Administration hovering and criticizing

[JerseyTomatoMDCrab, BSN]

I had to force myself to wait an hour before typing this because I was so angry. This is a vent. A long one. You have been warned!

About 5 minutes before the first bell rang, the secretary got a call from a bus driver saying a 5th grader (we will call her Jane) got on the bus just fine but about 5 minutes into the ride began screaming and crying, saying her arm is broken. The secretary let me know and me, the AP and the guidance counselor went outside and waited for her bus. I didn't ask for them to stay with me but I didn't mind. When she bus arrived the student had walked up from the back of the bus and was already sitting in the seat behind the driver absolutely beside herself, crying and screaming. Obviously in a great deal of pain. She's not a FF and doesn't really complain. She refused to walk or get up so we got everyone else off the bus while I assessed her. She told me she was resting her arm on the seat back and when the bus went over a bump, she lifted off the seat a little and when she came down, her arm landed on the seat back and she felt a pop followed by sharp pain. My immediate thought was dislocation. She was unable to move the arm but had full ROM of her wrist and all digits, capillary refill of

Now the whole time this was happening the AP was sort of hovering over me. I get it, he was worried, he wanted to see what was going on, it's a liability thing, whatever. But he kept interrupting my questions when I was trying to talk to the student. I understand he was concerned, but I needed to do MY job. That's why I am there! It was annoying but I was okay with it. Mom was called and on the way to get the student to the ED.

We get the girl into my office. There is a line of kids when I get back. None of them are critical so I send them all back to class except one daily med student who takes her ADD medication right off the bus. She takes another dose after lunch so it's kind of important she gets the first pill on time. I checked on Jane one more time and there was no change to her NV status. The counselor was sitting and talking to her, we were just waiting for her to be picked up. So I gave the other student her ADD medication. It took about 90 seconds total and off she went. I then sat with Jane, gave her an ice pack and told her what to expect once mom picked her up and drove her to the hospital. Mom came, we helped Jane into the car and off she went.

Afterwards, we are all standing in the office and the AP says to me "When something like that happens, you can't be worrying about the daily med kids. When a student is injured they are your first priority and you need to make sure the injured kid is ok before you do anything else."

I don't know if it's because I haven't been having the best week at work but this made me so mad for some reason. 1) I already made sure the injured kid was ok. I assessed her on the bus and once we got back to my office. A possible dislocation is painful, of course, but it's not an emergency, her NV status was unchanged and mom was already on the way to take her to the ED. 2) If I skip a child's medication dose, I need to document it and explain why. This particular child is dosed twice a day; missing her AM dose would have messed up her entire schedule and a student who is in a lot of pain but otherwise safe is not an acceptable reason to do that.

I don't understand. I would never go into his office and tell him "This is the way you should write up an IEP" or "You need to discipline a student this way" because that's not my job! Everybody thinks they can do my job? Be my guest. Nobody seems to think my position holds any value until some one has a nosebleed, belly ache or is throwing up. Then I'm the A-#1 and expected to save the day and fix everything with a wave of my magic wand. Teachers are so comfortable demanding I medicate students, irate when I don't send them home and annoyed when I don't hand out ice packs for imaginary injuries. What if I went in there and told them all how to do their jobs? It would be ridiculous because that's not my place. But everyone is more than qualified to do my job, allegedly. My BSN, license and 4 years of experience mean nothing to them. My assessment skills and ability to prioritize are totally ignored because everybody seems to think they can do my job better than I can.

If our jobs are so easily delegated, maybe they should see what happens in schools where there is no nurse. An 11 year old arrested at one of the other elementary schools in my district a few weeks ago. The nurse was there performing CPR within 30 seconds, there is a time stamp on the security camera footage showing this. ROSC was achieved and that child is currently in the PICU waiting for a heart transplant. Would the outcome have been the same if a delegated non licensed professional was the one responding? Maybe. Maybe not. But, you know. Any old person in the school can do what we do.

I don't complain about being used as a PCP. I don't complain about the offensively low salary. I don't complain about teachers (that much, anyway) and I try not to complain about the clueless parents. Because I love the kids.

But I have a real problem with the person who told me during my job interview that I'm the one calling the shots when a medical situation arises also telling me how those shots are supposed to be called. I feel devalued and disrespected and, with the week I just had, I really can't wait to get home and forget this place exists for the next two days.

[NutmeggeRN, BSN]

Aww ((BIG HUGS)) That's how I felt last week! Take a nice big deep breath, and know we are all here. I would not address it today, but maybe next week talk to the AP. Is/he new? That is often the cause of much angst, for everyone.

I would have done the same thing. The girls was ok, the other one needed her med....you can bet your sweet bippy if she had been out of control, it would have been your fault for not triaging!!!!!

