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"Can you do something about this?"

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Mavnurse17 has 3 years experience as a BSN, RN.

1,372 Profile Views; 100 Posts

I'm in my second year of school nursing.  I initially really loved it, but lately I've been feeling really burnt out by being made to feel like everything is my responsibility to fix.  

A kid is acting out in the classroom, happens to have ADHD but is no longer receiving ADHD medication at school d/t a new treatment plan.... "nurse, can you do something about his behavior?"

A student sleeps in their first class of the day because he's tired in the morning, "nurse, can he come take a nap in the clinic?"

A student has severe social anxiety and hides in stairwells instead of going to class, "we need the nurse in the hallway now!!"

A parent is sending her kid to school with a "helmet" because he has seizures and doesn't want him to hurt his head if he falls, "nurse, can you call the doctor to get a note so we aren't liable in an adverse event?" 

A kid has body odor, "nurse, I'm going to send my student because he reeks!!"

 

Almost never do the teachers or other adults in the building attempt to talk to the parents or their administrators before coming to me.  Is this something  you guys deal with too?  And if so, how do you respectfully set boundaries so you're not losing your mind at the end of every day?  I try to be a team player and help out when I can, but it feels like every day there's something else on my plate. 

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Flare is a ASN, BSN and specializes in school nursing, ortho, trauma.

2 Followers; 5 Articles; 4,202 Posts; 35,664 Profile Views

So most of those items would be a big NO from me.  I would probably follow up on the child needing a helmet for seizures, especially if I have no seizure action plan or no mention of a helmet on the seizure action plan.  

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Mavnurse17 has 3 years experience as a BSN, RN.

100 Posts; 1,372 Profile Views

Flare, I got a seizure action plan from his provider last week but of course there's no mention of a need for this helmet.  Mom wants him to wear it because the last time he had a seizure at school, he fell from a chair high off the ground (already had that talk with the teachers...) and hit his head pretty badly.  But since this is mom's request and not a provider's order, wouldn't it be more appropriate to ask the parents to provide documentation that it's needed?  

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SaltineQueen specializes in School Nurse, past Med Surge.

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1 minute ago, Mavnurse17 said:

I'm in my second year of school nursing.  I initially really loved it, but lately I've been feeling really burnt out by being made to feel like everything is my responsibility to fix.  

A kid is acting out in the classroom, happens to have ADHD but is no longer receiving ADHD medication at school d/t a new treatment plan.... "nurse, can you do something about his behavior?"  No.  That's a classroom management issue.

A student sleeps in their first class of the day because he's tired in the morning, "nurse, can he come take a nap in the clinic?"  Not unless he has an elevated temp.

A student has severe social anxiety and hides in stairwells instead of going to class, "we need the nurse in the hallway now!!"  Call the counselor.  

A parent is sending her kid to school with a "helmet" because he has seizures and doesn't want him to hurt his head if he falls, "nurse, can you call the doctor to get a note so we aren't liable in an adverse event?"  Mom can have the doctor fax something when the kid starts wearing the helmet, but If there were an event and everyone acted in good faith there wouldn't be grounds for a case.  Chill.  

A kid has body odor, "nurse, I'm going to send my student because he reeks!!"  There's no rule against being stinky in school

 

Almost never do the teachers or other adults in the building attempt to talk to the parents or their administrators before coming to me.  Is this something  you guys deal with too?  And if so, how do you respectfully set boundaries so you're not losing your mind at the end of every day?  I try to be a team player and help out when I can, but it feels like every day there's something else on my plate. 

Yes...  Plus - my shoe broke, can you fix it?  I'm not a cobbler.  My glasses broke, can you fix them?  Probably not (in my head...I bet your teacher has tape upstairs, too).  All sorts of things.  On one hand I view it as job security, but on the other hand it gets really annoying.  You're still in your stages of undoing everything the previous nurse did and doing things your way.  Stand your ground.  Especially if you've got a legitimately busy with sick/medical kids type clinic (I'm usually relatively calm...knock on wood).  My responses to yours are above. 

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SaltineQueen specializes in School Nurse, past Med Surge.

1 Follower; 881 Posts; 6,377 Profile Views

7 minutes ago, Mavnurse17 said:

Flare, I got a seizure action plan from his provider last week but of course there's no mention of a need for this helmet.  Mom wants him to wear it because the last time he had a seizure at school, he fell from a chair high off the ground (already had that talk with the teachers...) and hit his head pretty badly.  But since this is mom's request and not a provider's order, wouldn't it be more appropriate to ask the parents to provide documentation that it's needed?  

If mom is the one wanting him to do this I don't even know that I'd necessarily need something from the doctor, but I could be wrong.

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lifelearningrn has 6 years experience as a BSN, RN and specializes in School Nursing.

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My first couple of years I dealt with all of these issues in one form or another. My helmet kid was a hemophiliac and the doctor's DID not recommend the helmet (bicycle), but mom insisted he wear it at school. He was in PK, and mom was just paranoid. Over the course of the year, she backed off and he stopped wearing it. 

