Want some advice on what to do in situations

  1. Hi everyone. Im new here but not new to school nursing. I have been a school nurse for 4 years and I took a break and worked in another field. Well I am back school nursing but at a different school in the district I worked for previously. The teachers are very different here than my previous school and I have only been here a month so we are all getting to know each other. I need advice on the following things:

    Where do the sick kids go when they are waiting for their parents to pick them up. (Here they stick them in my elementary office but I serve the middle and high school too and I get called frequently to go there. I have meds and other things that keep me out of my office and it isn't practical for them to stay in there unsupervised. They don't want them back in class and they will not let them sit by the office.) This is also the problem when we find headlice. (No live bug policy)

    How do you handle injuries such as possible sprains/fractures. I do my nursing assessment but the staff and parents here think I should have xray vision. So usually the child ends up going home due to me and the staff worried there is a fracture and we will get in legal trouble.

    Ok last one... How do I handle teachers sending students for every minor thing. I do not mind putting on band aids and checking temps. But when I have diabetics needing insulin or an emergency across campus I should not have 4 kids in my office with old scrapes that happened over the weekend or my toe hurts. They can put on band aids and use a thermometer. I guess I am asking how to be nice going about this.

    Right now I am just frustrated and kicking myself for ever leaving the first school I was at because I thought it was "rough" there.
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  2. 12 Comments

  3. by   SaltineQueen
    Sick kids waiting for parents camp out in my clinic, occasionally in the office if I have a lot going on in here. My clinic is right off the main office. If parents can't come get live lice cases they go back to class with the expectation they will be treated at home.

    If I suspect a fx or sprain I call the parents to come get their child to be evaluated. I have flat out told people I don't have xray vision. I'd rather things get looked at and be nothing than not have them looked at and it be something.

    I give every teacher a box of bandaids at the beginning of the year for the minor things & tell them I've got lots more when those run out. Teachers here don't have a thermometer so those do all come to me. Somewhere around there's a list of 5 or 7 Bs that some nurses have given to teachers regarding when to send them to the clinic: barfing, blood, etc.

    Good luck. Hope you get them trained quickly.
  4. by   OldDude
    Welcome back!

    Well, the kids are going to have to wait somewhere so ask your principal where that somewhere will be; end of story.

    Don't obsess over the injuries; use you judgment and experience and don't pay attention to those sticking their nose in your business. You know you're gonna send kids home for negative x-rays and eventually you're gonna not send a kid home and they'll end up with a fracture; goes with the job.

    Bandaids in the room is a good idea and some teachers drive you out of your mind but that pretty much goes with the territory. In the grand scheme of things it's probably better for you to see the minutia than have a flippant teacher not send someone that really needs attention; leave it up to you to decide if it was unnecessary.

    If you set your rules/limits and remain consistent it'll settle down by the end of the year, you'll forget about it over the summer, and next year will be different.
  5. by   BeckyESRN
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    Hope this works!
  6. by   ABRN2012
    Thank you!!!!
  7. by   ABRN2012
    Thank you OldDudeRN for the advice. I feel like I am very good at this job. I am very confident in my assessment skills but our admin. is all about keeping parents happy. We all know that is not going to happen.
    Last edit by ABRN2012 on Nov 6 : Reason: add name
  8. by   ruby_jane
    Quote from ABRN2012

    Where do the sick kids go when they are waiting for their parents to pick them up.

    How do you handle injuries such as possible sprains/fractures.

    Ok last one... How do I handle teachers sending students for every minor thing.

    Right now I am just frustrated and kicking myself for ever leaving the first school I was at because I thought it was "rough" there.
    Welcome back! Things may have changed a little over the few years you were gone - life seems more litigious, and parents seem to be much more clingy than they were six years ago when I started.

    How sick is that kid? Can s/he go to attendance to wait? If it's minor and I don't need to reassess, the student can just as well sit in attendance (where they can use their phones, as I have a no cel phone policy).

    The advice given from our local children's hospital on diagnosis of strain/fracture is to send EVERYONE to them - because we don't have xray vision. Whether parents are compliant or not, that's a cover your assets issue. I call on anyone who damaged themselves here, no matter how minor. Do I send all of those out? Nope. Usually it's ice, elevate, and come back to see me at lunch/before you go home. You'll find a rhythm and a pattern.

    I have taken to sending a bag of band aids back to classrooms when teachers send a kid for a band aid. Writing the temperature on the pass and sending the kid back to the teacher swears he has a fever. Remember the teachers don't want to be on the receiving end of the "why didn't you let sweet baby go to the nurse" email/phone call either. I love the list of the B's.