[kidzcare]

Boo on that! Big hugs to you!!

[ohiobobcat]

Ugh. Sorry this happened.

Like Nutmegge said, I would wait until next week, but I would definitely address this with AP next week. You don't need a non-medical person second guessing your clinical judgement, especially in an emergent situation (not that his was a truly emergent situation).

I had an AP get all up in my biz over a lice "emergency". This was all done via email and I was able to cool my jets for a bit before I politely set him in his place. If would have emailed him back right away I might not be working here right now.

And for what it's worth, I would have done the same thing.

[Keepstanding, ASN, RN]

I'm sorry you're not being treated fairly You did the right thing and I totally agree with getting that needed medication into that student on time, or else you would be the one to sling mud at if they did start acting out.

Your AP is an Jerk ! At times it seems like school nursing is a losing battle. Like you, I'm all about the kids. They need to start treating you like the professional that you are !! Keep your chin up and have a good weekend

[MrNurse(x2), ADN]

Sorry you had such a crappy start to your day. Next week I would approach him and explain that your training allows you to triage and assess risk, which you did appropriately this AM. You also assessed the needs of those waiting and deemed the med high on priority because that student is here for an education and that dose is necessary to make the most of why all of you are there. I would remind him that you respect his judgement in matters of education and leadership, he should respect your decisions in matters of health. You are all on the same team and each of you should be allowed to give your unique strengths and skills for the students.

[Farawyn]

This is complete bullcrap and your anger is coming through loud and clear- I'm mad for you, too! BULL!

If I said what I really wanted to, I would get banned.

You did it all right. Sometimes people cannot be pleased no matter what.

Follow up with us when you cool down. We got you. *hugs*

[BeckyESRN]

Sorry you had such a crappy start to your day. Next week I would approach him and explain that your training allows you to triage and assess risk, which you did appropriately this AM. You also assessed the needs of those waiting and deemed the med high on priority because that student is here for an education and that dose is necessary to make the most of why all of you are there. I would remind him that you respect his judgement in matters of education and leadership, he should respect your decisions in matters of health. You are all on the same team and each of you should be allowed to give your unique strengths and skills for the students.

Or you could just e-mail your AP with exactly what MrNurse has here^.

This shows you how poorly some people handle stressful situations. As nurses, we know to stay calm and do what you can for each person that needs your attention, however, you cannot be every where at once and you can't fix a potentially broken arm. Other things must be taken care of; the world does not stop. You have to prioritize, you have to multi-task, or nothing will ever get done. You rocked in this situation and your AP felt helpless. Let us know how it turns out with the student and the AP!

[DEgalRN]

I'm sorry that you've got a micromanager who doesn't actually have the right qualifications anyway. The hovering is why I left my last job. I agree that you need to bring it up. Hopefully they just don't realize how unhelpful and obnoxious they were and back off.

[Farawyn]

Ugh. Sorry this happened.

Like Nutmegge said, I would wait until next week, but I would definitely address this with AP next week. You don't need a non-medical person second guessing your clinical judgement, especially in an emergent situation (not that his was a truly emergent situation).

I had an AP get all up in my biz over a lice "emergency". This was all done via email and I was able to cool my jets for a bit before I politely set him in his place. If would have emailed him back right away I might not be working here right now.

And for what it's worth, I would have done the same thing.

*gets all up in your biz*

[OldDude]

Well Jersey that was long and I wouldn't have read it if I didn't love ya as one of my own. It's a good thing Emergency Departments don't operate under his direction. One patient at a time, and I would tell him that. If that's the case the word "triage" would have never applied to emergency medicine. To think you can't continue with patient care just because you have someone waiting to be picked up is really really, well, like Ron White says, "You can't fix stupid."

Hang in there, I'll have a Bud Light toast to you this afternoon. You make us proud.

[JerseyTomatoMDCrab, BSN]

I bit my tongue so hard I nearly bled. I mean, I get it. This student was screaming and obviously in pain. The AP has no idea about medical procedures or triage and, to the untrained eye, little Jane was mere moments from loss of life and limb. But THAT'S WHY I AM HERE. He needs to trust that I am doing the right thing! I was hired for a reason.

I would like to bring it up to him but I really don't know how to approach it. He definitely crossed a line. I guess assessing is so natural to us nurses that someone on the outside may not even realize we are doing it and therefore it looks like we did nothing.

I am so proud to be a nurse. I really am. It feels like a kick in the gut whenever our profession is brought down, whether it's on a stupid TV show, in the news or at work. We used to be so respected and that just isn't the case anymore.

As soon as this happened, I knew I had to tell you guys. I hoped you would make me feel better and you did not disappoint. I could cry, I am so touched by how supportive this community is. I felt very alone and you guys fixed that.

Thank you.