Clinic Procedures

Flare, ASN, BSN · Apr 24, 2015

that is a stifling amount of medications! I have 800 kids and only have 5 daily medications and 5 diabetics - just to give you a little perspective. I am wondering when the bulk of your med dispensing is done??

As far as the non emergent visits - I whittled them down from a frustrating number to a more manageable amount by communicating with the students and teachers alike about what i can and can't really intervene with. Headaches, colds, and sore throats are the 3 biggies - i really can't do a whole heck of a lot- and surprise! the 3 just happen to be related. I'm going to give the same advice nearly every danged time - more fluids, follow up at home if still not feeling well. Stomachaches - try the bathroom- try and poop - 65% of the time kids will admit they feel better. 25% of the time they will feel better but not admit it. The remainder just might really be sick.

T-Bird78 · Apr 24, 2015

Be careful how you tell the teachers to curb nurse visits. My oldest was in 5th grade and jammed his finger at recess. It started swelling and hurting and when he asked the teacher to go to the school nurse she said it was fine and to sit down. When he got home his finger was 3x its normal size, purple, he couldn't move it, and he was crying from the pain. I talked to his teacher and she said the nurse had asked them to not send kids to her unless really necessary. I asked the teacher where her nursing or medial degree came from, first aid training, etc. because she missed it.

SchoolNurseTXstyle · Apr 24, 2015

40-45 Medications / Diabetics. That is outrageous!! I have 18 daily meds / diabetics and I have the same grades as you, about 1280 students.

Can I ask what kinds of meds are you giving? I have had parents want me to give daily allergy medications and silly stuff that can and SHOULD be given at home. I do give a few morning ADHD medication but parents better give me a good excuse! If you are a stay at home mom who drives your kid to school every day, you give it! If you are a single mom that goes to work early, then I am ok with helping out.

My advice, do not be afraid to set some boundaries. Make sure teachers have band-aids and gauze in the classroom for tiny boo boos and scant nosebleeds. Don't give ice unless necessary. And a kid bumping their arm on a nerf football 2 days ago at home is NOT necessary. Don't be afraid to call a teacher out on sending kids for silly stuff.

And a kid better be red, white or blue to present to me with no pass. Bleeding, cynosis or passed out. Otherwise, go get a pass!!!I don't know how many times I have sent a kid back for a pass and I never see them again. They figure it is not worth it, their teacher figures it was not worth it or they just wanted to avoid going to that class and they are fine once they get there.

Thruthfully, anything past 50-60 visits is unmanageable. Nobody is getting a proper assessment with 100+ for sure as you are just in bombardment mode all day long. Kids with valid complaints and health issues are paying the price. Not to mention, you will burn out quickly with those numbers.

rbytsdy · Apr 27, 2015

Be careful how you tell the teachers to curb nurse visits. My oldest was in 5th grade and jammed his finger at recess. It started swelling and hurting and when he asked the teacher to go to the school nurse she said it was fine and to sit down. When he got home his finger was 3x its normal size, purple, he couldn't move it, and he was crying from the pain. I talked to his teacher and she said the nurse had asked them to not send kids to her unless really necessary. I asked the teacher where her nursing or medial degree came from, first aid training, etc. because she missed it.

This is exactly why I have one teacher who sends every little bump, scratch, and papercut to me. She is deathly afraid of parents like you who will tell her off if I don't get to assess the child. I I get that you are upset because your kid was in pain. But being nasty to a teacher and asking about her "medical degree" is the reason many school nurses wind up having to assess nonsense all day. For the record, I think it was fine to talk to the teacher about your concerns. But asking her about her training was taking it a bit far. Jammed fingers can take some time to swell. So if he was moving it and there was no swelling or bruising, I'm not going to beat up on a teacher.

Back to the OP, my principal and I came up with a protocol sheet of "When to see the School Nurse." I was seeing 50 elementary school kids a day. I was going nuts. It was a lot of "I bumped my knee on my chair.... a book fell on my finger.... my belly hurts (said with a big, bright smile). I only have 1 diabetic and 2 scheduled meds though. I had a ton of prn meds (most inhalers and nebs) but your caseload sounds crazy. What kind of meds do you have to give out every day???

Anyway, teachers need to follow the protocol before sending kids down. Kids must come with a note except for my diabetic student and a few of my asthma kids. Teachers need to think about things when they write a pass. It's not just "go." A pass makes sure kids are accounted for, the students gives the teacher and me the same story, and ensures I get around to documenting visits.

midschoolRN12 · Apr 27, 2015

The medications vary. I give the majority of the meds at lunch time. AM meds are primarily ADHD. We are in a very rural area and some of the kids are on the bus for 1.5 to 2 hours before arriving at school. If mom/dad gives their ADHD med to them before leaving home, it does not last all, or at least the majority of the, day. Some of the students need boosters of their ADHD meds to make it the rest of the day. I do have some with anxiety and my special needs students with meds specifically for their disorder. I don't give allergy meds or other OTC meds on a daily basis...they can take those at home. I do have 6 diabetics.

Starting with the new school year, students will HAVE to have a pass in their agenda to come to the clinic. The administration is in the process of adding a page in their agenda solely for the use of the clinic. I believe this will greatly help in communication between teachers so they can see that little Johnny or Susie has already been to the clinic 2 times today from previous teachers and they were sent back to class as it was not deemed they needed to go home.