    Hang in there! Welcome back.
  9. by   Amethya
    In my school, we have them in my office until parents come. If I go to lunch or leave, they go to the front.


    Exactly what they said, it's better for them to go home and go see the physician, especially legal issues.

    Give them first aid kids, basically with bandaids and other things that can be taken care in the classroom. I sent a letter in the first day of school stating this that unless it's something that can't be cared of in the classroom, they can send them to me. Mostly I get only 24 children in a day, so it's no biggie.
  10. by   K_NM_rn
    At my school, kids wait in the health office to be picked up. But, we have 2 RNs and a health assistant, so there is almost always at least 1 person in our office.

    As far as suspected sprains/fxs, of course they need to be evaluated, but it seems like you're asking about injuries that are NOT obvious fxs, right? In those cases, even if I'm 99.9% sure the kid is fine, I still tell the parent something to the effect of, "Your child seems fine to stay at school, but if you notice any of the following signs/symptoms.....it would be a good idea to have him evaluated by a doctor." In my district, as long as the injury/office visit is documented, the parent is notified of the injury, and we document that we made a recommendation to see a doctor if x, y, or z is observed, then we're covered.

    As far as teachers sending kids for every little thing...sigh. This is an ongoing battle at my school. Like some others have mentioned, we give each classroom a baggie with bandaids, gloves, little envelopes for lost teeth, etc., along with a document that outlines guidelines for sending kids to the health office. We've had some success by asking teachers to try some interventions before sending kids to us, like let them drink some water or suck on a mint in class, have them try to have a BM, or ask them to try eating breakfast or lunch first. I still get a little push-back sometimes, but I try to emphasize how much instruction time kids are missing when they come all the way to my office JUST to drink some water for a dry throat, or get a bandaid for their invisible paper cut, or use our restroom.

    I hope this helps, good luck!
  11. by   WineRN
    Quote from ABRN2012
    Thank you OldDudeRN for the advice. I feel like I am very good at this job. I am very confident in my assessment skills but our admin. is all about keeping parents happy. We all know that is not going to happen.
    I think most admins are like this. Just be firm, you need to follow protocol and protect your licence.
  12. by   ABRN2012
    Thanks again all! I do believe I know what to give each teacher this Christmas...a tiny "first aid" baggie. haha
  13. by   Lyn Joseph
    Quote from ABRN2012
    I need advice on the following things:

    Where do the sick kids go when they are waiting for their parents to pick them up.

    How do you handle injuries such as possible sprains/fractures.

    Ok last one... How do I handle teachers sending students for every minor thing.
    If you had to leave your office to go to another location I would either send them to the main office to wait to get picked up because they cannot be left unsupervised (if they are well enough) or have the office find staff to "cover" your office while you are gone to supervise the child waiting to be picked up, as they shouldn't be left alone. You may have to put your foot down with this one. At my school, parents are welcome to pick up their kids, but we don't send them home with head lice. We of course call the parents and the expectation is that it will be treated at home but we don't mandate that they dismiss their child.

    With suspected fractures and sprains I have also flat out said that I wish I had Xray vision but I don't. A less fresh alternative I now say is "I'm unable diagnose, your child will have to follow up with their doctor" or something like that along with describing signs and symptoms to look out for at home since I know a majority of them wont be heading to urgent care once they leave school. Just to cover my butt I always recommend they get checked out and if I really suspect sprains/fractures we don't allow them to participate in gym/after school sports until they have a note from their physician clearing them. ALWAYS DOCUMENT

    With the teachers, I love the 7 B's someone posted! I want to try to utilize that as they seem to have a hard time knowing what counts as an emergency or not. In the beginning of the year we give all of the teachers baggies with gloves and band aids and they know we have more so they can stock up.
  14. by   ArryOtter
    I have a very small clinic and it's pretty busy in here. I do 4 caths a day and I get called out a lot to other areas on campus. I have said students can't wait in the clinic and if they must a para from the room must stay (special needs school).

    Sprains/fractures. I give ice and let them sit for 10-15 minutes. If pain is still present I contact parents and let them know there may be a bigger issue and may need to be seen. My son attended my school last year for preschool and broke his arm. Lots of fun. Still my only actual break at work (knock on wood a million times).

    Little stuff. I send out an email with Classroom Medical Procedures and let them know what they can and can't handle in the classroom. I also set up CLOSED hours this year for my heaviest traffic times and for my lunch period (although I still rarely get a lunch break). I also try to nicely say, "Do you need band aids in the classroom? you don't have to make a trip to the clinic for something small like this!" and most of them get it. A few still bring them up for every little thing, but there has been a vast improvement this year.

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