Confidence

Specialties School

Published

I just started as daycare early head start nurse/ advocate... I have to tell you every bump, skin rash, bug bite looks all the same to me... is there any way to get more confident in that area. It drives me crazy and adds to my anxiety.

I agree! I'm worried it's going to end up being something more serious and the parents are going to want to know how and why I missed it!

Flare, ASN, BSN

4,431 Posts

Specializes in school nursing, ortho, trauma.

The first thing to consider... now repeat after me... " as a nurse, I cannot make a diagnosis" -now take a breath and don't let anybody judge you or how you do things at work.

the second thing to consider is that many skin irritations / dermatological issues etc only get really identifiable after they really get ugly. At least by the id book standards/ google images. Some things are a bit easier than others and history is always helpful - like is this child know to have eczema and are you seeing a fine rough rash or did this child just get back from a weekend in the woods and now has papules that look an awful lot like poison something? Insect bites tend to have a little bite in the center of them, but of course by the time we see them the children forget all about being outside and have scratched the bejesus out of them and it's not uncommon for the entire area to be inflamed.

To be safe, I usually grab a temp on most rashy looking things that i can't automatically identify. If there's a mild temp, i will usually look for a pick up and further med attention - especially if there is any spreading or change in the rash.

MrNurse(x2), ADN

2,558 Posts

Specializes in IMC, school nursing.
The first thing to consider... now repeat after me... " as a nurse, I cannot make a diagnosis" -now take a breath and don't let anybody judge you or how you do things at work.

This is what parents just don't get. I constantly say that I would have a doctor look at it and they always want me to tell them a diagnosis. I constantly tell them I don't make enough for that.

kidzcare

3,393 Posts

The first thing to consider... now repeat after me... " as a nurse, I cannot make a diagnosis" -now take a breath and don't let anybody judge you or how you do things at work.

the second thing to consider is that many skin irritations / dermatological issues etc only get really identifiable after they really get ugly. At least by the id book standards/ google images. Some things are a bit easier than others and history is always helpful - like is this child know to have eczema and are you seeing a fine rough rash or did this child just get back from a weekend in the woods and now has papules that look an awful lot like poison something? Insect bites tend to have a little bite in the center of them, but of course by the time we see them the children forget all about being outside and have scratched the bejesus out of them and it's not uncommon for the entire area to be inflamed.

To be safe, I usually grab a temp on most rashy looking things that i can't automatically identify. If there's a mild temp, i will usually look for a pick up and further med attention - especially if there is any spreading or change in the rash.

This is all good advice and pretty much what I was going to type up :)

The confidence is a "fake til you make it" thing. Remember, silence is your friend.

For example:

You (on the phone)- Little Timmy has a rash on his arms and torso that is really bothering him. He'll need to be evaluated by your dr.

Parent- OMG! What is it?

You- Uh, I don't know. Could be an allergic reaction or a reaction to poison ivy maybe? I'm not sure, it's probably not chicken pox or anything though, but I'm not sure....

Parent- do you have chicken pox in the school???? why wasn't I informed?? How do you know that's not it???

You- Uh, it probably isn't but I just don't know....

Ect, ect. I give only the facts and nothing else. Don't respond if you don't know :)

You- Little Timmy has a rash on his arms and torso that is really bothering him. He'll need to be evaluated by your dr.

Parent- OMG! What is it?

You- I don't really know and he says he did not come into contact with or eat anything unusual.

Parent- So what do you think it is??

You- I couldn't say for sure.

Parent-

You-

Parent- You don't have any idea?

You- It could be any number of benign things. Please have the doctor write a note clearing him to return to school.

Thank you all so much. This is all such great advice and extremely helpful. I do remember the "fake it till you make it"... used that alot in nursing school. I have a friend that tells me to keep swimming and boy am I doing that too. I do need to learn to breathe and take it easy and not be so hard on myself. I sometimes expect that I have to be perfect and have the right answer and having the wrong will cause a disastrous situation such as a communicable disease spread throughout the daycare... I really need to breath

NutmeggeRN, BSN

2 Articles; 4,620 Posts

Specializes in kids.

In my 22 year and I'm still learning! It's all good!

Cattz, ADN

1,068 Posts

Specializes in School Nurse. Having conversations with littles..

Yes, please take a deep breath. I don't know what state you are from. But, this link

http://health.mo.gov/living/families/schoolhealth/pdf/Communicable_Disease.pdf . It is my one and only go-to for all my schools . It is an amazing resource. It takes the guess work out of various questionable health issues. I hope you will take a look at it and print it so that you can have it at your fingertips.

Farawyn

12,646 Posts

Yes, please take a deep breath. I don't know what state you are from. But, this link

http://health.mo.gov/living/families/schoolhealth/pdf/Communicable_Disease.pdf . It is my one and only go-to for all my schools . It is an amazing resource. It takes the guess work out of various questionable health issues. I hope you will take a look at it and print it so that you can have it at your fingertips.

*FLYING TACKLE HUG*

Cattz, ADN

1,068 Posts

Specializes in School Nurse. Having conversations with littles..
*FLYING TACKLE HUG*

Same to you Far. This makes me laugh :yeah: :roflmao:

MrNurse(x2), ADN

2,558 Posts

Specializes in IMC, school nursing.
Yes, please take a deep breath. I don't know what state you are from. But, this link

http://health.mo.gov/living/families/schoolhealth/pdf/Communicable_Disease.pdf . It is my one and only go-to for all my schools . It is an amazing resource. It takes the guess work out of various questionable health issues. I hope you will take a look at it and print it so that you can have it at your fingertips.

Bookmarked (we don't have enough toner to print at this time, end of year problems at small schools) for reference. Love it, thanks so much for sharing.

Cattz, ADN

1,068 Posts

Specializes in School Nurse. Having conversations with littles..

When I use it to decide to send a kiddo home or let them stay. I pretty much always say "according to the Prevention and Control of Communicable Diseases Manual" Then whatever the appropriate action is. THIS has a very distinct and direct tone.

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