Coping with emergencies at any time.

I just gave my 7th (or is 8th?) Epi pen this week. Full body hives, mouth tingling, dry cough, nasal congestion - one look and I just grabbed the stock Epi I had.

I remember the first Epi-pen I gave; 3:30 pm on a Friday, just about to walk out the door. School had been out for 30 minutes. I am literally at my car, when dean of students calls my name to say "I think a kid is allergic to something." Walk in. Kid covered head to toe in angry hives, coughing - has known peanut allergy and accidentally ate peanut twix vs regular twix after school. I ran to to my office (I was surprised how quickly I just ran!), grabbed kid's Epi-pen, stuck them, called 911.

Afterwards, I was an emotional MESS. Heart pumping, sat in my car and actually cried a little before I could drive home. Had a glass wine ready (I have a great husband) when I did get home.

But in the moment? I just did it. I had reviewed what to do a LOT - I was really a very new both RN and school nurse - it was my first year of nursing. When it came time, instinct and adrenaline kicked in.

When I gave Epi this week, the adrenaline was still there, but I had experience behind me. But still had take some time for me after before I headed home.

How can you be ready? Just prep for it - like you said, I don't have any other magic advice. When the time comes (and it likely will), you may be very, very surprised how you can kick fear into the corner of your brain and focus on patient care.

Okay, maybe one more thing - make sure your to go bag is stocked and easy to grab. Get to know your students - this takes time. If I'm told possible allergic reaction, I throw my stock Epi-pen and benadryl into my Go bag. I ask student name - student with seizure and meds - throw them into the Go bag. Student's emergency meds are labeled and kept in a shoe organizer on the wall in my office, so I can grab Epi-pens, Seizure meds, Inhalers super fast.

Jen is right. All you really can do is prep as best as you can and keep yourself calm at the moment. There are a lot of seminars that school nurses can attend to get more insight and practice that is specific to our unique line of work. As most of us work alone, school nursing severely lacks in the "team" component that we've all cut our teeth in. But we all manage. Prepare yourself for the worst. Read, study, view videos, and stay current in health trends. But don't spend every day of your school nursing career dwelling and stressing on the could be's. That will just create anxiety, and that's no state for the nurse to be in. Allergic reactions may happen. Be sure you feel confident with Epipen admin; be familiar with the anaphylactic students' action plans. Seizures may happen. Be sure that you're familiar with the seizure action plans of those students. And stay organized. Oh, and maybe take a general first -aid/ first responder course. During nursing school, we're not taught a lot of pre-hospital care.

Because school nursing is such a solitary practice, get a network of nurses that you can call on. We act as a virtual nursing station for one another, but also reach out to other nurses in your area. Join your local school nurse association.

when i got my first nursing job it was in med surg. for the first year I was so nervous that i wouldn't know how to care for my patient load. that there would be a patient that i didn't know how to care for. I find myself having that same feeling again 11 years later as a school nurse at times. I have a lot of what if thoughts.

what if there is a severe injury

what if a kid has a severe asthma attack

what if my diabetic student needs glucagon (i have given it in the hospital setting when a patient was low and didn't have iv access, and refused to eat, but they were conscious).

what if i have a student with a seizure that needs diastat or intranasal versed ( I have yet to give either of those, have given ativan for a seizure a handful of times iv in the hospital setting).

what if i need to use epi (my own child has life threatening food allergies but thankfully i have not needed to use epi).

one of these days if i continue in this school nurse role one of these scenarios will likely happen. I keep reviewing things when i am not busy. I try to remember that I was once a nervous new nurse in med surg and I have now responded to codes and performed cpr on real life people. i will do what needs to be done. my instincts will kick in. ems will come and help. I will do what I can until they get there.

I have to put the what ifs out of my brain sometimes. its hard but if anything happens i will critically think. i will learn from whatever I do and figure out how to do it better next time. the hardest transition for me is feeling like i am mostly alone. being the only medical person in a building with over 350 kids. I am used to having a full code team to respond to an emergency.

