Did I do the right thing?

[rainydaysRN]

I am trying to get opinions on whether I did the right thing. I am a new school nurse working with middle school kids. The very first day, I get a report that a student passed out and fell while enrolling. I run to the area where the student is and find her to be conscious and sitting up. We wheel her to the clinic and I assess her. She denies any dizziness, nausea, etc. and is alert and oriented. She did complain of a headache but said it was present before she passed out. She had not eaten all day and had been sick for a few days. It was reported that she hit her head on a chair when she fell. I palpated the area and felt a small bump and the area was sensitive to touch. I did not dig through her hair to visualize the bump. We applied an ice pack to her head. No bleeding was noted at anytime. Her mother was present the entire time. I recommended to the mother that she should take her daughter to be evaluated further by a doctor (but did not specifically recommend the ER). The next day, the mother came back to the school to speak with me and was extremely upset that I did not send her daughter to the ER. She stated she took her daughter to her doctor who discovered a laceration in the area where she hit her head. She was sent to the ER and needed a few staples. She accused me of not assessing her daughter well and not following proper protocol and she states that that is what the hospital told her. I am so shaken. Did I do the right thing? Should I have sent her directly to the ER? What would you have done? I am definitely second guessing everything now.

[duskyjewel]

You told the mother to take her daughter to get looked at. She did that. The doctor found a laceration, which I'm sure is one reason you recommended follow up. I see nothing here that you did wrong.

Some parents are just jackwagons. Better get used to it.

[brattygrl]

A scalp lac will heal eventually (even without staples). Thats what those of us in the ER call a distracting injury. When you focus on something nonlife threatening.

I would have sent her to the ER because she passed out and hit her head, period. Liability. You are not able to diagnose nor are you a CT/xray. Palpating a lump size will never tell you what is underneath or inside the head.

I understand why you would assume it was from not eating. But in not sending her to the ER, you overlooked other possibilities (new onset diabetic, brain tumor, eating disorder... etc. And yes, I've seen each dx in peds ER from such vague sx).

So I say, if in doubt, send em to ER. Live and learn right?

Good luck. Sounds like no harm on this one.

[fetch, BSN, RN]

1. How can the hospital say you didn't follow protocol? Do they have a copy of your district/school protocol? Do YOU have a copy? Read over it, cover your butt, you'll probably find you did everything according to your protocol. You gave an assessment and first aid, the parent was present the entire time, you recommended she see a doctor, and she took her straight to a doctor. Sounds like you did everything right to me. (What would have changed if the parent wasn't there? What would have changed if the student had fallen at home instead of at school? Just some things to ponder.)

2. Sounds like the parent was wanting to be a jerk because she thought it was nothing and it turned out to be something. Fear reaction, lashing out. It sucks but it happens. There's always something the parent thinks you SHOULD have done, whether or not you can legally or ethically do so. Some parents are just like that.

3. Don't let it shake you up too bad. Review your policies/protocols, take a deep breath, and move on to the next thing. The child is okay - the parent will get over it. Maybe talk it over with your principal in case the parent starts more trouble - say "this is what happened, here's what I did, here's our policy on head bumps, here's what mom thinks."

[AdobeRN]

You did fine. If the mother was around and saw what happened why does she need your advise about taking the kid to be evaluated? Why didn't she herself look at the wound more closely?? I don't get parents sometimes. I would have told the parent to seek medical attention - whether that be their own doctor or the ER. Tho with head injuries I usually tell parents to go to the ER - just because of the CT/Xray part of the exam.

[OldDude]

Hmmm, have you actually seen these "few staples" in this student's scalp? I don't recall ever, ever, seeing a scalp laceration, significant enough to require repair, that did not bleed. Regardless....what significance is a cut on the head in regard to your advice for further medical evaluation by a doctor? I realize few MD offices do laceration repairs now so yea, sending you to the ER for that would be appropriate but what was done in the ER in regard to evaluating her that wasn't done in the doctor's office? Was a CT done? By the way, if I think a kid needs to go to the ER I'll call an ambulance for transport. Otherwise my advice is "get further medical evaluation by the child's pediatrician or a doctor." And one more thing....I don't dig through hair to visualize every head bump that comes into my clinic. If there isn't any bleeding visible I palpate and that's it. And...last thing...I'd call the ER and ask for a copy of the protocol to which they were referring. You did fine

[garfieldrn]

As a new school nurse myself i would have done exactly the same. I too started to doubt myself after the head lac i got last week.

[Wave Watcher]

If the parent was present during the accident then they can decide what needs to be done. I would have recommended pretty much the same thing. Although, since she passed out and hit her head I would have told her to go to the ER. Either way....she (parent) is a grown adult and can make her own decisions. You are not a doctor and you do not diagnose. She needs to use what little brains she has and take care of her own child. No worries...you did what you needed to do.

[morte, LPN, LVN]

hmm.... a head lac, that severe, and no blood? no way, no how!

[NutmeggeRN, BSN]

And this was mom telling you what the ER said, not the ER calling you out on your policy, correct?...Always consider your source.....

[morte, LPN, LVN]

I would be interested in seeing the ED report, maybe you could request it for educational/follow up purposes?

if anything, I would bet on steri strips.

[100kids, BSN, RN]

The mom was there for the entire thing and you recommended that she get her daughter checked. What else could you have possibly done? Sounds like mom feels like making someone to blame for this. Don't let it worry you.