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.
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.
She's venting. Here. With other school nurses. Who understand.
Yea, yea, yea. We are all nurses. We all work with stressed people.
Got it.
Don't tell us what you "would have done" if you aren't in the situation of being the only medical person in the building full of kids. m'kay?
I'm with you 100%. What happened to you is the same thing as when an author is at a dinner party and any ol' yahoo says 'Oh yeah, I know I could write books too'. Really? - then why haven't you, eh? You had done what you needed to, and could, with the girl, and you took a very short time to take care of some routine but important things.
Specializes in Psych (25 years), Medical (15 years).
What everyone else said: Sorry, good job, etc., Jersey!
Having had Supervisors and Administrators who are not Medical Professionals has created difficult situations, like power plays, in my past. Heck, having Supervisors and Administrators who are ​Medical Professionals is currently creating similar situations right now!
Happiness depends not on what others do or say. Happiness is a result of being at peace with our self.
There will always be conflict. If we truly want peace, we have to give up the idea of conflict.
Those who seek and won't avoid conflict need to have hardball played with them.
So now OP, you need to start a campaign of seat belts on busses, and that EMS is called and waiting for anyone who is injured on the bus.
That should go over well.
You did the right thing. I would say to the AP--in an incident review that I am SURE you are going to have--(hint, hint) that you need to be able to do your job without his questioning your clinical judgment. Period.
And if anyone is going to bring forth the lawsuit--it would more than likely be on the bus company.
But I am just throwing it out there, the bus company should have a policy. And that policy should be clear. And the transition of care may need to be bus to ambulance. So that YOU are not taking on the liability of taking on care and making those decisions for students who are hurt while not at school in questionable circumstances.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
You did the right thing. I would say to the AP--in an incident review that I am SURE you are going to have--(hint, hint) that you need to be able to do your job without his questioning your clinical judgment. Period.
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.
EXACTLY. Admin hires us because WE are the trained medical people in the building. My Principal does the same thing...Tries to micro-manage scenarios and health situations that he knows NOTHING about. To the point where I have considered leaving over it. (And the nurse before me did.)
I definitely feel you should address it with him. Maybe in a fashion that says "I want to discuss what happened with regard to this student." Clearly, your AP does not understand Triage. Nor the importance of timed meds. Sounds like the student who was injured had the counselor with her, was safe, and had already been assessed. What were you supposed to do, sit next to her and wring your hands?
Face it now, so that you won't have to deal with this nonsense in the future. Sorry you have to deal with it! Does it help that I understand?
I always sort of thought that our admins look at us as beautiful graceful ducks swimming on serene ponds. They just choose to see what's on the surface and don't realize how much we're working our legs to stay afloat.
That being said, i stand by you. I've had plenty of situations where i've had a student that has been in my office waiting for EMS or in you r case Mom (btw how far out was mom? -just saying because if mom was like 45 minutes away then i think it was a bit unreasonable to think that your entire office would shut down with the child being stabilized...) and i've had to meet them at the door to take lunchtime insulin or a timed med. But i'd try to tell my teacher bouncer that was turning the bellyaches and sorethroats away from my office at that time to allow Sally Smith or Brian Jones and let me know when they are there or I'd simply say if they come for meds I need to see them.
Unless i'm doing cpr or something where i really have an unstable situation then there's usually no reason why i can't break away for for a moment to medicate a scheduled medication.
Specializes in med-surg, IMC, school nursing, NICU.
I took the whole weekend off from this thread so I could calm down. And I did. It's all water under the bridge now. But you guys made that happen by being so understanding. It can be very isolating working as the only medical professional in a building, as you know. It's great to have you here to talk to.
The student came to see me this morning. No sling or anything. She said the doctor told her the shoulder was dislocated but "self-reduced" and she didn't require any intervention. She's following up with the MD in a few days and when I told her no PE or recess until then, she was not very happy. A sure sign that she's feeling better!
Specializes in med-surg, IMC, school nursing, NICU.
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.
I'm sure he did feel powerless. Because he is. He isn't the "power" when it comes to medical issues. I am, which is why I was hired to begin with. He is the "powerful" one when it comes to discipline, hiring, firing, IEPs, staff meetings and nearly everything else in the building and those are areas where I do not impose myself. All I ask for is the same courtesy and respect.
Specializes in med-surg, IMC, school nursing, NICU.
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!!!
Farawyn
12,646 Posts
She's venting. Here. With other school nurses. Who understand.
Yea, yea, yea. We are all nurses. We all work with stressed people.
Got it.
Don't tell us what you "would have done" if you aren't in the situation of being the only medical person in the building full of kids. m'kay?