Medical needs with no nursing medical background

[FionMcCool]

I am currently a teaching assistant at a local primary school, have worked in my current role since 2017. Job role is literally a general teaching assistant, nothing extra. A new child has started at the school and has diabetes. She needs to pin prick her finger daily and has injections. She is also SEN so cannot do so independently, an adult has to administer the needles, take the blood etc. I have been 'told' - not asked, I am to be her 1:1 and tend to her medical needs. I have had no nursing experience, and am extremely uncomfortable with this. Firstly, I wasn't actually asked if I am confident and at ease with this, was just told blasé I would get training and get on with it. Simple fact is, no, I'm not going to do it. I'll take it all the way with meetings etc I don't care, I am uneasy, anxious and upset and will not be forced in to doing so. AIBU?

OK.

Well that's that I guess.

No, YANBU - but try out the training? You might decide you can cope? But it is entirely up to you if you say no. Of course, you might lose your job, but its your choice. No one can make you do these things if you don't want to. I have said no to similar, and have not lost my job ( although I would have been prepared to)

You ask first thing on Monday for the training you need to do the job.
If training not provided don't do it.
Child and parents depend on your knowledge.

If you work as a TA with SEN children you should be able to do minor nursing like this with proper training. Or that was the expectation at my children's primary school.

I'm a nurse. I don't blame you for not wanting to. Tbh I'm surprised you would be expected to administer insulin to a child. It's hard to work out the dosing for rapid acting insulin as it can vary depending on blood sugar levels, carbs, activity levels etc.

I would say a firm no too if I were you. Administering insulin is not minor nursing, it's very complex and if you get it wrong it can be fatal.

Do you think parents of children with T1 all have nursing experience? And T1 patients themselves?

All depends if you get the relevant training

I think seeing as they’re providing the training you’re being a bit unreasonable. I’m assuming that depending on blood sugar reading there will be some sort of flow chart of how much insulin to give. So you just follow what’s set out.

the pin pricks are easy, the insulin pens are very easy to use and to set to the amount you want. The needles are tiny.

if this was your child or yourself you’d have to learn to do it.

What do you think happens in schools across the country? Should children with additional medical needs just not go to school?

I have a type 1 child. We have 3 TAs and 2 or 3 teachers who are trained. The diabetic team came into school for a period to time to train everyone, handover the plan of care and I worked closely with the the school to ensure they were happy with injecting for several weeks. They are all fantastic.

I understand it’s daunting. At our school they asked for volunteers, no one was ‘told’.

I’m surprised this pupil doesn’t have a CGM rather than finger pricks, especially she’s got SEN.

I’m a nurse too btw.

I did exactly this for 3 years because every single other TA in our school completely refused just like you are doing. It ended up being myself and a teacher trained to do it but obviously she had to teach so unless it was an emergency then I did it.

We had a huge amount of training from the diabetes nurses at our local hospital. Mum worked out the carbs every day at the start then I took over when I became more confident.

The only negative (if you can call it that!) was that I became very attached to the child, I’d go home and worry about her all night (long story but Mum wasn’t on top of her condition). We spent so much time together as her diabetes was very unstable that she became very reliant on me.

But that’s a small price to pay for her to be able to be in school. She was in Reception, Y1 and Y2 at that point so she definitely couldn’t manage it by herself.

How severe are her SEN? Everyone saying it’s fine weren’t helping SEN DCs. I’d be worried -surely it’s very serious if it goes wrong.

Did the job spec not state that all aspects of care may be involved and does your contract not state "...and anything else as directed by the Headteacher"?
Yes, diabetes can be very daunting to support but you are there for a child. I have ceased to be surprised anymore by the number of people who want to work with children but don't want to do nappies, or lifting, or first aid.
I have several diabetic children in my school. I ensure staff are well trained to carry out all aspects of the children's care. Parents are expected to be part of this process and keep us fully updated. This is part and parcel of the care of a child and people who will 'take it all the way' to not look after a child, should not be working with children. Who do you think should do this?

How is that relevant. If that's your child then it's your responsibility to. A Ta who signed up to be that is now getting all sorts of stuff dumped on them. I say this as someone who has a T1 diabetic in my home.
Can't the child be taken to the school nurse to do this daily?

