Do you have clinic rules?

luvschoolnursing, LPN · Oct 26, 2009

Wow. I'm happy if my kids have a pass on a scrap of paper. I do insist on some type of pass, but nothing more.

bergren · Oct 27, 2009

Welcome to school nursing!!! The best role for a nurse ever! What age range are you serving?

My advice: Don't do this - you do not want to start the tenure in your school limiting access to your services. If you ever do it, don't do it now. It will irritate the teachers when you want them on your team and it sends a message to the students that they are not welcome. Create a reputation as a caring adult, a team player.

What is the problem you are experiencing that the clinic rules are aiming to solve, that is, if there is no problem, why have "rules"?

"clinic hours are 8 a.m. to 3 p.m. Only emergencies before 8 and after 3"? Why? Do you prefer the kids miss class to see you? One of our jobs is to maximize their "seat time" to learn.

"Only send one student at a time unless of an emergency or for safety. They should wait until the other student comes back before sending another student or at least 15 minutes."

I disagree with this under any circumstance - you are asking the teacher to use clinical judgment to triage. What if they send the student who vomits instead of the kid with the low blood sugar?

Take it slow - I am sure your nurse manager is well meaning, but creating rules to keep the kids we are to serve out of the office is not a way to start a new job. And I am trying to imagine a prinicpal who is approached by a new employee the 3rd week of the job whose first priority is to limit services and create problems with the teachers.

Good luck!!!

Keepstanding, ASN, RN · Oct 27, 2009

welcome to school nursing!!! the best role for a nurse ever! what age range are you serving?
my advice: don't do this - you do not want to start the tenure in your school limiting access to your services. if you ever do it, don't do it now. it will irritate the teachers when you want them on your team and it sends a message to the students that they are not welcome. create a reputation as a caring adult, a team player.
what is the problem you are experiencing that the clinic rules are aiming to solve, that is, if there is no problem, why have "rules"?
"clinic hours are 8 a.m. to 3 p.m. only emergencies before 8 and after 3"? why? do you prefer the kids miss class to see you? one of our jobs is to maximize their "seat time" to learn.
"only send one student at a time unless of an emergency or for safety. they should wait until the other student comes back before sending another student or at least 15 minutes."
i disagree with this under any circumstance - you are asking the teacher to use clinical judgment to triage. what if they send the student who vomits instead of the kid with the low blood sugar?
take it slow - i am sure your nurse manager is well meaning, but creating rules to keep the kids we are to serve out of the office is not a way to start a new job. and i am trying to imagine a prinicpal who is approached by a new employee the 3rd week of the job whose first priority is to limit services and create problems with the teachers.
good luck!!!

while i agree with a lot of what martha is saying, i respectfully disagree.

i think you must have guidelines, or else i see a lot of taking advantage going on. i have witnessed it first hand in my 900 student school. there are times that teachers do not respect your job. guidelines must be in place. and yes, i want the kids to feel comfortable coming to me too. :heartbeat

praiser :redbeathe

SchoolNurseBSN · Oct 27, 2009

I also respect what Bergren is saying. However, I must agree that "SOME" rules must be in place to prevent chaos. I am fine with letting kids come to the clinic for an injury or something urgent without a pass. However, I require a pass as much as possible for the following reasons.

1. I have PK and K students who cannot tell me their name, what class their in, who their teacher is, nothing! How can I help them? They are too scared to talk to me. Then, I spend an hour trying to get info.....

2. Same scenario as above except student is non-English speaking.

3. Student comes to clinic when they were supposed to only go to restroom and then other staff members are looking for them!

4. When I worked with middle schoolers, they would use the clinic to try to avoid a tardy or a TEST!

Therefore, I really feel that the pass is a good way to establish communication with the teacher as well as making sure the child is really where they are supposed to be!! I also place rules (general) on clinic times because I do feel like I have a right to eat lunch (7 months pregnant now), and do follow up phone calls, paperwork, etc. And, I am flexible......I have made many exceptions to my own rules in best interest of the student.

bergren · Oct 27, 2009

Another thought, I still say wait, and call them guidelines versus rules. And ask the principal about the best way to communicate them.

missfixit · Oct 27, 2009

I ask for passes, if possible, to make sure the student is where they are suppose to be. This usually has there name and why they are coming to the nurse written on it. This is helpful for my age group because some of them do not know their names or why they are coming to the nurse. ( I have 4K- 3rd)

In return I always send a note to the teacher explaining the out come of the visit.