I like the "Red, White, or Blue" to present without a pass. I will definitely have to add that to my list when I speak to the faculty/staff.

I am burning out with these numbers and have stressed to the principal that I am not giving the appropriate attention to those that truly need it. It's very overwhelming at times but with a few changes, I think we all will be successful in our individual jobs here.

Thanks for the support and the ideas/direction.

Flare, ASN, BSN · Apr 27, 2015

Holy crow! 1.5 - 2 hr commute for kids (four hour commuting total each day! and here i was moaning about having to drive to a side job a whole 15 minutes from home - i'm so spoiled)- that really makes me realize how much we can take our little 2.5 square mile town (walking district) for granted. That must be such a long day for those kids!

Back to the issue at hand - so from the way you post, i'm gathering that you are alone in your office. I'd say if anyone of on here were a candidate for a second set of hands - it's you. My advice - I'm sure you already chart everything - if you use an electronic system like healthmaster or snap - generate reports. Bring the reports to your administration. It's not about you not being able to "handle the job". it's about pure student safety. 45 meds in one day is a lot to keep track of for one person. I hope it never happens, but the potential for error is very high. I'm sure you're meticulous, but you also have students that are trying not to be out of class too long when they come for their meds (as those students usually are) paired with a packed office where you're trying to keep the flow going - it's a recipe for disaster. A second set of hands - a nurse to help you with visits while you focus on medications. (what happens if there is a true emergency while you are in the thick of med administration time - does it royally derail your day with now having to track down scores of students?)

Wave Watcher · Apr 27, 2015

Be careful how you tell the teachers to curb nurse visits. My oldest was in 5th grade and jammed his finger at recess. It started swelling and hurting and when he asked the teacher to go to the school nurse she said it was fine and to sit down. When he got home his finger was 3x its normal size, purple, he couldn't move it, and he was crying from the pain. I talked to his teacher and she said the nurse had asked them to not send kids to her unless really necessary. I asked the teacher where her nursing or medial degree came from, first aid training, etc. because she missed it.

This is where common sense from the teacher should also prevail. I tell my teachers don't send kids down for minor injuries, issues, complaints. We really don't know what goes on inside the classroom and how overwhelmed teachers can be on a daily basis. Most (not all) do the best they can every day to manage controlled chaos.

mamahuff · Apr 27, 2015

And a kid better be red, white or blue to present to me with no pass. Bleeding, cynosis or passed out. Otherwise, go get a pass!!!I don't know how many times I have sent a kid back for a pass and I never see them again. They figure it is not worth it, their teacher figures it was not worth it or they just wanted to avoid going to that class and they are fine once they get there.

LOVE THIS..Red, White or Blue!! I am using it!! Thanks

midschoolRN12 · Apr 27, 2015

Yes...it does derail my already crazy train! I have trained 2 office staff members to assist in the event of an emergency (which has happened multiple times as I have several students with seizures). Sometimes, I just have to put a sign on the door that says "Temporarily CLOSED unless emergency or daily meds/diabetics" just so that I can get through the necessities. Forget eating lunch...who needs that any way, right? I try to grab a bite here or there in the copy room next door, but for the most part, that doesn't even happen.

No medication errors to date. I stop and give the students with medication my undivided attention to make sure the Rights of Medication Administration are being followed. Several students take AM and lunch meds. I'd hate to confuse the two of them!

I have asked for assistance in the clinic, even an aide, but per our assistant superintendent, our school is already over staffed with 4 secretaries, 3 counselors, and 3 APs along with our main principal (I report to him). She suggested the secretaries help...great idea...except they aren't medical personnel. The secretaries do have bandages and feminine products and that has greatly reduced the number of visits.

Unfortunately, we use Infinite Campus for our documentation. It is not user friendly. I can run very few reports and those that I can are not what I need. Basically, I can run a report for how many students are seen a day but not the reasons or anything further. It is so complicated.

Flare, ASN, BSN · Apr 28, 2015

so let me get this straight... every principal for all intents and purposes gets a secretary(i'm sure it's not exactly like that, but that's how it figures). There are 3 assistant principals AND a principal. 3 counselors. And probably countless aides and teachers and co-teachers and tech personnel and assistants and librarians and perhaps assistants in there too.... yes, overstaffed indeed - but just as in your school, my school and probably practically everyone else's school on here - the one place no one thinks to give an ounce of assistance to is the one place that probably gets about the most use. We live in a litigious society - i have teachers that won't even keep bandaids in their desk for the occasional hangnail or paper cut. (I have others that want me to make them little first aid kits so kids don't miss 10 minutes of class because they picked a scab - they're my favorites!) There are teachers that won't let kids leave because they don't feel well - we've all seen it and some that will send them because they "don't look right" despite the child saying they feel fine. My point is that at some stretch of the road, a bad call is going to be made (it's already happened - if you scour the news you can find instances) or a nurse is going to be unavailable and a district isn't going to be able to sweep it under the rug with a cash settlement.

Ok, i'll put my soap box away... for now

SnugglePuggle, MSN, RN · Apr 28, 2015

There are teachers that won't let kids leave because they don't feel well - we've all seen it and some that will send them because they "don't look right" despite the child saying they feel fine.

A teacher just sent one of those to me. The student had no complaints. When I asked why he was here he just shrugged and said that the teacher sent him down because he looked a little pale, despite his insistence that he felt just fine. :banghead: