Middle School Clinic

[MWOOD,LPN]

I am trying to come up for some rules for my middle school (6th-8th) clinic. I do have some basic ones like coming with a pass. I am seeing on average 60+ kids a day.

[MrNurse(x2), ADN]

Put a scarlet "N" on their forehead so other teachers know they have been seen once today.

[nursetlm, ADN]

60?? Wow.

[MWOOD,LPN]

I wish I could do that... Administration frowns on that however.

[MrNurse(x2), ADN]

New nurse syndrome. Do you use written passes? Making the teachers pause to write out a pass that describes the issue may keep students from raising their hand and just saying I need to go to the nurse.

[BeckyESRN]

I send little baggies to each of the teachers: bandaids, vaseline and cotton swabs for chapped lips. This helps cut down on some of the minor visits through out the day. I would also ask to speak at the next faculty meeting to discuss what sort of things need to be sent to the nurse's office: a bloody nose, with no dripping blood, can be handled in the classroom with a tissue; student with a headache can get a drink of water and rest their head on the desk for a bit before coming to the nurse; a stomach ache that began 2 minutes ago can wait in close proximity to the garbage can(or yucky bucket) to see if it passes. Take a look at the types of visits you're being bombarded with and see if there are any ways these visits can be avoided or at least decreased. Once you've tried to slow the visits down, you can narrow down the offending students(or teachers!) and deal with it one on one. Last year, I made a chart of all the visit reasons and number of visits from a certain classroom- once the teacher saw that, on average, her class was missing 300minutes of class time per week!!!, the visits slowed considerably(4 minutes per visit with an average of 16 visits per day from that room alone)

You are dealing with older kids, so the students really should be able to deal with some of these things without your help! Also pass this out(j/k, sort of)

[MWOOD,LPN]

I do use written passes and any student without a pass is sent back to class to get one.

[MWOOD,LPN]

I did give my teachers a bag with bandages and passes in it. Most of my teachers are close to retiring age or are subs who let the kids do what they want. My administration is really amazing at making sure I am getting what I need to assist our students and to also help cut down on the traffic. When I started in November I was seeing over 100 per day. We got together as a group and talked about the most common reasons I am seeing students and then we came up with a plan that was discussed at the next faculty meeting. I am slowly weeding it down.

[MrNurse(x2), ADN]

That is still way too many. I take it most are temp and return? Are you able to give prn meds? If you are unable to medicate, headaches should be told in the class that hydration works most of the time, otherwise it is an inconvenience, the nurse isn't going to help you. Coughing? Push fluids. Cut? Wash it with soap and water, dry and come see me if still bleeding, otherwise OTA is best method. That should cut that number by a third.

[MWOOD,LPN]

Yes most are no fever, back to class students. We are unable to give prn meds in my district unless the parent provides the medication with a drs order on our specific form.

[NutmeggeRN, BSN]

The days I get super busy, I keep thinking this is job security. In an ever increasingly nasty budget battle, no one is safe. I DO feel that were there to be cuts, that the nurses have always been overwhelmingly supported, but who knows? I add every phone call, fax, quick visit with a teacher into MMS. Usually as a follow up-telephone/fax/letter writing code. Even on the days when I am not slammed by kids, there are a million and one phone calls. And I log separate calls as separate encounters! These all point to the hours of case management that you cannot necessarily see.

[NurseBeans, BSN, RN, EMT-B]

I saw similar things when I started. It was mid-year and I felt like the teachers and students all sensed I was "fresh meat" and were just testing the waters. I started calling parents and sending teachers emails when I felt like certain students were appearing on my doorstep too frequently...it slowed down. Then I started setting a lot of rules, like if you were just out at recess, I find it hard to believe you have a stomachache so bad you can't be in class...it slowed down more. I got rid of the crayons, coloring books, and books that the previous nurse had. Therapeutic boredom, for the ones that just wanted to hang out with their "headache and stomachache". Slowed down even more. Now I mostly see kids who actually need me.

You'll get there. I really think they (kids and teachers) are just testing limits. Show them your boundaries. Repeatedly.