Employee health

bebbercorn · Jan 2, 2014

I had a similar situation in my camp. I think I cared equally for staff as that mysterious belly pain for the kids. For pregnancy tests, I'd usually do as you did, send for the OTC and give out condoms. When staff arrived they all knew where the secret stash was. The Dollar store even carries the same upreg test that we used in my old hospital. If they are from abroad, do they want to go home after a positive result? Your camp might be in a setting that's not close enough to a planned parenthood. Maybe start them on a prenatal in the meantime... ah, to be 20 again.

CampNurse1 · Jan 23, 2014

It depends on the camp and its "camp culture." We have several policies re employee health and we go over this policy when we hire, and again during orientation. Here is some of it:

We do not hire anyone without health insurance. Period. This alone will save you much grief. Because of changes in health care rules, many of our staff are still on their parents' policies. Obviously, workers' comp is offered for on the job injuries.

We have the luxury of short, five-day sessions. We teach our staff that, like any other job, their health care is up to them. I can't think of many jobs that provide on-site free health care. Can you imagine going to the employee health nurse for a pregnancy test? If a staff member is sick, we have them tell their boss and we go from there. I let them spend about one night in the health center. If no improvement, I recommend they go home and come back next session with a note from their doctor. We, of course, provide first aid. If staff comes by and needs a cough drop or an ibuprofen, they are going to get it, as well as assessment and follow up, no worries. I'll send them to the camp doctor for non-emergent issues.

International staff is a different matter. Obviously, they cannot easily go home if they get sick or hurt. Also, the camp usually uses a third party, such as Camp America, to recruit and hire these staff. There are often contractual issues involved with illness that are not easy to resolve. We try to "soldier on" with these cases, use the camp doctor, and keep them in the infirmary, or send them to the home of a friend. We had a great fellow from Scotland last summer who turned out to have a pre-existing cardiac condition. He ended up needing a Holter monitor and other care. He did have insurance, but finding someone to take it was a challenge. My vote was to send him back to Scotland, but I was told this was not possible. He did recover, and ended up giving us a good summer, but we used a lot of resources on him.

I've been at another camp that used a good number of international students, and they did not have insurance. The camp culture was that the health center could be used as a clinic and this caused much trouble, including stretching my scope of practice. The camp doctor provided much pro bono care that summer.

This "take care of it yourself" approach seems cold-hearted, and on the surface, contrary to what we nurses stand for. The best nurses (the only kind I hire, lol) are brainy and kind. Inexperienced camp nurses do not realize their kindness and empathy may start a domino effect they are unaware of. For example, a staff member comes by the health center and tells the nurse he is sick, without telling his boss. The nurse agrees and admits him to the infirmary. A little later the camp director comes by and tells you he has no one to run the zip line now. He wishes the staff member had come to him first, so they could talk it over. Our camp director will test the waters by telling the staff member to go home and come back next week. This often results in the staff member deciding he can tough it out until the end of they day, and getting to bed early. The best place for truly ill staff is anywhere but camp, keeping infection prevention in mind. Also, now the night nurse has to stay up to check on the staff member, dietary has to send trays, and the staff assignments have to be shuffled. Terminal cleaning has to be done at the health center, another chore. These issues are sometimes unavoidable, but can be kept to a minimum by not running a "free clinic."

The free clinic culture also encourages what I call Hangar Queens. Every camp nurse has two or three of these a summer. They are staff members who use the health center frequently, starting during orientation. They may have every malady ever reported, including migraines, cramps, hangovers (always called something else), colds, elephantiasis, Ebola, and milk maid's knee. This often coincides with disagreeable activity such as cabin clean up. This is cured quickly by saying, "You know, I don't think you are healthy enough to stay at camp."

This minimalist approach allows the nursing staff to focus on the reason they are there: campers! I have empathy for these staff. They are usually at the age where someone has always taken care of their health for them. Now they are grown-ups and on their own. Sometimes it can be a tough transition. I have had staff ask me for everything from insulin to condoms to asthma inhalers. I think the best a nurse can do is offer choices and education, but not treatment. It may be necessary, with the staff member's permission, to bring the camp director into the conversation. BTW, I did give the insulin, to refill a pump, and the breathing treatment. They were both out of money. Sometimes you gotta bend, lol. They received some serious education, as well.

Big Al, I would copy and paste my reply and slip it under the camp director's door. Immigration requirements? Why is that up to camp? International staff are motivated on these issues, but only before they travel. Let them or the recruiting company take care of it. What if the HIV test is positive? Who will pay for care then? Not the pretend-insurance the recruiting agency provides, that's for sure. Sending the person home before the contract is up is difficult, if not impossible. What if an OTC pregnancy test comes back positive? What will you do? Initiate pre-natal care? Condoms? Tell them you just used your last one, and refer them to Planned Parenthood. This all sounds mean, but these actions imply the nurse has entered a professional relationship with the staff member, with liability, and scope of practice implications for the nurse and the camp.

Every camp is different. If your camp has a doctor on-site, and supports the clinic model, ignore everything above! This subject is a good conversation BEFORE camp starts.

Dang, I didn't mean to write an article!

Alex Egan, LPN, EMT-B · Jan 24, 2014

I think we have more obligation to the foreign staff. In general we do want everyone to take care of themselves, but we only give one day off a week and are 45 min from town. That's if you have a car, so telling people to go someplace else doesn't work. Also we don't have a ton of extra staff so doing things in house as much as possible is pretty important to keeping people in the game. I didn't mean to give the impression we were running a hug clinic, but we really do have some interesting situations come up. Broken bones, potential pregnancies, and missing Inhalers are not just something I feel comfortable saying "to bad your on your own figure it out".

Erikadawn RN · Jan 26, 2014

We generally handle anything over the counter, colds, rashes, etc in the health center. If the counselors are local, they are usually on the parents insurance. We do send to the urgent care center or ER. Some parents will opt to come pick up there children/ our counselours and transportthem to the ddoctors. Our international staff, is covered under Camp Americas insurance, which has a $50 co pay, so they tend not to want to go unly its extremely serious. We have had requests for pregnancy tests, we direct them to buy there own. Yes, they are college students and adults, no requests so far from a camper. Thank goodness!