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Coping with emergencies at any time.

School   (1,010 Views | 21 Replies)
by tomn13 tomn13 (New) New Nurse

tomn13 specializes in Healthcare Economics.

66 Profile Views; 3 Posts

Hi!  I need to provide some history before my question, because I'm looking for a little peer support/counseling/advice:

So I've been a nurse for about 8 years now but not really as a practicing one.  While I was in nursing school, I became a Healthcare administrator (for a medical plan) and have basically just been in administration ever since.

  • A few years ago during a slump with my day-job I worked on a Medical-Surgical floor for about 6 months.
    • I did OK but the hospital was dangerously understaffed (I was supposed to have 4-5 patients every night but I'd usually have 7-9, and a few times I had 11).
    • I left because, as a full-time-administrator, I knew exactly how the hospital was gambling with everybody's license and it made me deeply uncomfortable.
  • Now, as a side gig, I work at a elementary school for children with disabilities one day a week.
    • MANY of these kids have significant medical concerns (Anaphylactic reactions, seizures, etc)
    • I find that most of what I do is just record review, first aid, etc.

I really like it...  Sort of.  I like the record review... the first aid...  keeping everything organized...  But when I first started I was petrified, all day long, that one of our 8 students (of 72 -- so 11% of the students) was going to need emergency care (Epi-pen, diastat, etc).  A few weeks went by and that subsided.

BUT this morning I was just alerted that one of our kids that had a seizure once, three years ago, had a seizure a few days ago.  Staff are on alert that he may have another seizure, and I'm back to square one.  Not only am I petrified, but I feel less prepared now than I did before.  I haven't ever done this stuff.  I went to school like everyone else here but I don't do this in my day-to-day.

How does everyone else deal with the fact that any any second someone might enter a life threatening situation?

I'm also concerned about making mistakes during an emergency...  I'm the only school nurse here... but I feel like there ain't any good advice for that other than "Be prepared, do your best and have malpractice insurance paid up!" haha 😞

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

2,620 Posts; 24,198 Profile Views

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. 

Edited by JenTheSchoolRN

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

2 Followers; 5 Articles; 4,159 Posts; 35,511 Profile Views

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. 

 

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by ARN Member Nurse

ARN specializes in medsurg/school nurse.

67 Posts; 164 Profile Views

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. 

 

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Cas1in72 specializes in school nursing/ maternal/child hospital based.

155 Posts; 1,608 Profile Views

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. 

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tining has 26 years experience as a BSN, RN and specializes in School Nurse.

1 Follower; 928 Posts; 13,984 Profile Views

Agree with OP.  Coming into school nursing from Pedi Hem/Onc I had some preparation.  But not what is needed for school setting.  You always wonder 'what's next,' however you cannot make that your daily focus.  My turning point was working at a summer camp (8 years).  This camp had a new MD on camp every week, 5-7 nurses, and 2 nursing students.  Camp is school, floor nursing, and mini ER rolled into one.  There were seasoned nurses that I observed, MD was always 'come see this.'  I learned A LOT!  Concussion assessment, sprains, breaks, rashes, H1N1 outbreak, lice outbreak, allergic reactions and asthma attacks - I saw everything PLUS.  I would suggest camp nursing (if you can), however only in a setting like this - with support.  There are many camps where you are the only medical staff - NOT for you at this time. 

Hang in there OP.

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NutmeggeRN has 25 years experience as a BSN and specializes in kids.

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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

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ruby_jane has 10 years experience as a BSN, RN and specializes in ICU/community health/school nursing.

4 Followers; 2,721 Posts; 11,286 Profile Views

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.

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SaltineQueen specializes in School Nurse, past Med Surge.

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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

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NutmeggeRN has 25 years experience as a BSN and specializes in kids.

2 Followers; 6 Articles; 3,955 Posts; 43,139 Profile Views

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

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tomn13 specializes in Healthcare Economics.

3 Posts; 66 Profile Views

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!

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BiscuitRN has 4 years experience as a BSN, RN.

623 Posts; 2,565 Profile Views

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. 

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