Stress, students and stomach aches - a minor rant

[Flare]

Just had a teacher pop her head in to let me know that a student that she has sent down to me for stomach aches several times (that i have sent back to class usually after a short assessment and have also seen for many many c/o nausea, stomach aches) was hospitalized last week for an attempted suicide. Her tone came off as accusatory and almost gloating that thought i had been dismissive of this student. In reality, I had called and spoken with this student's family twice already this year about frequent visits and possible stressors. And I had sent this student home for stomach aches and vomiting just a week or so earlier.

Mind you, this is my first year in this district, the last nurse was here 25+ years and knew everything about everyone. The staff has been having a bit of a hard time adjusting to me and seem to forget that i've been a school nurse for over 10 years now.

I know that school is a rough time for kids. I know that students get a lot of non descript symptoms when they are feeling stressed and they may not even recognize that they are even under stress. And I try to do everything in my power to be supportive and positive for the students. But the staff needs to realize that #1 - we are school nurses, not miracle workers (over worked, tired...often working through lunch - ask a teacher to skip their lunch or prep and see how the fur flies). #2 we can't send home a kid each and every time his/her tummy hurts - especially if there is no vomiting involved. Maybe a little rest, but some of these kids would choose to rest here all day if they could. We have to pick and choose our interventions for what is appropriate for what we assess at that event #3 I am not trying to be mean, and i certainly don't want to see a child hurt themself or worse - i just want to see these kids succeed and learn how to work through their problems.

ok, rant over....

[Nurse ABC]

You should've said "we'll it's a shame you didn't refer him to the counselor!" I mean seriously, to insinuate that you were somehow at fault shows ignorance and a lack of professionalism! You did nothing wrong at all. Try not to let her get under your skin!

[vintagemother, BSN, CNA, LVN, RN]

Streaming thoughts....keep in mind, I'm just a nursing student but I am mom to 3 including 2 teens.

As far as the teacher seeming to be placing the blame on you, 1st, that's inappropriate because, I believe suicide (and attempts) can not be blamed on others. I think suicide results from poor personal environmental circumstances combined with poor coping skills/a chemical imbalance. It's not anyone's fault.

But...a better dialogue for you and the teacher to have is to discuss what signs were there that you and her both missed. I think it would be helpful to all children if you or your school or the teacher learned how to better assess for signs of suicide risk and learned ways to put those children with signs and risk factors into appropriate (in patient) treatment.

I think telling the parents that their child is stressed is not enough, as parents may 1) not know how to watch for further s/sx of depression, 2) may not know where to get professional psychiatric help 3) may not be able to afford medical treatment 4) may have their own emotional or personal problems.

The attempted suicide of this child I do not know saddens me, I am close to tears as I drive to clinicals right now. I have a 14 y.o. Son who is facing his own set of problems right now as I go through a divorce. It's not any of our fault when things like this happen, but I think we should all ask ourselves what could we learn from this to help prevent this in the future?

[Flare, ASN, BSN]

I should add, since there seems to be interest in the finer details, that in this particular case there is a language barrier between the parents and I. The times that I had called to talk to a parent, the phone was handed to an older sibling (perhaps in her early 20s) I explained that the student has been in the office frequently c/o stomach aches with reports that he has vomited small amounts in the bathroom. That he has been coming around the same times of day and while it was possible that there was some sort of illness, but that it could be something else. The first call was treated like a work avoidance, and the visits ceased for a while. When they started up again, I followed a similar communication line. Called a parent, handed off to a sibling and reported my findings. Language barriers do complicate things - and vintagemother does have a point in stating that mom and dad may have seen problems long ago but may not have known who to go to due to the affore mentioned barrier.

I agree that it was unfair for the teacher to just dump this problem on me and wash her hands of it. I hadn't really considered that the teacher was doing that until she came and had her little "talk" with me. But you guys are right - if she had those concerns, then she also had a duty to act and report and not dump it into my already overworked lap then get mad when it wasn't handled the way she thought it should have been (by sending him home every time).

Thanks for the support.

[Barnstormin' PMHNP]

This makes me so angry and sad, we just had a suicide of 7th grader at my daughters school a week ago. To try to dump responsibility onto you, the teacher is trying to relieve her own guilt, after all, how much time does she spend with that student compared to you? She probably feels she should have seen something and now is transferring her guilt trip onto you. Kids are GREAT at keeping things to themselves, I have teenagers and have had to really do some intense fact finding as well as watching tiny signs and details adding up to discover bullying issues with one of my kids in particular. If parents don't see what's happening under their noses, can we expect anyone else to? It was really unfair of her to do that to you, you are not to blame for ANYTHING.

[NutmeggeRN, BSN]

Flare

Is there the possibility of a bigger discussion around this? Guidance, you, administration etc. The agenda item could be "Identifying and sharing info about kids who appear to be a "at risk"....this opens up the discussion as to who reports/shares what, so that no one in operating alone and without support. Can your local hospital help with translation resources? OR at least refer uyout o someone who may be bi-lingual?

Good Luck!

[rdsxfnrn]

Shame on that teacher! WTH is wrong with her, trying to place blame like that? There is no way you could have known.............. trust me, someone I am very close to and talk to on a daily basis tried this recently. I didn't have clue. So, yeah, no way..........................