Almost walked out today

[momto5RN]

Okay, so I'm being a little over the top with the title but really could use some advice please.

Okay, quick background. Remember my post a few weeks back. Suicidal student, had to call 911. Not really informed about anything from the principal. She was sent out on a Friday and was back in school THAT Monday! Yes, it makes no sense. Did anyone give me information about this situation? No. I had to talk with the principal and it was basically like pulling teeth to get information out. Had to explain to her how these feelings just don't disappear like that, how she needs to be monitored, etc.

Fast forward to this past week. Student comes into my office earlier in the week at lunch time with a classmate stating she felt faint (exact words). No signs of being upset, not crying, etc. I sit her down, take her vitals. Then she started to break down and cry. She didn't want to talk. I had her friend bring her lunch in so she could calm down and eat lunch in my office where she could feel safe and away from whatever was causing her to feel sad. Teacher comes in once lunch was done to check in on her. I told her she wasn't feeling well and will walk her back to class after she finishes her lunch. I walk her back and notify the principal that she was with me. Principal flips out and says, next time she goes to you, send her to me. I state, why, her main complaint was feeling faint. As a nurse, I must assess her blood pressure, etc. If I send her to you and she faints, that will be on me. She argues with me again and says it again to send her to the principal's office.

Now for today. She came in the morning for a sore throat. I saw her for 2 minutes. All documented. I didn't bother to tell the principal because this was a non issue. Gave her water, checked her throat, back to class. Then I saw her at recess with a classmate. Visibly upset. I call the principal and state she is quite upset, would you like me to walk her to your office. She says yes, so I personally walk her up myself. About 10 minutes later she is back in my office. I said how did everything go with the principal. She says everything is fine but her stomach is hurting. I had her rest, took temp, water, etc. Class is still at recess. She left about 15 mins later (all documented) since I saw her class coming inside.

Next thing I know, I have a call from the main office, asking where she is, how her teacher has been frantically looking for her for a half hour. I said she just left at 1:45, had a stomach ache, and should be on her way upstairs. That she was also with the principal. Her homeroom teacher even saw me walking her to the principal's office as she was not outside during recess (another teacher was). So she was not "frantically looking for her for a half hour." As I was about to go to the office to figure out what was going on, the principal comes in, yells at me, "I told you to have her come to me whenever she comes to see you!" I told her she has a stomach ache. She says nothing and storms out.

I was beyond angry!!! Why isn't she allowed in my office? Aren't I a medical professional trained to handle these situations?! Who was the first teacher who allowed permission to go to the nurse's office since everyone is acting like they had no clue where she was? What do i do when the principal is not in the building? This is a small Catholic and we do not have any counselor or anyone like that around. Why doesn't the principal have a meeting with the teachers and I if she is that adamant about having her be sent to her office instead of mine. So I guess I should send her to the principal's office for every complaint then...Stomach ache, sore throat, scraped knee, etc.

I am writing her a letter and an email because I am beyond upset about her unprofessional attitude and would like to know in crystal clear instructions what she wants me to do. I also want to implement nurse's passes since a similar situation earlier in the year where another teacher had no clue where her student was. He lied to his teacher and said he had to use the restroom but instead came to my office. How would you have handled this?? Thanks for listening!

[NutmeggeRN, BSN]

Ugh...I would send her... Every. Single. Time...

and also ask her specifically what she would like you to do in the event she is not there.

[NurseBeans, BSN, RN, EMT-B]

As far as student accountability, I don't see how they would expect you to know where students are if they are not with you. I don't know about you, but I barely am able to leave my little nurse's cave. Can't keep track of much if I can't leave my office. And aside from a few of our ASD kiddos and the brand new KN's, they should be able to get back to class alone. And be held responsible for not being in the right place or the place they said they were going.

As far as the child with the behavioral health issues, is the principal a counselor? Or a psychologist? Why does she feel she is more qualified to deal with a child in mental distress than the nurse? Whatever the issue is from now on, I would send that child to the principal (after treating) EVERY TIME. Drive home the point that the principal is being crazy.

And remember, summer is coming. Soon this will all be but a memory:up:

[OldDude]

Do your assessment and take her to the principal. And, as Nutmegge said, get it in an email, who is the designee if the principal is not there, and who is the designee's designee just in case. As far as her unprofessional attitude; she is who she is and she is the queen of the castle, don't let her misery ruin your attitude. I bet she uses her horn a lot when she's driving.

[JenTheSchoolRN, BSN, RN]

Ugh...I would send her... Every. Single. Time...

and also ask her specifically what she would like you to do in the event she is not there.

This.

