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.
Tell the AP to find out why the kids aren't buckled in and facing front lol. Our bus back rests are tall so there is no way a kid can sit with their arm on the back rest. Of course they are all standing, facing backwards etc. You did well. It's Friday...have a glass of wine tonight and fuhgettaboutit.
"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."
There you go, that says it so well!!! I am in a suite set up. I see most kids when they come in the suite door from the hall before they even make it to my door. I can already tell if they are sick or not, truly injured or just milking it before we have even spoken.
The AP is an ---! You did everything as I would. My admin is opposite "Oh, I see you doing CPR over there but we have this kid that has a 2 drop nosebleed that needs a bag of ice."
You absolutely did everything right. Nurses have super powers that lets them assess multiple situations at one time. This student was waiting for their parent, you had done what you could. There is no reason why you couldn't give a student their medication. You can't deny one student the services they had been ordered either. Their success in class is dependent upon them getting their medication at prescribed times.
I had a 5th grader come in this morning at 7:40. Fell off her bike on the way to school; I was pretty sure she had a fractured distal radius from the way she presented and the point tenderness. I splinted her arm and called mom to take her for an x-ray. Where I messed up was I continued to pass out medication and tend to the other "needs" of the students while she was sitting here waiting for mom to pick her up...we'll just never learn!!!
Specializes in Peds Urology,primary care, hem/onc.
I am not a school nurse, but I wanted to commend you on the job that you did. I think you hit the nail on the head...people outside of nursing have NO IDEA what is going on in our heads in a situation like it. We can triage seamlessly and multi-task quickly. He probably did not have a clue on how you were assessing the child, why you sent the other kids back but felt it was very important to medicate that one child etc. He cannot see your thinking process and he probably assumed you were not doing anything. Triage and multitasking is a key nursing task. I have had my friends comment on various emergencies they have seen me deal with and about how calm I have been, how I managed it etc. When I tell them what was going on in my head at the time, they are always shocked.
Maybe next week, when you have cooled off,you can approach him. Tell him you just want to let him know how/what you were assessing and why you made the choices you did. Should you have to? No...he should just trust you. But he didn't, and now you need to try and repair the relationship with him. Give him the benefit of the doubt, explain your thought processes for the whole event (he is going to be surprised how much was going on in your head at the time). you can even give him some different scenarios that could occur where you would NOT have given that child his meds because it WOULD have been too much of an emergency to do it. If he does not listen, or repeats the behavior, then you can put him in his place. My guess is he was totally freaking out and your calm manner of handling the situation (which is your job) came across like you were not doing enough or not focused on the injured child.
You hired me to be the nurse because that is my specialty. Soooo trust that I know what I am doing....
Crunch I agree with you totally. The issue we run into in school is that the majority of the staff has never existed outside of some kind of educational institution. They attend school as a child/teenager, graduate and enter school for college, graduate from college and return to school as a profession. Educational institutions are completely different than the world outside those walls and the majority of these people have never been exposed to the "outside world of life." I'm not saying they aren't good people, they're just ignorant as to "the other side."
Crunch I agree with you totally. The issue we run into in school is that the majority of the staff has never existed outside of some kind of educational institution. They attend school as a child/teenager, graduate and enter school for college, graduate from college and return to school as a profession. Educational institutions are completely different than the world outside those walls and the majority of these people have never been exposed to the "outside world of life." I'm not saying they aren't good people, they're just ignorant as to "the other side."
YES!!! This is it.
They have spent their life in a bubble, career wise.
So he made a comment; at least he's not there in your office everyday is he? If you make a big deal of this he might start showing up. Life's too short and you need to choose your battles wisely.
As an RN, you must understand he felt powerless, and it is his job to be the power (so to speak). I would just have smiled and let if roll off my back; but that's me...I work with stressed out everybody all the time.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
I agree with the posters who think you should talk to the AP. I wouldn't bother providing him with medical rationales; that would just reinforce his belief that he's qualified to second-guess you. For the same reason, I wouldn't waste any breath defending my actions.
I would just remind him that I have a license to do what I am doing and that he wouldn't find it very helpful if I hovered and second-guessed how he does his job. Express sympathy for how concerned and helpless he must have felt, but remind him that professional respect works both ways. Hope that curtails any future episodes.
Windchaser22
408 Posts
Tell the AP to find out why the kids aren't buckled in and facing front lol. Our bus back rests are tall so there is no way a kid can sit with their arm on the back rest. Of course they are all standing, facing backwards etc. You did well. It's Friday...have a glass of wine tonight and fuhgettaboutit.