First week as a school nurse- advice needed

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Hi everyone,

I started my first school nursing job this week (came from the icu). Overall it went well- still figuring out where everything is, policies, etc. I love the school, kids, staff, and schedule!! However- I had one negative experience which I can't get out of my mind!

My second day, a little boy (2nd grade) came in from recess because he slipped (not witnessed and couldn't get a good story of mechanism). His wrist was hurting- not swollen, full range of motion. I applied ice and sent him back to class. I attempted a call home (no answer on mom or dad cell) and left a message. When he came back to drop off his ice pack, I assessed again. This time it was slightly swollen, pain was minimal but still full ROM. I called mom again, this time she answered. I told her what happened- described the swelling and suggested X-rays if the swelling continues. I also Sent a note home with the boy restating this.

2 days later I hear from my principal- turns out it was a buckle fracture! She didn't call me, but called him to tell him how angry she was with the "new nurse." She was upset that I kept him in school and "didn't try to get a hold of her sooner." I explained the whole story to my principal. Now I feel like he thinks I am incompetent and I am second guessing everything! I see 50-60 kids a day, many of which present with similar stories. Should I send a kid home anytime there is swelling? I feel kind of lost!

Thanks for reading. I think I just needed to vent!

This is my first year as a school nurse too and have had several instances where I had trouble contacting a parent. I document each and every attempt to reach the student's family and when I don't reach them, I always make the principal aware. That way I am covered. I also send a brief note with the student (and document that I sent it). Of course it would be so much easier if they would keep the school up to date on the ever changing phone numbers! The parents here seem to change phone numbers on a monthly basis, then get upset that we didn't call them over the least thing...ugggg!

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I'm beginning to think that "missing" a fracture, and then proceeding to beat oneself up about it, are rites of passage for the new school nurse! I was surely there myself earlier this year.

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Specializes in Acute Care, CM, School Nursing.

I don't think you did anything wrong! IMO, mom feels guilty that nobody was reachable by phone the first time you called. She is taking it out on you!

Also, buckle fractures are so sneaky! When my daughter was in kindergarten, she jumped over a baby gate and landed on her arm. She barely even cried, then she was fine. She even laid down on the couch, on the side of the "hurt arm". The next morning, she was unable to bend her arm back to put her jacket on. Up until that moment, she hadn't made another peep about the arm. I took her to urgent care, and she had a buckle fracture to her arm! The dr said that often, these fractures don't bother the child until the next day. I felt like a huge moron, letting my poor daughter sleep on a broken arm! But there was no swelling, bruising, nothing! It amazed me...

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Specializes in L&D, school nursing.

Sadly, having to contact parents is by far the worst part of school nursing in my opinion. Parents are constantly changing phone numbers, voice mail boxes are full, and when they finally do call back they seem so freaked out and concerned!

You'll toughen up as time goes by to that type of reaction. It happens all too often. But you did the right thing! One of my favorite sayings is "I don't think it's broken. But I don't have x-ray vision, so I'm not sure!" That puts the ball in the parent's court and allows them to make the call.

Good luck with the remainder of the school year!

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Specializes in Urgent Care, Oncology.

When my brother was 8, he broke his wrist playing tennis. However, we did not know this at the time. Parents were called, and my brother was brought home, but his wrist wasn't swollen and he had full ROM. Didn't complain at all. Two weeks later, he was playing during recess and landed on the same wrist. This time mom mom did take him to the hospital where they did an x-ray, showing that it was broken. It also showed that it had previously been broken, and that it had already started to heal on it's own. It was a buckle fracture. My mom felt so guilty, and she was a nurse! I've worked in Pediatric Urgent Care for a year now, and let me tell you - it is always the kids you least suspect that have a broken bone. Usually the children being overly dramatic that are wheeled in crying in pain are the ones who walk out with a band aid. The ones that are running around the waiting room are -most of the time - the sickest kids. Children are amazingly resilient. This isn't to say all children are like that, of course. I wouldn't beat myself up over it. Documentation is your friend, and that's the last I'll say about it!

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You didn't do anything wrong. Welcome to school nursing. No job is perfect and this just happens to be one of the negatives of school nursing. Some parents will find anyone to blame and often it falls on the nurse. You will learn which parents to call for a scratch and which not to bother unless the kid has an arm hanging off. I don't know how many times I've said "I'm not a doctor"! We don't have a clinic where we run xrays, blood tests, etc but some parents think we can magically tell what the problem is. :banghead:

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I don't think you did anything wrong! IMO, mom feels guilty that nobody was reachable by phone the first time you called. She is taking it out on you!