Did this student have the medical OK to return to school? Our policy is we cannot let a suicidal student return to school without a signed letter after being evaluated that the student is safe to return; we also require a safety plan that our counselor makes with the student. Sometimes a recommended safety plan is sent in with the student, but the student & parent will sign it/verbally agree to it.

It sounds like you have no policies in place like this, which is very frustrating . In your case, I'd send to the principal after getting her policy to do in writing, document on my end. If something happens to the student, it will be on the principal.

Of course, as an aside, it still sucks. Because you want to help this student who definitely needs help. Have you reached out to the parent for an update on outside counseling? Or would you principal poo-poo that? (Which I'd likely still do as a simple health follow-up...)

Also passes. I love passes. I require them. I send students back to class without them or have verified with teacher via email/call to classroom that they were actually sent to see me. But I deal with MS/HS kids - they will fib. A lot .

[MrNurse(x2), ADN]

Your hands are tied. That being said, your license mandates that you report suicidal ideation, this may be exactly why she wants to limit contact with you. The family may be upset it was reported. Being private, parents hold the pursestrings and hold huge sway over what happens. It is my opinion (I had this happen last year in my private school with no counselor) that you are being taken out of the loop so this child doesn't get emergency petitioned. I WOULD NOT want to be that Principal if ideation turns to action.

[halohg, RN]

Agree with all the above, when dealing with a private school or catholic school secrecy and control is very common and just part of the culture that your not going to be able to change. Frustrating yes but...you will never have them agree to your side.

[Kooky Korky, BSN, RN]

Your hands are tied. That being said, your license mandates that you report suicidal ideation, this may be exactly why she wants to limit contact with you. The family may be upset it was reported. Being private, parents hold the purse strings and hold huge sway over what happens. It is my opinion (I had this happen last year in my private school with no counselor) that you are being taken out of the loop so this child doesn't get emergency petitioned. I WOULD NOT want to be that Principal if ideation turns to action.

The foregoing sounds like it hits the nail on the head. Your Principal isn't doubting your abilities, she is afraid you'll be too good at your job, as stated above.

Document every visit to you, walk her personally to the Principal after you deal with the medical c/o.

Don't let yourself be the last person alone with this child.

Make sure someone besides the Principal knows you are bring Miss Student to the Principal. Do not let this child out of your sight. She might go outside of the building, she might hang herself in the basement, she might have a gun, or God knows what.

If your license really does require you to report SI (to whom?), do it, big donors be damned (but don't say that, just say your license requires you to report).

I knew of a teacher at a private school who had given an F to a student. The Principal asked him to change the grade because the student's parents were big donors. Teacher refused. Teacher was fired.

Frustrating, but a wiser approach would have been to have the girl do extra credit work to at least earn a passing grade and maybe even learn something in the process. Teacher could have kept his job, student might have gained knowledge of the subject and learned that she had to work to pass, and that Mom and Dad weren't going to always rescue her and pave her road in life.

[FolksBtrippin, BSN, RN]

Seems like something is not being communicated here.

My suspicions are that the family or principal or both think the child is faking illness and/or attention seeking. What they may not realize is that even if the child is faking, it is still a sign of distress that needs to be evaluated and treated.

I would ask for a private meeting with the principal. And then ask why she has requested that the student be sent to her every time she goes to the nurse. What does she think is going on with the child? What is her motive?

If you continue to be shut out and you can't solve the problem with the principal, your role as the school nurse is not being respected. The principal is essentially stopping you from doing your job.

[Apple-Core, ASN, BSN, RN]

DOCUMENT EVERYTHING! Every communication with the Principal, teachers, this student, every student. I mean, above and beyond your medical documentation. Keep a private notebook and make note of time, date, what was said. Everything. You need to CYA in case things go further.

[palli]

Bring student, thermometer, BP cuff to the principals office. Do vitals in front of principal , deem her healthy enough to stay in school and leave, you have other students to care for. Let the principal handle it from there. You are there for the student, if the principal insists on having her brought each and every time, then do it.

[momto5RN]

Thank you everyone for the responses, much appreciated!!

I was quite upset about the situation and ended up taking a personal day right before spring break started. Have been back to school from break for two weeks now. Just saw this student today because she got her period. I immediately called the prinicipal (who is a Nun) and stated everything is okay with the student, she is in my office because she just started her period. She used my bathroom and then I walked her directly back to her class. The principal clearly sounded uncomfortable on the phone when I told her why she was in here but hey, she makes the rules right. I document everything as I always do. I think I over document but I would rather be safe than sorry. Thank you again for the advice!! My first time dealing with a heavy mental health situation.