I ask that the students knock or say my name and wait to be asked to come in my office. Of course, I asked the teachers to explain to them that if it is an emergency that they are to enter and let me know what they need without waiting.

These are my "rules".

Purple_Scrubs, BSN, RN · Oct 27, 2009

I agree that you need to set boundaries, but I would hesitate before putting them in writing as hard and fast rules as well. If there is one certain teacher who sends 5 kids at once, talk to that teacher. If many teachers do it, maybe ask the principal if you can address it at a staff meeting.

I had a sub once send me literally half the class at once. He started out doing passes for all of them, then just gave up and handed one kid the whole book of passes and said "just go, all of you". Um, no. Not cool. I gave the class a good lecture about taking advantage of a sub and sent every one of the back to class. I told them too bad if any of you was really sick because the rest of your class ruined it for you (all of them passed the visual inspection, no obvious distress and all were minor complaints). I am not going to play that game!

As far as being seen before 8 and after 3, I agree with minimizing class time missed. I appreciate it when they send an ill child before school because it cuts down on the other kids that could get infected if the child is contagious. I am not sure the rationale behind not wanting to see kids before 8, maybe the OP can clarify this? I do get annoyed when they finally send a kid at 2:40 who has been complaining all day and they have a 102 temp. When other kids come after dismissal, I just tell them it is time to go home and they can address the problem there (unless emergency or serious problem, of course). If they are in the after school program, I have been told they have their own budget for supplies and have basic first aid training, so they can handle it.

bergren · Oct 27, 2009

The reason I asked how old they were because the teens may wait until after school when they can ask sensitive questions. That is why I would not want to "close" at 3 pm. My high school experience tells me teens who come in before school are sick, teens who come in after school want to catch you alone.

Trueblood83 · Oct 27, 2009

Thanks for the responses!

Well I think I have what I'm going to speak with the principal about. It is a policy that the teachers are suppose to fill out a pass and send it with the student. I get a lot of kids that won't speak, can't speak english, forget whose homeroom class they are in (this is how we look up the student's home phone numbers is by home room). I feel it is also a safety issue as well. The pass has a perforated bottom portion that I tear off and give to the student to take back to the teacher. I list what time they leave the clinic. So if the student leaves at 1:15 and doesn't make it back to class until 2:00 then the teacher knows that the student wasn't where he should be. So I think I will not set it as a "rule" but remind teachers to send the passes with the student.

The clinic hours I was thinking about setting b/c my nurse manager recommended it especially since I will be split between two schools. It would give me a little uninterupted time to document health office visits/immunizations/screenings etc. in the computer at the end of the day and do conferences/follow-ups because I won't be back in the next day to do it. I think I might just ask to set clinic hours for when school opens until 3 p.m. only if I see I'm getting a lot of students at the end of the day for things like papercuts maybe.

So basically right now, I guess I am just going to send a reminder e-mail about the passes to the teachers.

As far as the one student at a time thing. I think I will go with Purple_Scrubs and bring that up to a teacher only if it was to become a problem.

AngelfireRN, MSN, RN, APRN · Nov 2, 2009

When I was a school nurse, I had a list posted on the wall outside my door:

Nurse Angelfire's Health Room Rules

1.) Always have a note

2.)Always wait your turn

3.)Please knock before coming in

4.) If Nurse Angelfire is not here, go to the office.

And no, it didn't do a blasted bit of good. They'd barge in any old time, the big ones would shove the little ones out of the way, the teachers would flat-out REFUSE to write a note, and lunch? Forget it, you stayed in your office, you got bombarded, you went to the caf, your radio would go berserk, you turn off your radio, they'd page you on the PA or send someone to track you down and for what? Bessie Sue spilled water in her lap and you're the only person in the WHOLE SCHOOL qualified to operate a telephone!

I do not miss that place.