Tips to shorten visits?

  1. Hello all,
    Do any of you seasoned nurse's have any tips and advice to shorten student's visits to my office? I am new to school nursing, anything would be helpful. I find my average time for a student to be in here is around 35 minutes! I believe my average time to be about double from what I've seen on here, looking for ways to improve and expedite the process.
    Thank you.
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  2. Visit NurseVal93 profile page

    About NurseVal93, LVN

    Joined: Dec '17; Posts: 19; Likes: 32

    14 Comments

  3. by   SaltineQueen
    Whoa!

    What grades do you have & how many are in your school? I have 280 K-3 kiddos so what I do might be different from what I'd do if I was at a MS or HS. Most of my visits are for headache & stomach ache. I always check a temperature. Next question is whether or not they've had breakfast (if it's morning) or how lunch was (if it's later). Next question for stomach aches is when they last had a good poop. If they haven't eaten I give them something to eat. If they have they get 10ish minutes to rest & see how they're doing. A lot of the time they say they're OK & ready to go back. Sometimes I'll give tylenol or tums if they haven't improved much - especially if they're rare visitors - and give them 5 or 10 minutes more before I kick them back to class. Ear aches get an ice pack warmed up & told to come back later if it's still hurting. Sore throats usually get a cough drop & encouraged to drink lots of water.

    Have I sent a kid back and had them barf in the classroom? Sure. I'd guess we all have. It just happens. I apologize, joke that I forgot my crystal ball that day and move on.

    I was a lot nicer when I was new & visits were longer. Now I've been around long enough to ID my frequent fliers vs fakers vs kids who just need a minute to escape. Do you have notes from the previous nurse, or can you look back at records to see who your FFs might be? You'll get there.
  4. by   MrNurse(x2)
    I ask for the issue as I am grabbing my loaded and ready Braun Tympanic and try to have their temp checked within 10 seconds of entering the door. The final 90 seconds are spent educating on hydration, very Barb G like. My average is about 3 minutes. This may sound harsh, but the students love me, they stop on their way by my door to do a quick chat and I have never heard that I am mean or unfair. We are a small school and I keep their butts in the seats. Works great.
  5. by   Farawyn
    Welcome!
    My max is around 15 min, although I do have a coughing student waiting for her dad all day here, today.

    Tips?

    Take their cell phones away.
  6. by   kidzcare
    Quote from Farawyn
    Tips?

    Take their cell phones away.
    Therapeutic boredom for the win!
  7. by   WineRN
    Quote from kidzcare
    Therapeutic boredom for the win!
    Boredom is my best intervention. If you feel up to making a snow flake, coloring or reading outloud to me, you can go back to class.

    A lot of what SaltineQueen said, except I have strict rules on OTCs so if someone comes back a third time I call home to see if a parent can come up and administer something or pick the little one up because they aren't able to learn today.
  8. by   ruby_jane
    Welcome to the group!

    1. Strict no cel phone policy - that usually means kids voluntarily get up and return to class in about 10 minutes.

    2. I have no meds to give unless they were provided by a parent. If you want to call a parent for symptom relief from my clinic and parent doesn't answer, I allow between 5-10 min for a call back. Otherwise, back to class; if parent checks in I'll tell them what you want (or you can text on the cel phone I just took away and put in my pink basket).

    3. Menstrual cramps - 15-20 min with a heating pad.

    4. Do not engage in chit chat. I try to be genuine without coddling.

    5. If it's a chronic condition like migraine, IBS, sickle cell crisis, etc. - none of the rules apply except 1 and 4.

    Mine are high schoolers and by this time, even the frequent fliers are beginning to understand that discomfort is not an emergency.

    It gets easier the longer you do this.
  9. by   Flare
    i'm mean compared to you guys. My malingering complaints get the vera temp and get a zap desk side. No fever then we discuss getting a drink and if the headache / stomach is due to post nasal drip that i have no other remedies other than good old water and can't give them medicine. IF i'm nice enough to let them rest, it's max 10 minutes, normally about 5. "Hey Siri, give me a 5 minute timer." It works great with the little ones
  10. by   NurseVal93
    I work at a high school, ages 13-18. 2,000+ students.

    Thanks for your tips!
  11. by   moreoreo
    I think everyone has said what I would have said! I am from pre-k to 5th grade so a very different population from yours. But like others have said--experience will help. You will start to know the students who come frequently and you will develop a routine that will shorten their visits (and hopefully speak candidly with their parents if they are coming frequently for minor reasons). It was hard for me as a newbie because it's such a different environment than the hospital. Every neck ache I had to rule out meningitis, abdominal discomfort had to be ruled out as appendicitis, etc. Of course I still think about worst case scenarios and ensure that students are truly OK before they leave my office, but my processes have become much more stream-lined. Even for students who are not frequent flyers. It's really about establishing your own rhythm, and you will get there!

    Like others have said, you may have to learn the art of being caring without being fun/nice/coddling. I coddled so much when I started that I started seeing up to 100 kids on days when only 3 would go home. Not every discomfort needs rest on the cot, not every injury needs an ice pack. If a student is afebrile and I can't identify a reason they HAVE to go home, they are out my door within a few minutes after a drink of water.

    Good luck! It will get better, I promise! I have just a hit one year and am feeling calmer and better able to do my job.
  12. by   kidzcare
    Quote from NurseVal93
    I work at a high school, ages 13-18. 2,000+ students.

    Thanks for your tips!
    Something that our high school nurses have done is get some digital timers and for each student that is going to rest for 10 minutes, they set a timer and put it on top of the student's pass on the desk. That way when there are lots of students coming in, no one loses track of time and has a student there for 20+ minutes.

    My tagline was always "OK, Kiddo. It's been 10 minutes with no fever and no vomiting, time to head back to class"
  13. by   BeckyESRN
    Our HS nurse requires a pass for every visit and doesn't allow students to "rest" during core classes, which helps cut down on some of the avoidance.

    Quote from kidzcare
    Something that our high school nurses have done is get some digital timers and for each student that is going to rest for 10 minutes, they set a timer and put it on top of the student's pass on the desk. That way when there are lots of students coming in, no one loses track of time and has a student there for 20+ minutes.

    My tagline was always "OK, Kiddo. It's been 10 minutes with no fever and no vomiting, time to head back to class"
    I LOVE this. I'm going to pick up a timer to go with each cot and start doing this! Thanks for the idea!
  14. by   JenTheSchoolRN
    Quote from kidzcare
    Something that our high school nurses have done is get some digital timers and for each student that is going to rest for 10 minutes, they set a timer and put it on top of the student's pass on the desk. That way when there are lots of students coming in, no one loses track of time and has a student there for 20+ minutes.

    My tagline was always "OK, Kiddo. It's been 10 minutes with no fever and no vomiting, time to head back to class"
    THIS. I've set timer on my phone as a reminder.

    I also use therapeutic boredom. A lot. And once I've signed a pass with a time, I don't change it if a student is trying to linger. And I remind them I'm not changing it. I'm a bit mean, I suppose, but that has worked very well with my MS and HS students. As has sarcasm. My average visit time is 3-4 minutes. I can get backed up in my queue, but than I'll switch to triage mode and get three kids' complaints, for example, at the same time. I can weed out the quick visits (like cramps, for example) quickly.

    (Side note: Fatigue is huge with a lot of my high school kids - they never get enough sleep. I'm not above giving them a 10 minute brain break if needed every once in a while - maybe I'm not totally mean - but I do look at student schedules and structure it during a study hall period. And set the timer.)

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