Kids that you KNOW are faking it???

If you think they are faking it and are acting fine but feel the need to call the parents, I would leave it up to the parents as to whether they want to pick them up or not. I call the parents, tell them what the child said happened, tell them my observations (no swelling, bruising etc. and also how the child is acting ie, smiling, laughing, etc) what I did about the situation (usually ice pack). Then I tell the parent that only an xray would be able to tell if it is broken or not. Do they want to wait to see how the day goes or pick up the child right away. You could also add that you think the child is fine, but it is up to the parents.

There are always those children who are constantly "hurt". Usually with these children I do my assessment and if I feel they are ok, I won't even call the parents and send them back to class. (If they need an ice pack, I might give them one, depending on the situation) After the child goes back to class and I feel it necessary, I may call the parent just to let them know what happened and that they should watch the child at home.

For the children who say they threw up but no one saw them, I picked up a trick from the other nurses in our district. We collect the large plastic buckets that ice cream comes in (we buy ours at walmart). We use these for barf buckets. (I think they are 5 quarts) When a "frequent flyer" comes in, I always take their temperature and document that. If no fever, I give them a bucket and tell them if they need to throw up, use the bucket. Then I send them back to class with the bucket. I tell them they are not going home unless there is vomit in the bucket. The older kids hate carrying around a bucket and usually make a miraculous recovery!! Send out an email to staff that you need plastic ice cream buckets and you should be able to collect enough buckets for the year. I write on the buckets "return to nurse's office."

We do this at the high school, too, and the kids called us sadistic. If they are fever free and have missed too much school or are frequent flyers, we give them a bucket and send them back to class. They hate us when we do that.

If you are going to do this, make sure it is okay with the principle that you do this. So far, I have only heard of one principle in our district who does not like the bucket. Those kids are just sent back and they throw up on the floor, which does not make sense to me, but whatever.

I agree with CrazyTrainRN. One thing I often did in elementary school, like she mentioned, is call the parent AFTER you send the kid back to class. Once the kid gets their parent on the phone, they will become so dramatic, that the parent will almost always take them home.

A lot of this depends on the support you get from administration. I have had principals that would prefer I just send everyone home rather than risk a parent complaining that I didn't call. This occurs especially in high school, because if I don't call home, they just go to the bathroom and call their parents to pick them up, then the parent shows up to take them home anyways...

I'm at an elementary school. After my first year, I made am unwritten rule that (for those without fever) unwitnessed vomit does not "count". If the kid says they vomited in the bathroom, I keep them in my office for 10-30 minutes (just based on in my judgment, how sick they look). If they do not vomit again, I send them back to class and tell them that vomit doesn't count unless I see it or a teacher sees it. I tell them that if they need to throw up, grab the trash can and come back to my office. Works like a charm, I have not had one return yet!

For the injury drama queens and kings, with the older kiddos, I give them "the look" that means I think they are faking. I will tell them my assessment, ie "your ankle is not bruised, not swelling at all, and I can see no sign of serious injury. Is it really as bad as you are making it sound". Usually they will make a miraculous recovery. I do call the parent after the child has returned to class, or I go in the office to call. If the child insists that they are in severe pain or cannot bear weight, I will call the parent and refer for an x-ray.

I have a window that lets me see whoever is coming into my office, and often I see kids that do not start limping until they get in my office, and I call them on that and send them back to class, LOL!

Yes, we have one HS principle that thinks the nurses are "mean" because we don't send kids home for every complaint. I have discussed this with my supervisor and she always says, "Our job is to keep the students healthy and in school." When trying to decide whether or not to send a student home, I try to remember this.

If they can stay at school, they should. The minute the students (esp. HS) figure out they can go home for every little complaint, the nurse's office will become a chaotic mess. My general rule is if the student is afebrile and not vomiting (in the bucket or trash can in my office), they stay at school. Of course, there are exceptions, such as a sore throat that looks like strep throat, etc.

If in doubt about whether to call a parent or not, I err on the side of caution and call. Like luvschoolnursing stated, calling parents when the student is not around is also a good option for those who you think are "faking it" or you think they seem ok to stay.

As far as the HS students going to the bathroom and calling parents, that happens to us, too. Here is how I handle that: If I have decided that a student is okay to stay and they end up calling the parent on their cell phone to pick them up, I refuse to write them a pass to leave school. If the principle wants to excuse them to go home, that is their call, but as far as I am concerned, they are okay to stay and I am not going to give them an excused pass to leave. The principles at our HS are pretty good at backing us up.

I know the exact situation!

Or the student who is in the hall cutting up and laughing with friends and 15 minutes later they are in the nurse's office acting like they are "dying" and need to go home.

Yeah, right! "Get back to class!"

How long have you been at your school? I found that when I first started, there was a lot of "testing the limits" to see how much of a pushover I was. I was a little naive for a while, but I quickly caught on to their games. Although the kiddos still try it every once in a while, it has decreased a lot now that they know I am not going to let them go home because they supposedly puked once in the bathroom!

This is my 2nd year at my job full time (I was a sub the first year) I have never been a school nurse, although I was med/surg/ostomy/wound care/trauma/ortho in the past, this is a whole new game!! I am at a small elementary school 2 days a week and a larger high school (1400 students) 3 days a week. There is also a full time nurse at the high school who has worked there for 12+ years, so she has taught me a ton about school nursing. I also get pulled frequently to cover for other nurses who are out sick or on vacation. We don't have enough subs.


It is the high school kids that push the limits daily, even with the other nurse who has been there for years. Many of the frequent flyers don't even care that we know they are faking - they just want to leave school. Some of them scream and cuss if we don't give them a dismissal and sometimes they leave the school anyway. I am still learning to be tough with these kids and it is hard for me sometimes.

I never thought there would be so much psych involved with school nursing.


Any advice or suggestions are welcome!

How about you? How long have you been in school nursing?