Re wrapping splints?

  1. Hi everybody,

    I work for an elementary school as one of the support nurses. today a student came in with her finger splint off wrapped in coband/some sort of elastic wrap tape. We have no documentation/doctor's note whatsoever about her having a splint. Anyways we put the splint back on her finger but I didn't not want to wrap it because of liability, plus I did not even know why or how she got this injury! I called moms work and when she came, she was super upset yelling at me. Stating that she is the "athletic director" at the high school and how she doesn't understand how I can't wrap her daughters poor finger. She also said she wraps athletes frets "all the time" and does treatment. As for as I knew, athletic directors aren't doctors? Anyways, I explained to her how she needed a doctors note, how I can't apply ace bandages or wraps. It's like a prescription. She continued to yell at me stating that "she knows my scope of practice" and what I can and cannot do. Then she continued to yell at me for keeping her daughter there and missing class.

    I told her she can talk to my district nurse and she threatened to "email her".

    I talked to my district nurse right after the incident and she was right on my side about everything, how she will talk to the parent/"athletic director" about our rules and policies.

    Just wondering what you guys would have done.

    That ended my day. Lol!
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  2. 26 Comments

  3. by   zombieghoast
    Oh man I got you beat. The urgent care through my organization SUCKS. They honestly try to avoid doing work as much as possible and I referred a patient to UC because of a sports injury. They called me up telling me the athletic director "diagnosed" them with shin splints and that I needed to put in a referral FOR them. The doctor even made a comment that these directors are not doctors and shouldn't diagnose.
  4. by   Shellaaay10x
    Quote from zombieghoast
    Oh man I got you beat. The urgent care through my organization SUCKS. They honestly try to avoid doing work as much as possible and I referred a patient to UC because of a sports injury. They called me up telling me the athletic director "diagnosed" them with shin splints and that I needed to put in a referral FOR them. The doctor even made a comment that these directors are not doctors and shouldn't diagnose.
    Exactly! These directors are not medical doctors, and do not have medical background in order to make these calls.
    I wasn't even mad at her yelling at me about the "tape" I was just felt a little disrespected and offended that she said she "knows my scope of practice" and goes on to try to tell me how I can do my job. She clearly does NOT know, because we wouldn't have had that conversation! Totally appalled and she lost my respect. Don't care if she's the athletic director, I have a license and I'm not going to lose it because of her!
  5. by   akulahawkRN
    What I would have done and what you did would have been very different. This is partly because I have been trained as an athletic trainer. That's very different than an athletic director, though they usually have some training in basic taping, splinting, and bracing. In my (previous) capacity as an athletic trainer, I worked under the team physician and was given broad latitude to evaluate and treat athletic injuries and also to refer to appropriate outside entities as I deemed necessary. I've also been through Paramedic School and Nursing school and given that both are likely fairly representative of Paramedic and Nursing education for entry to practice, neither came close to the physical exam depth that I received as an athletic trainer. Yes, I have a Bachelors in Sports Med. Now then, for people that wandered into the training room that were asking for first aid, I'd give them first aid help and send them on their way. If they've already got a finger splint, it's in hand, and it just needs to be re-wrapped, I'll do that and send them on their way.

    The only liability you normally would face from re-taping a finger splint would be if you taped it back on with the tape being applied too tight or the elastic wrap being applied too tight. What would I have done? I would have wrapped the split in place after doing a quick eval and sent the kid on her way. I would also have required the parent obtain a physician's note excusing the kid from PE as I'm not going to want to keep treating an aggravated injury from PE activity. How long would that take me? Far less time than it would take to type this post. If the parent (and AD in this case) refuses to get the Medical Excuse, I'll draw a very hard line at the first PE injury... no treating in-house, it's off to the MD for evaluation.

    If I was not previously aware of the injury, I won't issue notes to get out of PE or anything like that, that's something I would require the physician to do. My athletes? That's a slightly different story. All I'd generally have to do is contact the athlete's PE teacher and advise them of the injury, what I've done, and what the athlete must avoid. The PE teachers do respect what I tell them because they'll have their athletes under my care soon enough... and if they push the issue, I'll send the athlete out to the team Doc and obtain a formal medical note. The team Doc and athletic department would provide me the authority to excuse athletes with sports-related injuries from PE.

    No, I'm not a physician and I don't pretend to be one. Athletic trainers usually follow 1 of 2 major tracks if they stay in healthcare. They often become PAs or they become Physical Therapists. I became a Paramedic and an RN.
  6. by   Shellaaay10x
    Quote from akulahawkRN
    What I would have done and what you did would have been very different. This is partly because I have been trained as an athletic trainer. That's very different than an athletic director, though they usually have some training in basic taping, splinting, and bracing. In my (previous) capacity as an athletic trainer, I worked under the team physician and was given broad latitude to evaluate and treat athletic injuries and also to refer to appropriate outside entities as I deemed necessary. I've also been through Paramedic School and Nursing school and given that both are likely fairly representative of Paramedic and Nursing education for entry to practice, neither came close to the physical exam depth that I received as an athletic trainer. Yes, I have a Bachelors in Sports Med. Now then, for people that wandered into the training room that were asking for first aid, I'd give them first aid help and send them on their way. If they've already got a finger splint, it's in hand, and it just needs to be re-wrapped, I'll do that and send them on their way.

