Clinic Numbers

SchoolNurseBSN · Feb 23, 2009

I have about 450 and I see about 30 kids daily - plus, another 10-15 staff and parents coming in and out.

Purple_Scrubs, BSN, RN · Feb 24, 2009

I have around 540 and I see around 20-30, not counting the "drifters" who wander in from lunch without a nurse pass. I send them right back to lunch :) I usually see only 5-10 parents/staff per day. Towards the beginning of the year I was only seeing 15 students per day on average, but now that cold/flu season is here I have easily doubled that.

luvschoolnursing, LPN · Feb 24, 2009

Have 1,000. Seeing about 30/day + the regular meds and diabetics, but that number is much higher than usual with all the colds/flu/stomach things going on right now. Usually see about 15

Aneroo, LPN · Feb 25, 2009

I saw about 20-22 today. A lot of it is simple stuff, but a lot is time consuming also. I have been working on finishing my BMI/vision stuff too.

lilbiskit78 · Feb 25, 2009

Hi everyone! I am new to school nursing (only a month now) and my clinic visits are super high and I need some advice as to how to lower them. I am running ragged and can't get anything done except see kiddos. We have 650 students in my school (3rd and 4th grade only), I have been seeing an average of 70 a day (sick visits) plus about 20 that take daily meds and any parents that stop in to refill meds, ect. I don't know if the teachers are just sending down anyone that asks or what...most of these kids are not even sick, altho we have had a big flu influx the last week or so. I instituted a new rule that they must have passes....that has actually decreased the numbers since I used to have a lot of "wandering in" as well. Any advice is much appreciated.

Lil

cowgirlBSN · Feb 25, 2009

I've been wondering the answer to this question since I've started school nursing as well! Really, it depends on your teachers. If they are inclined to send every little thing so they don't have to deal with it, then you're sunk! I've considered writing a letter to teachers letting them know what should and should not be sent to the nurses office. But, I'm afraid they might hold someone that should have came down so that's kind of a catch 22. What might help is giving every teacher/classroom their own baggie of bandaids, cough drops. That way they can handle the very minor things that really do not need a nurses attention. Hope that helps.

Purple_Scrubs, BSN, RN · Feb 27, 2009

Hi everyone! I am new to school nursing (only a month now) and my clinic visits are super high and I need some advice as to how to lower them. I am running ragged and can't get anything done except see kiddos. We have 650 students in my school (3rd and 4th grade only), I have been seeing an average of 70 a day (sick visits) plus about 20 that take daily meds and any parents that stop in to refill meds, ect. I don't know if the teachers are just sending down anyone that asks or what...most of these kids are not even sick, altho we have had a big flu influx the last week or so. I instituted a new rule that they must have passes....that has actually decreased the numbers since I used to have a lot of "wandering in" as well. Any advice is much appreciated.
Lil

Holy cow that is a lot for 650 students! Hang in there! When I first started, I think there was a lot of "let's see if the new nurse falls for this one". I saw 40-50 for the first few months, now I am down to 20-30. Once they realized they will not be sent home needlessly, the number went way down. My tips:

1. Insist on nurse's passes. The only exception is if the teacher accompanies them to the office. No wanderers.

2. Vomiting: you need to see it or the teacher has to see it or it does not "count". I had kids ask teacher to go to the BR, come back, tell the teacher they threw up, go to the nurse. No fever, no vomiting in my office. Sent back to class. Lather, rinse, repeat. That got REAL old. Now when they come in the first time I tell them me or another grown up has to witness the vomiting, or if in the BR they have to leave it in the toilet (and yes, I check). Cuts way down on pretend vomiting.

3. Have criteria for discharging home and stick to it. For me, no fever or other s/s of illness and no distress = back to class. If they come in a second time, I will step out of my office to call the parent, explain they are complaining of xyz but I think they are fine. Generally the parent agrees they should return to class. I avoid letting the child talk to the parent because they can be manipulative. This way I can tell child and teacher that I have talked to mom/dad and they do not get to go home!

4. When you are slammed and a kid is c/o headache or stomachache but look generally ok, give them an appointment time to come back. So if it is 10 AM I tell them if they still feel sick after lunch they can come back. Now that it is cold/flu season, though I am more apt to take a quick temp then send them back. If I have room in the office they can rest at most 10 minutes then back to class.