Everything you describe, we have all been there. After 5 years, I still have moments when I sit in my car and have to give myself a pep talk to enter the building. Prep, get to know the kids, be organized and most importantly BELIEVE in yourself. You will do the best you can at that moment. If you do have an emergency. PLEASE PLEASE PLEASE process it with someone. This job can be very isolating, we are still human and need to have support. Sending you much love and encouragement.

Great advice (we ARE a smaht bunch!) and I would now start reviewing videos related to seizure care and after care. There are some great ones on line put on, (I think) by the Epilepsy Foundation. Youtube will have ton of info as well. Make sure the source is credible but you already know that.

https://www.epilepsy.com/learn/types-seizures

I promise that feeling goes away. It may take a year (and it may briefly reoccur every new school year) BUT it isn't permanent.

I will admit...I've had a relatively "cushy" nurse career. I never had a pt code when I was working in the hospital, I've never given an Epi-Pen, no really big emergencies ( a few touchy situations) - so I get your feeling of trepidation. But I run through situations in my head. Hopefully, I'll never have to see one played out, but chances are something will happen at some point. One thing I always tell myself (that I've said since taking NCLEX and deciding how to prioritize situations) is - ABC's then safety, safety, safety. Every thing else will follow. Yes, it's just you but you've always got 911.

Does your state have resources for school nurses? Are there any conferences you can go to? I've gone to a couple through this organization that were pretty good: https://www.ber.org/seminars/index.cfm

There's some good info on this page, too: https://dpi.wi.gov/sspw/pupil-services/school-nurse

Contact your state organization, they should have lots of resources for you, maybe even a mentor?

I just want to take a moment and say thank you to everyone for sharing your stories and advice. Now that 24 hours have passed from the 'panic meeting' that set me off I'm not only feeling better but I really appreciate reading how everybody has been there. I'm glad there isn't some giant thing I'm missing.

I'm definitely going to spend more 'down time' watching videos because I think they are good-enough preparation for emergencies. I mean, short of running drills... which is impractical and not possible.

Thank you again!

All the advice above is great.

At my first job orientation (private duty/home health for vent patients) we had a lesson called "What could go wrong?" where we were given increasingly ridiculous scenarios. "Your vented patient is asleep when you discover the kitchen has burst into flames. You go to evacuate the patient but realize you need their back up batteries. After grabbing the back up batteries you see the fire has spread and you're unable to get to the patient without walking through the inflamed area. What do you do?" We were all coming up with ways to save the patient, put out the fire, jump over the fire and shove the patient out the window. Then our instructor says "you're all wrong. The right answer is call 9-1-1. If you haven't been trained on what to do and the situation is dire you call 9-1-1."

That sticks with me. We can only do so much. We know what we know, we should keep our emergency supplies handy, we should create an efficient system for getting around our school in an emergency, learn about all the situations, but sometimes we'll just have to call 9-1-1.

I am going to lay it out realistically, I apologize if it seems harsh in advance. Nursing is all about critical thinking, a skill that takes education and experience. More education can never replace more experience and experience alone can not make up for education. Your floor experience is too short to really gain experience, therefore your critical thinking skills for emergencies are deficient. It is one thing to develop experience where you have more experienced nurses to bounce things off of and help to debrief after situations, but you have put yourself in an isolated position without oversight. You may luck out and never experience that emergency you are not prepared for, but you are putting yourself and students at risk. Sometimes the right job comes at the wrong time, and your choice to take another track in nursing means that there are certain positions that you should shy away from, like this. There are many nurses that would be salivating over the choice you made for administration and would read your resume with great envy. This isn't a critique of you as a person, it is an analytical assessment of your nursing career until now, and is only a snapshot of where you are now. I suggest you take a step back, get your acute care experience over the next two to three years and develop those critical thinking skills that allow you to function independently and then dive into this.