    The only liability you normally would face from re-taping a finger splint would be if you taped it back on with the tape being applied too tight or the elastic wrap being applied too tight. What would I have done? I would have wrapped the split in place after doing a quick eval and sent the kid on her way. I would also have required the parent obtain a physician's note excusing the kid from PE as I'm not going to want to keep treating an aggravated injury from PE activity. How long would that take me? Far less time than it would take to type this post. If the parent (and AD in this case) refuses to get the Medical Excuse, I'll draw a very hard line at the first PE injury... no treating in-house, it's off to the MD for evaluation.

    If I was not previously aware of the injury, I won't issue notes to get out of PE or anything like that, that's something I would require the physician to do. My athletes? That's a slightly different story. All I'd generally have to do is contact the athlete's PE teacher and advise them of the injury, what I've done, and what the athlete must avoid. The PE teachers do respect what I tell them because they'll have their athletes under my care soon enough... and if they push the issue, I'll send the athlete out to the team Doc and obtain a formal medical note. The team Doc and athletic department would provide me the authority to excuse athletes with sports-related injuries from PE.

    No, I'm not a physician and I don't pretend to be one. Athletic trainers usually follow 1 of 2 major tracks if they stay in healthcare. They often become PAs or they become Physical Therapists. I became a Paramedic and an RN.
    I looked deeper into the situation and apparently that "athletic director" was the former "athletic trainer" for the high school.

    But I am not an athletic trainer, so no, I still would have not re applied the splint. Considering the fact that the daughter told me that "her cast came off" and she told me her "doctor was the one that applied it". I'd rather have called the parent. I was also going through my districts policies on ace bandages and other wraps, and unless it was for initial tx for a "suspected fracture" we are to not use wraps or ace bandages, because it would seem as if we are diagnosing a client to have to use one. One of our CN's can't even apply one, and she's a nurse practitioner.
    I understand where you are coming from for what you would have done, I think the difference is that you have that training and I do not. Hence why we would have dealt with it differently. It's nice to hear another point of view. Maybe that's why she was so irritated. I still don't like how she tried to tell me how to do my job and she knows my "scope of practice." I have a license to keep, and I'm not going to lose it because I had applied a wrap wrong. If I don't have a doctors order, I won't do it. It's different from working in the hospital vs public schools. Lots of differences...

    My district nurse talked to her, and the mom is bringing a doctors note on Thursday. She also told me I did the right thing.
    Yay!
  7. by   Farawyn
    I've rewrapped splints. *shrug*
  8. by   NutmeggeRN
    Quote from Farawyn
    I've rewrapped splints. *shrug*
    Me too.
  9. by   Flare
    i'll re-wrap splints, but I don't supply them. I would rather wrap up the splint the right way than have the student attempt it or go around with it incorrectly applied from a home application. (which, incidentally gets a call home)

    I also don't tape fingers as a "first line treatment" (i.e. i hurt my finger in PE today but I have a game today, can you buddy tape it?) This also gets a call home.
  10. by   OldDude
    We have no policies prohibiting this so I certainly am not saying you should have done something differently. But because no one says we can't, I re-wrap anything that needs it. MD diagnosis or not. I'm a parent of 4 boys and have often applied splints and elastic wraps for a couple days to see how an injury is going to evolve; along with a request for them to sit out of PE or sports for a day or two. If no better after then it's off for xrays.

    Occasionally, I'll have a student show up with a splint or wrap that was applied incorrectly, parent or medical facility, and could actually cause circulatory issues; for instance non-elastic tape applied around a swollen digit or crutches not adjusted correctly. On the flip side of this subject I'd be negligent if I became aware of the condition and didn't intervene.

    The parent behavior you describe above is pretty pitiful.
  11. by   AdobeRN
    I will rewrap but I am also not quick to buddy tape or apply a wrap after an injury at school - I call the parents.

    ETA...I hate to say this but once you start wrapping all the kids want to be wrapped for any little injury.
    Last edit by AdobeRN on Sep 13
  12. by   Farawyn
    Quote from AdobeRN
    I will rewrap but I am also not quick to buddy tape or apply a wrap after an injury at school - I call the parents.
    Me too.
  13. by   Shellaaay10x
    Thanks everybody for your input!

    I'm guessing everyone here would have rewrapped it...lol!
  14. by   BeckyESRN
    I will reapply a wrap/splint as needed. I usually call home after to let a parent know that I rewrapped, especially if it was on incorrectly when I saw the kiddo(most often because said kiddo was messing with it!). The only time I've called a parent to come apply a splint was a girl who came in with a 5 piece achilles' splint that she had removed before coming to my office and I had no idea how to reassemble it! Oh, and for wrap jobs that I suspect the kiddo did without the parent's knowledge.

    However, if it's your schools policy not to reapply without an order(which isn't a bad policy) then you did the right thing. No matter what, the parent was out of line.

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