5. Always ask if they have eaten breakfast. This clears up about 70% of my morning headaches and stomachaches.

6. Educate the educators! Tell them that if they cannot see a cut or splinter, you can't either! Let them know it is OK to let the kid put their head on their desk for 10 min before sending them down. Definitely hand out band aids. Let them know that a healing cut that is scabbed and not bleeding does not need a bandage, and you do not need to examine a week-old bruise! On the other hand, make sure they know that you are always willing to check out anything they are concerned about - that is why you are there and they need to have confidence in you, but you can't let them walk all over you.

7. If you are getting kids from the same class at the same time, you might need to tell the teacher they can only send one at a time (especially if your office is as small as mine!)

8. If you can find the time, go talk to the students to introduce yourself, especially the little ones. Let them know you are there to help them when they are sick or hurt, but that your main job is to make sure they are healthy so they can stay in school, not just to send them home when they don't feel well!

9. If the same students are coming in frequently, keep tabs on it and don't hesitate to bring it up to the teacher, parent or administration. There is probably something else going on whether it is problem at home or feels overwhelmed at school.

That is all I can think of. I have only been doing this just over a year and I have learned SO much in that time! I know most of the other school nurses on this board have lots more experience then I, so you will probably get lots of good tips. I remember how frustrating it can be, so just keep plugging along! Oh, and take your lunch breaks even if you have to leave kids in your office for that time. Not much is a true emergency, and you deserve the break! Once the kids realize you are not going to let them go home for every little complaint, I bet your numbers go way down. Have fun!

lilbiskit78 · Feb 27, 2009

Purple Scrubs thank you so much for all the advice. I am trying to set standards for what needs to come to the nurse and what doesn't but there are so many gray areas.....like headaches. Alot of kiddos c/o headache or stomach ache they know these are the two things we can't prove or disprove...but I've had quite a few "just headaches" with the 102 temp and the flu. The teachers in my school do send everything down I mean everything.....they even send me the loose teeth kids cause they are tired of the kid wiggling it in class. SORRY!!! I get a lot of what I call "repeat offenders" during the day...ie...the kid came in with stomachache clinically fine sent with a note to the teacher back to class. Then they go off to their music class, tell that teacher they don't feel good, like you said lather rinse repeat. I think they believe if they come down enough I will eventually send them home. Had one yesterday came in 3 times within one hour...once before school had even started, once from her homeroom, once from music. She was clinically fine c/o stomach hurting and I looked her over several times afraid I may be missing something. Finally sent her back to music and the teacher was mad saying she was crying in class and upsetting the other children and that she must be hurting....I should at least call mom. I was so annoyed I did call and talk to mom and mom told me she was faking....she not only had made a comment to mom the night before that she was going to stay home from school but told me several lies about not eating, ect. I sent her back to class and went straight to my prinicpal I was so irritated.....I saw the child playing dodgeball in PE about an hour later. What has been hard for me with the "I puked in the bathroom" thing is that I may or may not believe the kid puked but if I try to send them back the teacher gets PO'ed saying they don't want a sick kid infecting the class, or them, or puking in class. I have also had a teacher decide a student needed to go home that had no temp, no vomiting, ect, call the parent themselves without my ever knowing the child c/o being sick, and then send her down to the clinic to wait for mom to pick her up. Ummm excuse me? I wanted to send the student back up to class and tell the teacher if she wanted to play nurse she could keep her in "her clinic" until mom got there. It is hard for me because I am new, I hardly know anyone, and I don't want to make enemies, but gosh....how would you like if I just came in your class and took over, ya know? Overall I like the job and it is great for my family, I just need to figure out how to run my clinic without getting run over by teachers or students.

