Crowded clinic

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Specializes in School health, pediatrics.

Full disclosure. I am a medical assistant working as the building staff member (grade 6-8) in a district with a supervising RN. I am a public health student preparing for accelerated nursing post grad and I have 5 years pediatric primary care experience.

Okay, this is my first year as a school health staff member and my clinic gets chaotic. Part of it is my set up, which I am hoping to change next week, but the other is that I think sometimes kids stay too long.

I have two plastic chairs, an extra desk chair, and a recovery bed. Usually halfway through lunches it's standing room only.

How do I solve this? It's confusing and terrible for privacy when I need to know if you have menstrual cramps or need to poop.

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I haven't run into this problem yet as I am blessed with a huge clinic but a good friend worked in a very small clinic that had upwards of 80 visits a day. At busy times she started giving out "come back in X minutes" passes to anyone that wasn't actively bleeding, vomiting, in distress etc after a quick triage and only let those needing quicker care remain in the actual clinic. It sounded like a good idea

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I have a one student at a time policy in my clinic. If I have one on the recovery couch and need to bring another in, I check with both before nu.ber 2 comes in. Kids here will blow the most minor ailments into major trauma. Teachers Don t like the longer wait times but it has cut down on the unnecessary visits this year. I'm approaching the teacher complaints with confidentiality concerns. There are days it doesn't work but most days it goes well.

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Specializes in School Nursing.

Do you know if it has always been that busy? Do all of the visits seem warranted?

I work pre-k to 5th so it's very different from your student population- I hear that our middle school nurse sees fewer students but each visit is more complicated and drawn out. But for what it's worth, YOU determine the amount of time the student is in your office. When I started, each student got a bunch of questions, in depth assessment, rest on the cot or a snack or an ice pack, etc. Maybe as a result, I went from seeing 20 a day to 100 a day in a matter of months. While we have sent out some info to teachers about appropriate reasons to send, I have also gotten my assessment and intervention on most students down to a couple of minutes. Many hardly get a chance to even sit down (the ones who walk in smiling and chatty. I promise I don't just turn away children who are legitimately ill!).

My recesses can run up to 20 visits in an hour. I am lucky to have four chairs in a roomy office and an alcove with two cots but it still gets congested, especially when there is an actual emergency. As a newer school nurse one of my missions is to cut down on fluff visits (we saw 50% of our 800 student body in the first four weeks of school which is just silly as I have never needed to send more than 2 home in a day). I would keep an eye on trends and communicate with your principal if you see a continuous rise in numbers without good reason and if you see lots of visits for frivolous reasons. One of the things my district nurse and I did was explain how many other important things we have to do other than seeing the students who come in-- and for example how an overly busy office impairs crucial functions like emergency management.

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"school health staff member"

Thanks so much for using the above descriptor instead of "school nurse." I am sure you are making an awesome contribution to your school.

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Specializes in Cardiology, School Nursing, General.

Honey, I understand your struggle. I only got 3 chairs, and one bed. So I have limited space too, and last year was horrendous! I had so many children in my office at one time, and it get very hard to care for a bunch of them. My advice is this: Talk to your admin team, tell them about your concerns of the lunch rush and suggest if you can set up some rules.

Here's an excerpt of my letter I sent in the first days of school to teachers.

""To the returning, teachers, hello and welcome back! To new teachers, let me introduce myself!

My name is [my name], your Medical Aide here at [school name]! I hope we can all work together as a team and make this year the best!

Just a few pointers to make this year better!

· Student must have a clinic pass to visit Medical Aide! I will not accept any students without a pass, unless it is an emergency! The purple slips included with this letter are the clinic passes, if you need more, let me know!

· Ice packs will stay only in Clinic! If you find any, return to clinic!

· Only send students if they have the following:

· Stomach aches

· Vomiting

· Headaches

· Injuries (Paper cuts are not injuries!)

· Rashes

· ALL head injuries

· Only way students are to go home if they have a:

· Fever of 100.4

· Vomiting (From illness)

· Diarrhea (From illness)

· Serious injuries

· Parent request

· Lice

· Of course, please use your best judgement, and if you think, your student is not feeling well, when in doubt please send to Medical Aide's office! Any emergencies please send to Medical Aide's office, ASAP!

· I will be sending you first aid kits with Band-Aids and such, for the tiny injuries that can be taken care in the classroom! Either way, if anytime during the school year you are running low on supplies, let me know!

· If you find lice on a child, do not panic and just contact me as soon as you can, quietly. I will go to your classroom ASAP and do a lice check.

Just a reminder that I am not a nurse, as such there are some questions I cannot answer, but I will try to help you as much as I can do with the extent of my abilities and skills. If you are worried about any health issue about yourself, I would highly suggest contacting your doctor or nurse for any concerns. Other than that, if you would like to talk and meet me, I am very friendly and I love to meet new people! "

Give them passes and tell them unless it's an emergency, you will not accept any student with no pass. That completely dwindles the line down.

Of course, as time goes on you'll start to catch on who's faking and who's not.

My protocol was each student only gets 15 mins in total in my office, more than that is only for special reasons. If you have no room, the students who are not in grave need of you, you can explain to them to come back later if they are not feeling that well. Ask for their names, and call their parents later if they come again.

What I do if I have a lot of students, it's either by who's here first or who's in need of me more.

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Specializes in School health, pediatrics.

Thanks for all the encouragement and advice. It seems to have calmeddown a bit. I started making kids wait in the hall when I'm full, and sometimes they just go back, hmmm.

Our school requires everyone to have a pass, and honestly I can't believe how many passes some of these kids get. And there is a set of kids that know what sounds urgent to come down and try to play me.

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Specializes in Cardiology, School Nursing, General.
Thanks for all the encouragement and advice. It seems to have calmeddown a bit. I started making kids wait in the hall when I'm full, and sometimes they just go back, hmmm.

Our school requires everyone to have a pass, and honestly I can't believe how many passes some of these kids get. And there is a set of kids that know what sounds urgent to come down and try to play me.

You know it... I had 2 kids try to play me today, but I'm slick. I call their parents and back to class they go!

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