Did I do the right thing?

[rainydaysRN]

I am trying to get opinions on whether I did the right thing. I am a new school nurse working with middle school kids. The very first day, I get a report that a student passed out and fell while enrolling. I run to the area where the student is and find her to be conscious and sitting up. We wheel her to the clinic and I assess her. She denies any dizziness, nausea, etc. and is alert and oriented. She did complain of a headache but said it was present before she passed out. She had not eaten all day and had been sick for a few days. It was reported that she hit her head on a chair when she fell. I palpated the area and felt a small bump and the area was sensitive to touch. I did not dig through her hair to visualize the bump. We applied an ice pack to her head. No bleeding was noted at anytime. Her mother was present the entire time. I recommended to the mother that she should take her daughter to be evaluated further by a doctor (but did not specifically recommend the ER). The next day, the mother came back to the school to speak with me and was extremely upset that I did not send her daughter to the ER. She stated she took her daughter to her doctor who discovered a laceration in the area where she hit her head. She was sent to the ER and needed a few staples. She accused me of not assessing her daughter well and not following proper protocol and she states that that is what the hospital told her. I am so shaken. Did I do the right thing? Should I have sent her directly to the ER? What would you have done? I am definitely second guessing everything now.

[bsyrn, ASN, RN]

I would have recommended the ER just based on the mechanism of injury and the fact she passed out. don't beat yourself up about this. Live and learn, it's what we all do :)

[Rubor]

So lets nick pick over you saying follow up with a doctor or go to the ER? Seriously! That really is not the point, the mom was present and you RECOMMENDED follow up care. She is present she is the parent of the child she needs to take some responsibility.

You are not there to take her by the hand and walk her (meaning parent) to where she needs to be. I will refer parents all the time to seek medical attention and half of the time they make the choice NOT to do so. I document everything regarding my recommendations but I am not their master. It is very frustrating how as schools we have enabled parents/catered to them.

The situation could have been a lot different had mom not been present, a call placed perhaps to 911, call to parents (by the way parents can DENY 911 transport over the phone if they talk to the paramedics). Really who knows what/how it would've played out. For the situation you were in you responded appropriately. Just make sure you document EVERYTHING you did, said, saw, etc.

[Flare, ASN, BSN]

don't dwell on this one. mom was right there and you told her to take the kid to A doctor. If the mom chose the take her to the pediatrician instead of the ER then got mad at you because you didn't specify the ER and she wasn't bright enough to figure out that a child that passed out and has a possible laceration may need the ER over the pediatrician's office - then she's on her own. Just know that she's out there and will probably be a thorn in your side again

[PrayeRNurse, ASN, RN]

Having had several head lac. in my office I do standard assessment including PERRL and Alert X3, Reflexes, I measure the lump and yes I eye ball it also looking for sunken areas. I always tell parents with any head injury to seek further medical care from PCP, Urgent Care or ED. I document the exam, Tx and the directions given. If they pass out either before or after I ask the parent to go right to ED. You did good and confidence is earned over time! You are seeking knowledge to grow from this experience and that indicates you are a great nurse!

[SchoolNurseSince95]

When parents are present, they are responsible for their children. The intention of the parent to be on-site was to register the child, not to seek medical care. The ER staff either did not really say what that parent stated, or they are ignorant of what really happens at a school. You are not a primary care provider, nor are you an ER triage nurse or MD. Don't let bully parents get in your head. You gave prudent care and suggestions. The parent just felt guilty for not making their child eat prior to attending registration.