We all had training" or "We all had a meeting" is. She said I should always be told who's in the meetings.
Anyway, we'll see what happens with that but for now I'm feeling much better about everything. I can tell the Special Ed director is involved in our case now and Monday's meeting will be a making or breaking point, I'm sure.
and after thinking about things:
When I got to the Allergist's office yesterday we had a new nurse. One we've never met before and she took it upon herself to reassure me she was familiar with Reece's case and that she had a meeting with Linda (our regular nurse and the one who has been dealing with the school) and the doctor before our appt.
So, we got into the exam room and she sat down and pulled out her file so I stood next to her and had mine out. She said she had some signed papers for the school and that we needed to discuss everything. I told her I had a list of quetions from the school too when she had a chance and she told me we'd get to that and I said that's fine. She then said she needed to go over recent health issues first and I said that's good. She then told me "why don't you calm down and have a seat". WTH? I was calm as I had just gotten out of that meeting with the 504 guru. I was very calm, actually. So, I told her I was fine and she said "ok". Then we went through Reece's current issues and then started on the paperwork for the school. That's when she told me that she was impressed with the accomodations the school has made and I told her they were great and working out well that it's the treatment we're all confused about. She then said that I need to be not so directive in dealing with the school. That I need to basically "back off" but she didn't say it that way. I told her that the list of accomodations came about because I had to fight for every single item on that list. I can't remember what she said exactly but overall she was trying to tell me that you catch more flies with honey. I let it slide as I mentioned in the other post.
Anyway, the doctor came in and he was not his normal self. He's normally very friendly, smiling and just super talkative. I was lucky to get two words out of him. He asked me questions that he's asked me before and I even had to remind him of details of things he has told me. It was pretty odd. He then bent down to exam my ds and to break the ice I asked him if he had been on vacation recently. (he was super tan) He barely looked at me and said "no". I said "oh". Then he said "Why?" I said "You're tan" and she said "Oh, I went to San Diego with my wife" and I said "that will do it then".
Anyway, he was very, very reserved and seemed critical of me and I felt it.
So, just now as I was mopping the floor I put it all together. The school nurse spoke w/the doctor. I'm sure she wanted to clear her name on "changing the orders". (One of the first things the nurse at the office said was "we need to discuss the orders and talk about the confusion" to which I said "that would be great!").
Anyway, another thing the nurse (at the office) asked me is if I've been on the FAN website. I said I have. She "I thought so after seeing your letter to to the doctor and everything". She then said it's great that I'm getting so much information and then she said something else about how I'm taking it all to the school. That gave me an odd feeling too.
I did type of a questionairre to have the doctor fill out and his nurse did it and then he signed it so that's good.
But, I can't help but be uneasy about what's going on that I don't know about. I really am wondering what will happen in Monday's meeting.
I wonder if the doctor gave out any med info to the school nurse? Even if he did (not sure if that's legal or not per HIPPA laws and I think not. I have NEVER signed a release of any sort)Even if he did nothing would change as far as Reece's allergies and meds and treatment protocol but there's something I can't put my finger on.
Maybe I'm just expecting things to take a turn for the worse again since that's how it has been going from day one. Or maybe the school is going to deny the 504.
The 504 guru told me they can't deny it (because ds qualifies without a doubt) but I bet they try. I asked her what to do if they say he's inelligible and she said to tell them to prove it because he does and she said just go armed w/my info. She said if they continue to deny them then to stand up and say "I see we're going to have to take this to a higher level".
I did feel the entire time that it was odd Linda (our usual nurse) wasn't handling things. Towards the end of the appt. she poked her head in and said "Hi, how are you?" and I said I was good and thanked her for everything.
Oh, also at the end of the appt. the nurse (not Linda) went on to tell me how she deals with difficult situations and how being nice gets more done. (She have me an example of how she's done it in the past" WTH?
I wonder what the school or school nurse has said? Yes, I have fought and hard to make the school comply to keep Reece safe. I haven't asked for any out of this world accomodations. However, the school is acting like everything that has been done is their idea (and have tried to say that to me too!) and in the most recent letter there are things about how they've been working with me from day one. Yeah right
So, who knows what's going to happen on Monday.
I'm so sick of all of this! While we've made great strides there's still a lot unresolved.
I'm starting to realize it has been dumb of me to have everything be a one on one coversation with the school director. Only once was there ever another party in the room. I KNOW she's not looking out for our/ds' best interest. That has been apparent from day one.
With that said I need to go over the doctor's most recent (and much clearer) doctors orders with the school. I don't feel that I should do that soley w/the school director. It seems anytime things go from me to her they get lost once they leave the room or confused or something. I think I should make sure the school nurse is involved in this conversation, don't you? Of course I could just hand the paperwork to the school director but there are some things I want to make sure are clear with her so that she relays it correctly to the staff/teachers and etc. I wonder if I should wait till Monday's appt. and just keep ds out of school until then?
Oh as far as the side convos about being overly sweet or sweet in general to get what you (general you) want I can see that to a point but I can also see being assertive when it's necessary. If I hadn't asserted in way my ds would be in a classroom sitting next to "Janey" eating her PB& J everyday because "That's a staple of the Kindergarten diet and they in no way can take that from her". Also, he wouldn't be able to have his epis and they'd be using the communal hand washing buckets.
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