Of course you can refuse, the same as you can refuse to work with a child with challenging behaviour or doubly incontinent etc. However, I would like to think you could step up to the role.

Following training, you should be confident enough to support the child. I’ve assisted two children with diabetes and it really isn’t that daunting. Yes, initially doing their injections was scary but you soon get used to it. I just didn’t want to hurt them. You learn to recognise when they’re at risk of a hypo and can step in early enough.

If you’re considering remaining as a TA you may have to get used to this, as more and more children seem to be getting diagnosed.

What school has a school nurse? Never known one. Not even 30 years ago when I was at school.

I don't know where you live, but primary schools in the UK don't usually have their own nurses!

How many UK primary schools do you think have a full time nurse??

I think it's a huge responsibility. I was in a similar position some years ago, and didn't feel competent to do it, despite being given the training. If you make a mistake, the consequences are enormous.
But not everyone felt the same, some of the younger staff were quite confident doing it. On reflection, I wonder if that's because they weren't dealing with the menopausal brain fog I was suffering from!

I did the training as a class teacher with a T1 diabetic in reception with significant additional needs including incontinence and little verbal communication. They had a 1:1 in the mornings, but three of us did the training so we had back-up. It was not complicated.
The school cannot change your contract unless you agree, so they need to employ a 1:1 for the child until they’re able to take control themselves. I had Y5 who were at that stage, but some will not get there by the end of primary.
The child’s needs are paramount, if you can’t meet them, it’s the school’s problem, not yours.

We didn’t administer insulin, we called a parent if we were very concerned about the levels. Sometimes phone advice from them was enough, sometimes the parent came in.

This is part and parcel of the care of a child and people who will 'take it all the way' to not look after a child, should not be working with children.

What an unpleasant attitude for SLT to have. The OP is frightened of the responsibility for a child’s safety and well-being, that she isn’t trained and is aware of the possible consequences if she screws up.
I’ve worked with countless TAs and teachers, all with different strengths and worries. Some they overcame, some they didn’t. But that’s what working as a team means. Together you can deal with most issues.
And you think telling her not to work with children is the answer?

School nurse?? What school nurse? 😂

TAs and teachers do take on a massive amount of healthcare. I’m very grateful for everything they do for my child. He goes on residential, school trips. He shouldn’t and doesn’t have to miss out.

I’ve only ever encountered one TA who has declined to be trained to assist with Dds diabetes. She had a needle phobia so it was understandable.

At her first school two TAs, her one-to-one and another who spent time in her class, plus two teachers (hers and the other from her year group) were trained. It was mostly her one-to-one that was involved, but the rest could if needed.

At her current SEN school most of the staff are trained as there are a number of diabetic pupils.

No staff member can be forced to do anything like this is they don’t want to.

my son is tube fed and has feeds in school (mainstream, secondary now but same at primary) 5 staff members are trained to do the feeds and care around it but that choice was given to the staff, no staff member has been made to do it.

he has another condition which means that he needs to carry an emergency injection in case he is injured/severely ill. When he was diagnosed with that we were given a kit for school but they don’t provide staff training in giving it the instructions for school are call 999 and parents whoever gets there first will give it. This is because so many staff wouldn’t feel comfy setting up and giving an injection (it’s not auto injector like an epi pen)

I am very greatful for the staff who have had extra training but I don’t expect it or think any less of a staff member who says they aren’t comfy. I work in a school and before having to learn so much for DS I wouldn’t have felt comfy with it either.

Can't the child be taken to the school nurse to do this daily?

School nurses haven't been based in schools for donkeys years!

I work in a mainstream primary school and our TA's would do this (and have done this) but they have a lot of training and support. It is not unusual at all these days for TA's to be supporting students with complex medical needs in mainstream schools. The alternative is those children don't attend school!

It’s very normal to be expected to meet the needs of a diabetic child in a mainstream school. Diabetes is fairly common. What do you suggest as an alternative?

Even if there were such people as school nurses on site (which there aren’t!) it would still need to be someone based with that child that was trained.

It shouldn’t just be you who is trained though. You can’t guarantee you’re at work all the time. There should be 2-3 staff that the child is regularly in contact with who can check levels, administer medication etc