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?

@CormorantStrikesBack it would be a different scenario if it was her own child. There would be no liability/potential laws in a home setting as opposed to a work setting. If it was her own child the op could get as much support as necessary to feel competent.

Well intentioned waffling? What a way to snidely put down people sharing their actual experiences

As someone with a child who needs medical care and someone who worked in schools for over 20 years until recently I can’t think of a single parent whose child required medical care who threatened or abused staff.

The abuse of school staff is a whole other debate that isn’t related to kids with medical issues. It’s most often over behaviour issues (be they the pupils behaviour or the parents).

I know what a nurse is thanks, I am one.

The school nurses don’t support my diabetic child, the diabetic team do.

Ha!

ds is in year 9 now. The school nurse wrote a care plan when he started in reception. That was the last contact we have had with them.

nurses from his feed company have provided training for both schools on the feeding tube (and ongoing support if needed but not day to day) and for his other medical conditions the hospital have provided them with a written care plan but not actually spoken to school.

most of the training/information comes via me.

Schools don’t have nurses on a daily basis anymore. They don’t even have them on a termly basis.

@Sirzy I couldn’t even tell you who our school nurse is…

I thought this was electronic now?

Op you are right to stand your ground. Posters who are saying YABU clearly have no medical training either and worryingly would take on tasks that could have dire consequences without adequate knowledge. Monitoring and medicating to control insulin levels is not a 'pick it up as you go along' sort of task, it is imperative to get it correct with very little scope for mistakes. I have 15 years of medical experience and it requires full concentration, there is no way you can be complacent - I would definitely continue to refuse to do this due to the responsibility and your lack of nursing background.

Strange. Maybe different in Scotland.

Also the “but the parents do it” argument is very different. Pre DS I never thought I would be changing feeding tubes, or trained in emergency injections but as a parent you do it because it’s what’s needed. I wouldn’t have learnt to do those things for another child as the idea would have petrified me. it did when I had to learn it for DS but I had no choice.

i would do it now for another child because my life experience has given me the confidence but I wouldn’t expect anyone else to if they weren’t comfy.

@FlyingPizzaMonkey ok, so we both agree diabetes need managed by professionals in the field then as opposed to under-confident TA with no medical background. Your reply was disproportionate response and tone to respond to me. I am agreeing with you! Diabetes needs medically managed.

Agree that there should be more than 1 person trained as they may be off sick or something. If proper training is given then there is no reason not to try. Doing extra like this helps with professional development and you might find you enjoy it. It should be recognised by the school though.

With regard to the nurses? I can assure you it’s not.

Scottish primary schools don’t have daily or weekly nurses either anymore.

@Sirzy would the risk assessments not need the staff to have training certificates in date? How could they if it was you delivering the training?

There are generally no official courses that come with certificates for things like this.

DDs specialist nurse trained her school on her needs, but nobody got a certificate for it. It was just recorded down.

Some places do diabetes training, but generally anything medical is specific to the child involved so no certificate for “care for Mary’s x condition”

How was it disproportionate? I wouldn’t want a school nurse who tbh I’ve no idea who they are anywhere near my child.

Maybe it is different in Scotland but school nurses have lots of schools to cover and I imagine are taking up with safeguarding cases.

Yes the diabetic team manage his overall care but it’s the TAs and teachers who have been trained (by them) that administer his insulin, treat his hypos and give correction doses. Overseen by me and following his plan of care. I’m very lucky that I trust them and they phone me with any query. He has to be able to live a normal life. You should have seen the amount of organisation it took for a 3 night residential!

The op wouldn’t be allowed to administer anything until trained by a diabetes specialist. At my school they come in from the hospital and provide a set amount of training. Over my years teaching, I’ve done the training 3 times. The training also runs out, so if you were based with the same child for 5 years, you’d still redo the training each new academic year.

They then have to supervise you giving insulin before they sign you off to do this independently. If you’re not confident they won’t sign you off. It’s not a case of the child turning up with a bag of medication and you hoping for the best. At our school, parents administer the insulin at lunchtime, until school staff are trained and signed off.

In my experience-
-Schools generally have a fridge for medication and if they don’t would have to provide one for a diabetic child.
-The sharps box is part of the child’s prescription. The child takes this home when full.
-The parent calculates the insulin, based on the school lunch menu or what the child brings in their lunchbox.

Hi Op,

Being expected to do something like this as part of your role can be extremely daunting, and I fully understand your concerns.

This is how it worked for us:

The training was given by the Junior Diabetes Team - fully qualified medical professionals who knew the child well. It included information about what diabetes is and how to manage it. We received full training on how to use a glucose monitor and how to use the insulin pen and had plenty of opportunities to practice using these before doing it for real. We even got to try taking our own blood sugar too so we understood what it felt like.

Then, when we were ready, we did this with a medical professional to support, then supported by someone that the medical team had deemed as competent. When we were confident, the medical team returned and observed. If they felt we were confident and competent, they signed us off. This for some people was several months later, and we had one where it was agreed that she would support but not administer the insulin as she was not confident in doing so.

In my workplace, we had four staff trained who administered the insulin on a rota basis to keep their knowledge and skills current and to allow for absence. They always worked in pairs when giving the insulin, and everything was double checked, recorded and signed. The Diabetes Team provided a flow chart of exactly what to do and when, which was clear and easy to follow. The carb counting was done by the parents according to the meals set, with a chart of how to adjust this according to the child’s blood glucose reading. We were also provided with emergency numbers for the team in case we had an urgent query. The support and guidance was fantastic, and the staff felt incredibly supported.

Beyond school, we worked with the team and parents to support the children (several over the years) in attending day trips and residentials both in the UK and abroad.

if you have any questions, feel free to drop me a message.

Firstly, she is not SEN, she has SEN.

I'm sorry, I wouldn't pull anyone else up on this but you've been a TA for 7 years and this is important.

Secondly, if you've absolutely made up your mind you won't be doing it or the training, tell them that and call in your union if necessary, unless you've missed it in your job description.

It’s exactly the same in England. The diabetes team from the hospital train school staff then observe us and sign us off. Parents generally support at lunchtime to begin with, to bridge the gap.

We don’t even have a named nurse anymore. It’s a school nursing team and they wouldn’t be involved in training us up, as they’re not diabetes specialists.

Ok well my bad. My dc are in a private school and I just assumed that there is at least some medically trained person at school for anything like this. I got an email from the school nurse last term that she put a plaster on my ds for a cut. It was a little paper cut 🤣
Although I did go to a state school in another country and we always had a school nurse and sickness room for anything medical related so assumed all schools have that here, private or state.

Not sure if you’re in England, but school nurse provision just doesn’t work like that here. Schools don’t have one nurse just sat in the school all day long, every day of the school year to deal with bumped heads and medicines.

School nurses cover all of the schools in a defined geographical area and only really have contact with the most vulnerable children - either health or safeguarding needs. Even those with health needs, it will be an infrequent check in with school so they can liaise with health services and social care, if involved. It’s an administrative role, at the heart of it, rather than hands on physical care.

School Nursing is the follow on provision from the Health Visiting program once children reach 5 years old. Health Visiting in England is much the same, actual Band 6 health visitors often only have contact with the most high intensity vulnerable families.

Schools don’t actually technically have to even have a first aider for the children. There is a legal obligation to have one for staff in a workplace, but the first aid regulations don’t actually cover pupils.

Obviously they all do, but state schools don’t have nurses available easily. There are school nursing teams in each area, but they are small in number so don’t have daily, even weekly, contact with individual schools let alone pupils

Absolutely correct, from a friend who works as a health visitor in Scotland I understand that the provision of health visiting couldn’t be more different from how it is in England. It sounds like a Utopia!

The school nursing system isn’t that different in Scotland. It’s no utopia.