We have a 'wrap around' specialist on campus now that helps deal with the behavior and social issues, which has helped immensely. When there is no councilor on your campus, those things tend to fall on the nurse.  

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I am amazed at the things they send or call me for. 

There are 2 counselors, 3 administrators and only 1 of me.

If it is behavioral, call an admin.

If it is anxiety, etc. - call a counselor. 

Now, I don't mind being a team player and it does take a village. However, when you pull me away from my diabetic with hypoglycemia to handle something another adult in the building is as or more capable or qualified to handle - then you need to be the team player!

Those other people also can go in their office, close the door and give the one on one attention the student needs at that point in time. I, on the other hand always have a clinic full of kids that need IMMEDIATE attention. 

You have to learn to either say no or tell them it will have to wait until you are not so busy. Triage is our friend! 

I use a lot of "is this the most therapeutic / appropriate place for this student right now?"  or "I can handle it after I am done with these 12 kids who are waiting to see me.:

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Flare is a ASN, BSN and specializes in school nursing, ortho, trauma.

2 Followers; 5 Articles; 4,202 Posts; 35,664 Profile Views

1 hour ago, Mavnurse17 said:

Flare, I got a seizure action plan from his provider last week but of course there's no mention of a need for this helmet.  Mom wants him to wear it because the last time he had a seizure at school, he fell from a chair high off the ground (already had that talk with the teachers...) and hit his head pretty badly.  But since this is mom's request and not a provider's order, wouldn't it be more appropriate to ask the parents to provide documentation that it's needed?  

I would probably mention to mom that I was going to have the dr re-send a new seizure action plan addressing when the helmet is needed during the school day.  (all day, while playing on playground, during PE only, etc.)  It's a litle passive aggressive on my part, but I'd want to dr to know this was something the parent felt he needed as well as having a more formal guideline.  If the parent forgets to send it or the child takes it off because he is hot, I wouldn't want it to come back on me.  

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SchoolNurse91 has 8 years experience as a BSN, RN and specializes in School Nursing.

134 Posts; 2,295 Profile Views

I had a teacher ask me to speak to a student with bad body odor. I couldn't smell anything, but I spoke with him anyway. He states he showers daily, wears clean clothes, has running water etc. He forgets deodorant at times. He's human. It happens. I called the mom just to follow up. She basically just said what the student did. Fast forward two weeks, the teacher said "He still smells!" What exactly do you want me to do about it? I've addressed the issue with the parent and student. It can be so frustrating. 

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laflaca has 5 years experience as a BSN, RN.

388 Posts; 8,850 Profile Views

In my experience, all of the things you mentioned are common.  And in my opinion none of them are nursing matters, except maybe following up on the helmet.  

I work in a HS and allow naps during their breakfast and lunch time only - it's first come, first serve, and requires leaving immediately when the bell rings (without complaint, or you lose the privilege).  Also requires getting out immediately if someone's sick and needs the cot.  I make this offer to students sent in for a nap during class time, and maybe three times a semester a student returns at lunch...they "need" naps a lot less during their own free time 🙄

My tier 1 responses:
"I would not be supporting his education if I allowed him to stay in my office in a non-urgent situation"
"What have you (teacher) tried so far to deal with this?"
" I can't really comment on the disciplinary or counseling issues with this behavior, but the good news is that his vital signs are stable and I'm not concerned about a medical problem right now."
"The ordering physician isn't recommending medications, and I'm afraid I am not your best resource about classroom management with (ADHD or whatever)"

"I'd be glad to discuss this, but I have (x number) of kids waiting to see me first"

And with some people you just have to say no.  No excuses, no apologies, politely but....just no, that's not the policy, or no, I can't do that.  Some people won't like you, but eventually they will get the message and you'll be able to work effectively.   Otherwise you will be overrun with body odor, cough drop requests, glasses repair, naps, menstrual accidents, dress code violations, gum stuck to things, etc. 

 

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JenTheSchoolRN is a BSN, RN and specializes in School nursing.

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I will say, I do fix glasses. I've got the repair kit, medical tape does work well, and being able to see the board in the classroom feels health related to me. Plus, often I can find out if parents know about broken glasses, if any insurance issues getting a new pair - things I can also often help with; I even have a small budget to order glasses if I can a copy of the prescription and there are insurance blips (thanks, Zenni Optical!). 99.9% percent of the time, parents and student are very, appreciative. 

I also have small deodorants I give out on request - students have learned this and most often is HS boys that ask and my counselor will ask for some as well to give to students they work with.

But, I manage the uniform stock at my school. I have no idea why or how I ended up with this - likely due to needing pants for period mishaps. But now I get sent every MS out of uniform. It drives me NUTS. I will make a uniform kid wait if I've got sick kids ahead of them and sometimes send them back to return later if I have an urgent student issue that needs my attention (like my newly diagnosed Type 1 student.)  

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MrNurse(x2) has 28 years experience as a ADN and specializes in IMC, school nursing.

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Funny that the teachers that don't want to talk to parents are the same ones who call when they are sick and they don't want them in their classrooms.

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