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.
Today, I was discussing when to do my annual evaluation with the AP in question in the office and the SLP happened to be in there. She looks at me and says "You need an annual eval?!" and I said "Sure. Why not?" and she replied "Well, how on earth is AP going to know if you're doing your job correctly, he has no medical knowledge!" right in front of him.
I felt pretty validated!
Shhhh . . .don't tell anyone but I never had an evaluation in the 5 years I worked as SN. Since I was the only medical person around, no one thought to do this. I was happy about that.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
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.
This AP has no idea how out of line he is.
You express yourself very well and I think you should have a talk with the AP.
He needs to know that you are trained to prioritize these situations, and that you wouldn't and shouldn't have done it any other way. It would have been totally inappropriate for you to neglect to give the ADD med. This is your call because you are qualified to make the call.
Now that you have vented here, I know you can talk to this guy (lady? ) in a productive way.
Specializes in med-surg, IMC, school nursing, NICU.
Another update!!
I just got a call on my walkie that there is a 5th grader (my 5th graders are a mess this week!) sitting on the floor of the gym, refusing to get up. Says she sprained her L ankle while running and demanding a wheelchair. I told the office I was heading down and, sure as day, the AP was on my heels.
AP- Don't you think you should be bringing the wheelchair?
JTMC- Not until I assess her and decide if that's necessary.
This student comes to see me a lot and I know for a fact she really hates PE class so I had a feeling a w/c wasn't necessary. Sure enough, I got there and magically she could walk! It's a miracle.
I'm glad I stuck up for myself. It seems small but I felt some vindication.
Specializes in School Nurse. Having conversations with littles..
Today, I was discussing when to do my annual evaluation with the AP in question in the office and the SLP happened to be in there. She looks at me and says "You need an annual eval?!" and I said "Sure. Why not?" and she replied "Well, how on earth is AP going to know if you're doing your job correctly, he has no medical knowledge!" right in front of him.
I felt pretty validated!
This is a definite, loud and long- WOOOOOHOOOOOO! I almost did this out loud, all by myself, in my office as students and teachers are passing by, quietly, in the hallway :)
That's beyond annoying and I'm really sorry. I used to think school nurses had it made until I graduated and looked into it further. I don't think I could take all that garbage all the time, plus trying to figure out if a kid is at my office "for real" or not.
Administration can be so annoying and that's a big part of why I work nights (however, it does tend to seep over so I can't avoid them altogether haha).
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."
My husband has been a teacher for 17 yrs and he has always told me that. No real world experience and usually the only jobs they've ever had.
Teachers were difficult to take care of on post partum but I really see what he's talking about now.
I'm so sorry you had to deal with that. I have dealt with this from time to time as well, and it IS very frustrating. *Hugs* hope they eventually realize how lucky they are to have you :)
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Spidey's mom, ADN, BSN, RN
11,305 Posts
Shhhh . . .don't tell anyone but I never had an evaluation in the 5 years I worked as SN. Since I was the only medical person around, no one thought to do this. I was happy about that.