Also, buckle fractures are so sneaky! When my daughter was in kindergarten, she jumped over a baby gate and landed on her arm. She barely even cried, then she was fine. She even laid down on the couch, on the side of the "hurt arm". The next morning, she was unable to bend her arm back to put her jacket on. Up until that moment, she hadn't made another peep about the arm. I took her to urgent care, and she had a buckle fracture to her arm! The dr said that often, these fractures don't bother the child until the next day. I felt like a huge moron, letting my poor daughter sleep on a broken arm! But there was no swelling, bruising, nothing! It amazed me...

Same thing happened to my daughter when she was about two - she slid down a two foot plastic slide and at the bottom she fell over onto the grass. Initially cried but then was fine. The next morning she was complaining about a sore arm. Took her in and an xray showed a small fracture and she got a cast.

I had a child my first year who fell off the monkey bars. He wouldn't stop crying and that was my clue to call mom even though there was no swelling or deformity. She came to get him and he had a buckle fracture.

You did the right thing. I think the biggest issue working in a school is your background is medicine and their background is education. They will not understand medicine. And can be judgmental.

Keep your chin up.

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You did call! That's what kills me. What else did she want??

I'm a new school nurse and I have the WORST time getting a hold of parents. One parent called me freaking out last month because she got a call from the school that her daughter's absence was not called in. Mom was freaking out because her daughter was there and would not hang up until I found her daughter.

Last week, her daughter started spiking a fever. I called mom and dad at least 6 times each. It took 3.5 hours for them to come pick her up. This child was born at 25 weeks and has a huge history of illnesses and allergies. Mom finally send the epi-pen in - 6 months into the school year. She will never answer or call back if I call about food/allergy issues. So I issued a blanket recommendation that this child not be served any food that doesn't come from home. It's ridiculous. But her child comes to school late and misses attendance and she is ready to fly off the handle (like it's my fault!).

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I had a student once with a head injury who became very sleepy, acted out of it, and slow to answer so I called his mom right away and told her what happened. She got mad at me for interrupting her on her way to work when I said he needed picked up and evaluated by a dr. right away. She argued she had to teach some class and I said I'm sorry but this is an emergency! She asked what would happen if she refused and I said I would call an ambulance. She came and got him and took him to an urgent care (this was 20 yrs ago) and they insisted she take him to the ER. She tried to sue the school system because the dr told her he should've been evaluated at the ER much sooner! I'm sure she didn't tell them it took her almost an hour to pick up her kid! They asked for my documentation and needless to say nothing further ever came of it since I didn't do anything wrong. He was ok but he did have a concussion. I really felt bad for him that he had a mom like that. I've never forgotten that and still get mad when I think about it. Some parents you can never please!

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Having to face these same families over and over for the next 5 or 6 years is probably the hardest thing about this job. You did all of the right things. My only advice is document document document! Every call, every note, every time. Its the only way to cover yourself in the he said/she said world we live in.

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Specializes in Labor/Delivery/Postpartum/GYN.

I too am a new school nurse. My background is L/D. I didn't have any orientation at all and was thankful I have a friend who was a school nurse who I could call 10 times a day when I started in the fall. I was feeling really unsure about myself because I have had a couple parents really upset when I didn't call them. I don't have as many kids as you, but my office fills up fast during recess and I'm try to assess and get them back to class ASAP. I went to my nursing supervisor, because I was going home at night,almost, hating my job. And that was not normal for me. I have never had a bad day being an L/D nurse, and I hated feeling like that because I LOVE being a nurse. I spent a couple days with another nurse in my district and was reassured, because I am doing what I should be. Before I spent those couple days with another school nurse, I decided I was going to call parents for everything. Most parents, I have found, are irritated that I call them but I don't care at this point. I have to cover my ass. The nurse before me said "your a mom, just do what you would for your kids." I'm the kind of mom who is not worried about bumps, scrapes, bruises. My kiddos have to be bleeding out, or have an infection I am sure of before I take them to the doctor. I love my students so much, and am so thankful for my job.

Bottom line... Call parents if in doubt, if they don't answer.. Not your fault! Document everything! You are not their parent and you are not a provider and can't diagnose. Just keep loving the kids and calling parents and you will do great:)!!!

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thanks everyone.. it has been almost a month now and things have definitely improved. I pretty much call for anything that will "leave a mark," any head injury (even if it is just a minor bump), and any multiple visits (c/o sore throat in the am & afternoon, etc.). I err on the side of calling. However most parents do not pick up the phone :)

Thanks for all of the support. This site has been a life-saver as an inexperienced (school) nurse!

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