Frequent flyers

Flare, ASN, BSN · Jun 3, 2010

yes, i do think that's a lot. especially if it's for the non-specific things that make up a frequent flier. A kid that has 25 entries for the year for things like paper cuts and such is clumsy, but i suppose not malingering.

I have a notice i send home when a student hits 10 visits that reinforces the importance of being in class and getting an uninterrupted education. It basically tells the parents in the nicest way possible that their kid is making a PITA out of themselves.

rdsxfnrn · Jun 3, 2010

does everyday count? or multilple times a day??????

safarirn · Jun 3, 2010

firefightingRN, I'd love to see that letter! I've been wanting to have something like that for a while now. I just never knew how to word it.

Flare, ASN, BSN · Jun 3, 2010

i'm away from my office, so i don't have the exact memo in front of me but it's something to the effect of :

Mr/mrs

This is to inform you that your child had made x visits to the health office since x. While it is important for your child to know that they are free to visit the nurse with any health issues, it is also important for them to have an uninterrupted education and to remain in class as much as possible. Please reinforce with your child the importance of minimizing interruptions in their academics. If you have any questions or concerns, please feel free to call me.

I'll take a look at the real version and let you know if i was far off on the wording.

momnurse23 · Jun 3, 2010

To me, that seems like a lot. I have had a few that seemed to have a lot of visits so I'd call parents and actually found out there was something going on at home, a divorce, change in custody, etc. (they got a referral to the school counselor) One mom, however was very surprised to know her daughter had so many visits and they stopped right away. This year I saw her for a valid reason, bleeding scraped knee, and she was so proud for not having any unnecessary visits.

luvmykidz · Jun 4, 2010

I think that 20 is definately a lot! Any more than 10 I would be questioning why they are in so much. In the first couple months of school if I start seeing a student quite a lot and think they are just wanting to get out of class I will send the parents a note that I'm concerned about their child since they've been into the nurse's office so much lately feeling bad that maybe they should be checked by their family doctor. Then I will stress the importance of not missing class time if there is nothing really wrong. That usually takes care of it. I also let the teachers know which ones are coming in all the time and there are always those that understand and will nip it but others will say I don't want to take the risk of there really being something wrong and send them anyway.

bergren · Jun 5, 2010

There is an article on Frequent Vistors in this month's issue of the Journal of School Nursing:

The literature defines a frequent visitor as a student who visits more than 5 times in a school year, with medically unexplained symptoms.

Shannon, R.A., Bergren, M. D. & Matthews, A. (2010). Frequent visitors: Somatization in school-agend chidlren and implications for school nurses. Journal of School Nursing, 26, 169-182

The Journal of School Nursing -- Sign In Page

Access is free for NASN members, non members can access the abstract.

mustlovepoodles, RN · Jun 5, 2010

I don't even bother sending home a letter--most of our parents have less than a 5th grade reading level anyway. My rule of thumb is 5 visits in a month. Once they hit that magic number(sooner if they are VERY regular) I make a call to parents to make sure there is nothing going on organically. Depending on the situation I may suggest that the child be seen by a doctor. Once I have the parents on-board the frequency usually drops off. Sometimes it continues and I have to investigate further. I find that there are certain teachers who will send a kid to the clinic for almost anything and they never asks questions. If a kid says he has a stomach ache every day during math it's "off to the clinic with you.":clown: So I will conference with a teacher who is overusing the clinic and we brainstorm ways to handle a frequent flyer in class. If the behavior continues I get the school counselor and the principal involved, and sometimes the social worker.

bergren · Jun 5, 2010

The review of the literature shows over half are missing an enjoyable class, lunch or a free period. Frequent visiting is associated with anxiety and depression, exposure to violence, bullying. Lack of teacher support and classroom noise can exacerbate the situation.

" School nurses need to view frequent somatic complaints as indicators of potentially serious problems. Once organic health problems are ruled out, students should be assessed for family and social dysfunction, emotional and behavioral disorders, violence exposure, victimization, and problems at school. The scope of the issues identified may require directing a multidisciplinary plan involving the student, educational team, family, and primary care. Population-focused assessment and prevention efforts are necessary to improve the school environment and overall student well-being, attendance, and academic performance. "

luvmykidz · Jun 5, 2010

That's very interesting and a good idea. I think there is an underlying reason why any kid is a frequent flyer and sometimes you can help fix it but not always. I had a girl that came in every day for a week with a stomachache after lunch that had never seen me before so I referred her to the dr and they found out she had diabetes. I had another student in all the time and it turns out she was being bullied by her teenage brother. A lot of the time I think it's that they just don't get enough attention or nuturing at home. Sometimes they are just spoiled. It's hard to find the time to investigate these things when you have so many students needing so many things all the time. Sometimes you just have a gut feeling whether it's something important or not. I was a frequent flyer when I was in grade school and grew up to work with the nurse that remembered me well. I think it was because I was facinated with her office, loved the attention, and I did have a lot of emotional upheavel in my life growing up (due to divorces, alcoholism, emotional abuse, and other things I'd rather not mention) that I seriously could've used a counselor for but just seeing this smiling, caring face that remained calm all the time made me feel instantly better. Maybe that's why I ended up as a school nurse! I think it's important to rule out anything serious before you tell teachers and parents their kids are in too much.

noreenl · Jun 7, 2010

When I do my annual inservice with my school nurse subs I tell them to be sure they send a note home with EACH STUDENT SEEN that day and call a parent on ALL seriuos casees and preferably all cases if possible. The Office of School Health has 2 form letters with either check off the symptom and treatment or a space to write something important. there is also a form letter for head injury as well. All but the head injury form have a carbon so a copy is generated for the nurses that we are subbing for to catch kids who run to the nurses "to check out the new nurse" or are frequent flyers. EHR has made our jobs a little more difficult because there is no Log Book of visits in some places or it has not been kept up to date on their 103S(medical record on paper) because nothing major (Fever, accident etc.) has happened, but we are working with OSH to facilitate this issue. Thank goodness we have such a good relationship that any agency can speak up about a concern with any issue and the current Nsg Administration has an open door policy which I love! ( No, I am not just kissing butt! LOL)