New to school nursing...Please help with a few questions!

  1. Hello everyone! I'm not a new nurse but was asked to help out at a school that is "kind of messed up." They plan on hiring me but I have a lot to learn and plan on doing some training. I would appreciate it if some of you could answer a couple of questions:

    1. Do you keep a daily log and that is the only way you track what type of visits come through? Or do you do both and chart electronically? This school only has kept a daily paper log.

    2. How many visits approximately do all of you see? And do teachers send the same students back to see you that day? There is about 300 students and I see anywhere from 30 to 45 a day.

    3. Are you responsible for going into the system and changing absences to unexcused absences because you have a doctor's note stating "<insert name> was seen in my office today?

    4. Do you send kids home who have a fever of 100 degrees or more home?

    I would appreciate anything feedback!

    Thanks!
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  2. 15 Comments

  3. by   BeckyESRN
    1.) I chart electronically with SNAP, i jot visits down on paper when it's crazy in here.

    2.) I have around 400 kiddos and see anywhere from 15-70 a day. Mondays are always the worst, especially after a break or long weekend. This Monday(we were off last friday) I saw 58 kids and maybe 10 of them were legit reasons to visit the nurse. You're new, the kids want to check you out and see what you'll do with them, so once you lose that shiny new school nurse smell, they should slow down.

    3.) I have nothing to with attendance, thankfully!

    4.) 100.4 or over goes home with a note stating they cannot come back to school until fever free without medication for 24 hours unless otherwise they present a note from the doctor stating that they are cleared for return.

    Congrats on the new job! It's usually a great gig once you settle in. Keep the questions coming- this is the greatest nurses I've ever been a part of!
  4. by   RNLisaC
    Thank you Becky, for your quick response! I really love the kids and am so happy I found this forum. Today is a snow day so I'm viewing everything possible and looking things up! I have been sending kids home with a fever over 100 but the note is a great idea! Since there is nothing in place, I think that it is something that I can make a policy on (they expect me to write policies too). Thanks again.
  5. by   kschenz
    Welcome!

    1. I chart with Skyward. I cover 2 schools. My middle school health aide writes them down on a paper log and then puts them in the computer when she has a few spare minutes throughout the day and finishes them at the end of the day when it has quieted down. My elementary school health aide puts them directly into the computer and we only use a paper chart when there is a substitute.

    2. At my middle school we see around 30 to 40 a day and that includes the 23 daily meds we give. At my elementary school we see 55 to 60 a day with only 13 daily meds.

    3. The middle school has it's own, full time attendance person and the elementary school health aide does attendance and Child Study (Special Education paperwork and scheduling).

    4. Fevers of 100 degrees or higher go home
  6. by   RNLisaC
    Thanks Kschenz! They are open to suggestions so I ag ask about someone else handling the attendance piece. The filing is so backed up. They also expect me to find RN coverage for field trips and then communicate whether the field trip can happen based on my getting coverage. I may bring that up as something that can be turfed. Reading responses so far has me convinced visits should definitely be documented in the system. They actually have not counted meds visits which I thought to be odd. I have been doing that. I've had second thoughts about staying but maybe I can make a positive change. Thanks!
  7. by   kschenz
    Without proper documentation they have NO IDEA how busy a school health office is. We document every single person that crosses our doorway because it's what they base our staffing on. According to suggested staffing from NASN my large district should have 13 full time RNs. We have 7 but are hiring another one for next year! Woot!
  8. by   moreoreo
    1. I keep a daily visit log with in and out times and whether they returned to class or went home. Additionally we have large index cards on which we record details about each visit--complaint, assessment, intervention, and disposition. I am to chart every single visit, even just for chapped lips.

    2. We have 800+ students, PK through 5th grade, and I see 30-50 most days, plus 9 daily medications and one student who I work with twice a day. Some teachers send children back down (and I in fact tell some students to come back if still not feeling well, or feeling worse).

    3. I do not do anything with attendance, thankfully! Attendance makes note of the doctor's excuse and then gives me a copy for the health file.

    4. Yes, we send any child with fever 100 or higher home. I do round up on the 99s especially if symptomatic.

    Best of luck to you! If you are like me, you will gain a lot of knowledge and reassurance here!!
  9. by   BethG73
    1. We use CareDox, a web based charting system. (It's free. You should have your admins & legal look into it) If you use paper logs, you need a separate sheet for each student.

    2. It varies, but usually 12-20 per day. I have about 300 in K-3.

    3. No

    4. Yes

    welcome to the trenches!
    Last edit by BethG73 on Mar 10 : Reason: Because
  10. by   BethG73
    Quote from RNLisaC
    Thanks Kschenz! They are open to suggestions so I ag ask about someone else handling the attendance piece. The filing is so backed up. They also expect me to find RN coverage for field trips and then communicate whether the field trip can happen based on my getting coverage. I may bring that up as something that can be turfed. Reading responses so far has me convinced visits should definitely be documented in the system. They actually have not counted meds visits which I thought to be odd. I have been doing that. I've had second thoughts about staying but maybe I can make a positive change. Thanks!
    What state are you in & what are you medical kiddos' issues? Do you need RNs for a field trip or can you delegate tasks to teachers or paras? In indiana, we can delegate quite a bit to UAPs. I don't have any complex medical kiddo's, so I don't send RNs on field trips.
  11. by   RNLisaC
    Thanks!! I'm taking notes. So this computer systems also tracks vaccines and physicals too?
  12. by   BethG73
    Quote from RNLisaC
    Thanks!! I'm taking notes. So this computer systems also tracks vaccines and physicals too?
    Vaccines, yes. Physicals...I'm not sure, but probably. You can scan & upload any document you want. We don't require them any longer, but most get them for K.
    Last edit by BethG73 on Mar 11 : Reason: Forgot
  13. by   RNLisaC
    Hi Beth,

    Did you decide and come up with a policy that the physicals are no longer needed? Thanks.
  14. by   BethG73
    Quote from RNLisaC
    Hi Beth,

    Did you decide and come up with a policy that the physicals are no longer needed? Thanks.
    That was the policy when I started last year, so I'm not sure if it's a district decision or state decision. Sorry. We don't tell people they're not required any longer, if anyone asks we tell them we strongly recommend one. Most people end up getting one anyways because they still need that last round of vaccines.

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