Advice Needed

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Hi all! I am wondering what to do next after a scary incident. Long story short, a student had been placed on a suicide watch plan with administration and counseling, but no one thought it might be nice to let the nurse in on the secret. Student presents in my office with erratic behavior, is a known frequent flyer, and admin had called mom to come pick student up and take student home as student was disrupting class with odd behaviors. A little more digging with student and mom reveals the info that student had been threatening suicide this week. At this point situation was emergent, and I sent mom and kid to ER right then and there. Kid gets admitted to psych unit and all hell breaks loose at my school district with HR, and the school administration demanding I be fired because I did not activate EMS right away for suspicions that student may have ingested drugs. This is when it came out that student had been on a suicide watch plan. I have yet to find out if student DID ingest drugs. All I know is that vital signs were all within normal limits at the time and student was alert and coherent in my office.

I want to write a letter to all admin and my bosses stating that withholding information from the nurse, no matter who that might be, is reckless. I am still in major self-protection mode right now, and I might not be seeing this clearly. I am looking for other jobs as this is the last straw in a string of incidents with admin and no support from district. Part of me wants to make a huge stink about it, but part of me says cut my losses and run.

Any advice always appreciated. Thanks!

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Wow, so admin called before you saw the student? How long until Mom arrived? Using a term like emergent and erratic behavior seems like a 911 call could have been warranted, but you had vital missing information to complete your assessment. Keeping this information from you is a critical misjudgement that I only experienced while in private vs. public school settings. If you did not witness the erratic behavior and had stable student in front of you with parent on the way I do not view that as emergent.

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Specializes in ED, psych.

Omigosh!

Well, I'm not a school nurse. I do, however, have common sense and am a mom to boot. You absolutely did the right thing.

You don't screw around with suicidal ideation. ED was the right call. Administration did the absolute *wrong* thing. They don't call mom to pick up the kid b/c of erratic behavior. Counseling/administration calls mom to tell her what's going on as he sits in the nursing office getting an assessment with a nurse in the know, with ED in the wings. If this child was on watch, there are any number of ways he could have taken his life, at any point during the school day. And drugs? If they suspected drugs, an OD could've been one of them. How about letting their nice neighborhood nurse know the deal?

This is on THEM.

I mean, why would you notify EMS right away for suspicion of drug use? Your assessment didn't support it. A/O, VS stable, etc.

Jesus.

I'm so sorry.

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Specializes in kids.

That stinks!! You can only do so much, with what is in front of you. I get so tired for the turf wars and information hoarding. Totally on them.

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Specializes in Pediatrics Retired.

Could you explain a little more about how admin became involved when the student presented in your office with erratic behavior? If the student was sent to you first, how did admin get involved or if the student was sent to admin first, how did you get involved?

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Specializes in ICU/community health/school nursing.
I sent mom and kid to ER right then and there. Kid gets admitted to psych unit and all hell breaks loose at my school district with HR, and the school administration demanding I be fired because I did not activate EMS right away for suspicions that student may have ingested drugs. !

OK - mom felt it was safe to drive the student, and student must have stated s/he would comply with parental directions and not attempt to exit the car. Yes?

With normal vitals, with no reason to suspect the student ingested anything, and without the parent TELLING YOU kid was on suicide watch...I really don't think EMS would have transported the student. In my limited experience, if the kid is complying with verbal instructions and is not an immediate threat to self or others...EMS often "encourages" that parent to take the kid in versus transporting.

All you can do is fall back on your documentation. If you have no clue about the suicide watch AND the parent chose not to tell you - you did what you could with what you had.

Regarding cutting and running....yes, you could. And you could say that you had a difference of opinion with administration regarding the care of a student. But I would make sure that this got cleared up, and that your integrity and your reputation are not slandered (that's speaking) or libeled (if someone writes it).

Good luck.

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Specializes in ICU/community health/school nursing.
turf wars and information hoarding.

AMEN.

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Admin got the student first. Student has been a discipline problem off and on and what was first described to me was that student was being disruptive in class. Referring teacher did not say anything about being suspicious for drugs. Student apparently had been involved with admin earlier in the week for discipline issues. Admin had a representative bring student to my office next. At no time was there any mention of a harm reduction plan for the student at that or any time until several hours AFTER the incident, and then not from Admin but from the district office.

It has been a long, hard weekend, but I have decided that I will NOT be coming back to this school next year. I will finish this contract and see if there are other openings at other schools, or find something new. Too many of these issues have popped up this year. My sanity and my license are not worth it.

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Specializes in Pediatrics Retired.

Gee my heart goes out to you. Under those circumstances, with mom sitting in front of me, unremarkable student assessment, calling EMS would have never entered my mind. It's real easy for everyone to Monday morning quarterback you so try not to let that get under your skin but If you've decided this is a place where you are frequently thrown under the bus it's probably a healthy idea for you to move on. Please keep us informed as to your progress.

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Specializes in NCSN.

With normal vitals, with no reason to suspect the student ingested anything, and without the parent TELLING YOU kid was on suicide watch...I really don't think EMS would have transported the student. In my limited experience, if the kid is complying with verbal instructions and is not an immediate threat to self or others...EMS often "encourages" that parent to take the kid in versus transporting.

^This^

We are not mind readers.

You did everything correct based on the situation and information you had at that moment.

I'm sorry you are going through such a rough situation. I hope you find a school that is a better fit.

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Specializes in Med-surg, school nursing..

I'm sorry this happened and I am glad the student is getting help.

I would let them know, probably in my resignation letter that the lack of communication is the reason why you are leaving. I would let them know that failing to tell the nurse vital information, like that a student has a watch paln!! will come back on them and will bite them in the butt, not you. This was 100% their fault. If they were that concerned why did they even send the student to you, why not call 911 themselves.

I would not take the fall, leave if you wish, but let them know THEY were in the wrong.

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Specializes in school/military/OR/home health.

Well, since the next thread is about an 8 year who committed suicide, as the admin in your school I would definitely be concerned whenever any student has SI. Erratic behavior does not always mean drug use, so not sure where they were going with that.

They withheld critical health information from you and got very upset when you didn't act the way they thought you should have, based on the information you didn't have...was mom concerned about drug ingestion? Was mom wanting an ambulance? Unless the student had lost consciousness, or vitals were concerning and consistent with drug ingestion, why WOULD you call EMS?

I keep seeing this theme with school nursing, this admin thinking they know medicine better than the school nurse. They seem to confuse their authority with our knowledge. They aren't the same thing.

I think you took reasonable actions with the information you had.

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