SchoolNurseBSN · Feb 27, 2009

Holy cow that is a lot for 650 students! Hang in there! When I first started, I think there was a lot of "let's see if the new nurse falls for this one". I saw 40-50 for the first few months, now I am down to 20-30. Once they realized they will not be sent home needlessly, the number went way down. My tips:
1. Insist on nurse's passes. The only exception is if the teacher accompanies them to the office. No wanderers.
2. Vomiting: you need to see it or the teacher has to see it or it does not "count". I had kids ask teacher to go to the BR, come back, tell the teacher they threw up, go to the nurse. No fever, no vomiting in my office. Sent back to class. Lather, rinse, repeat. That got REAL old. Now when they come in the first time I tell them me or another grown up has to witness the vomiting, or if in the BR they have to leave it in the toilet (and yes, I check). Cuts way down on pretend vomiting.
3. Have criteria for discharging home and stick to it. For me, no fever or other s/s of illness and no distress = back to class. If they come in a second time, I will step out of my office to call the parent, explain they are complaining of xyz but I think they are fine. Generally the parent agrees they should return to class. I avoid letting the child talk to the parent because they can be manipulative. This way I can tell child and teacher that I have talked to mom/dad and they do not get to go home!
4. When you are slammed and a kid is c/o headache or stomachache but look generally ok, give them an appointment time to come back. So if it is 10 AM I tell them if they still feel sick after lunch they can come back. Now that it is cold/flu season, though I am more apt to take a quick temp then send them back. If I have room in the office they can rest at most 10 minutes then back to class.
5. Always ask if they have eaten breakfast. This clears up about 70% of my morning headaches and stomachaches.
6. Educate the educators! Tell them that if they cannot see a cut or splinter, you can't either! Let them know it is OK to let the kid put their head on their desk for 10 min before sending them down. Definitely hand out band aids. Let them know that a healing cut that is scabbed and not bleeding does not need a bandage, and you do not need to examine a week-old bruise! On the other hand, make sure they know that you are always willing to check out anything they are concerned about - that is why you are there and they need to have confidence in you, but you can't let them walk all over you.
7. If you are getting kids from the same class at the same time, you might need to tell the teacher they can only send one at a time (especially if your office is as small as mine!)
8. If you can find the time, go talk to the students to introduce yourself, especially the little ones. Let them know you are there to help them when they are sick or hurt, but that your main job is to make sure they are healthy so they can stay in school, not just to send them home when they don't feel well!
9. If the same students are coming in frequently, keep tabs on it and don't hesitate to bring it up to the teacher, parent or administration. There is probably something else going on whether it is problem at home or feels overwhelmed at school.
That is all I can think of. I have only been doing this just over a year and I have learned SO much in that time! I know most of the other school nurses on this board have lots more experience then I, so you will probably get lots of good tips. I remember how frustrating it can be, so just keep plugging along! Oh, and take your lunch breaks even if you have to leave kids in your office for that time. Not much is a true emergency, and you deserve the break! Once the kids realize you are not going to let them go home for every little complaint, I bet your numbers go way down. Have fun!

Good post purple scrubs! You pretty much hit it right on. I especially agree with the vomiting thing - it is an awfully big coincidence that so many kids make it to the RR for pukies. Then, they don't smell like it or look like they vomited either!!!

kidsnurse1969 · Feb 27, 2009

I joke with my staff that I want to see chunks in their teeth and splash marks on their shirts if I am supposed to believe the kid had anything more than a chunky burp.

I have a supply of 1 gallon milk jugs that I cut the tops off, leaving the handle, to use as "barf buckets". (They are appreciated by parents of kids that are really sick to save their vehicles on the way home--just in case) I tell the alleged sick kids that if they throw up again to bring it back to me in the jug so I can "evaluate it". They rarely come back.

Rosie67 · Mar 2, 2009

Great ideas- I use most of those myself. I've been here 5 years so have worked out many of the kinks. Problems at times with new staff. I feel we are here to not only keep kids in the classroom, but to teach them how to use healthcare- to become Responsible Consumers. They rush down to me, I'll ask duration. They will state 10 minutes, 20 minutes. I'll explain that sometimes waiting is the best thing to do in many instances. Many of my students are taken to the ER for a jammed finger, S/T, pink eye!!! Drives me crazy. My first month here was in the middle of the year. I had a 7th grader come down asking me for hot chocolate and chicken noodle soup for a stomachache. I found out from other staff that she cooked for the students and would have lines of "sick" kids out the door. I always heard how the kids loved the old nurse. That just seems so irresponsible. I went from 60 kids a day down to 25-40 depending on the season. I don't care if they like me. I want them to learn when to seek medical care and when to wait. I call the teachers quite a bit to fill them in. This builds trust. Often we get different stories from the same student. Ice packs are still an issue for me. A 5th, 6th, 7th, or 8th grader doesn't need an ice pack for every little bruise. My gym teachers don't always agree with me. That continues to be a struggle. Even with the negatives, I must say that school nursing is very interesting and rewarding. I wouldn't want anything else.