I'm a new school nurse at a High School, and more than once I've felt that they look at me like I'm dumb. The funny thing is that the nurse who oriented me told that they do that (lol)
Earlier, they came in to take a student to the hospital to get checked out because his pupils were the size of the moon (suspected drug abuse) and he was non responsive, EMT asked me if I knew his history, I said no, he replied "Oh so you're not the nurse",
.... Uh yes I am, excuse me if I don't know the history of my 300+ students
So yeah, I only know if I'm in front of my computer. Ugh. Plus I don't really know what to do when they come in, I just let them take over. Maybe I shouldn't ? Eh I don't know. lol
As an ER nurse, I can think of a number of scenarios where EMS could have gotten a more secure airway (oral or nasal) instead of just sticking them on a nonrebreather mask. This patient is snoring - barely breathing - and unconscious and will clearly be intubated and you can't put in an oral or nasopharyngeal airway?
As a nurse you have far more knowledge to say - this person doesn't look good, than your typical EMT-B and even paramedic. We have much more fine tuned assessment skills which comes from seeing someone decompensate vs showing up when they are already decompensated.
I'm a new school nurse at a High School, and more than once I've felt that they look at me like I'm dumb. The funny thing is that the nurse who oriented me told that they do that (lol)
Earlier, they came in to take a student to the hospital to get checked out because his pupils were the size of the moon (suspected drug abuse) and he was non responsive, EMT asked me if I knew his history, I said no, he replied "Oh so you're not the nurse",
.... Uh yes I am, excuse me if I don't know the history of my 300+ students
So yeah, I only know if I'm in front of my computer. Ugh. Plus I don't really know what to do when they come in, I just let them take over. Maybe I shouldn't ? Eh I don't know. lol
If there's time between when they are called and when they arrive, it would seem judicious to get the immediate history and the longer term history so you can make it available to the EMT's.
That is, if you're not doing CPR, holding pressure on a bleeder, or performing other lifesaving maneuvers, it only makes sense to be prepared for the arrival of the emergency crew. Know the allergies, at a bare minimum.
Like having your ducks in a row when you call a doctor - labs, VS, S & S, why you're calling.
I always try to get a set of vitals and their hx and allergies, if I'm in my office and have access. I just give them my assessment and let them do their gig. Small town, small dept, they are used to me now LOL!. Have worked with them for many years. Maybe if you can schedule a meeting with them to get a feel for how they view your role. They may be in for a surprise! Remember to address YOUR scope of practice and the liability the school system carries for the students while in their care. You are probably much smarter than many of the folks initiating a 911 call and they need to remember that!
What does being smarter, however you define it, have to do with being able to dial a phone?
Wouldn't it be smart to have some basic info ready for the emergency crew?
i don't have a problem with sending others to my office to fetch a file for me. It makes my admins feel useful in a crisis situation. They understand that there is no way that i can keep the complete medical history of the entire student body off the top of my head. Additionally, we keep the abbreviated medical history on their student emergency cards and keep copies alphabetized in my office and also locked in the main office. Of course this info is what the parents supply us year to year and if they choose to leave something off or if something happens during the course of the school year, it may not be accurate, but it's better than nothing.
Do you have the ability to update the emergency cards with pertinent school health happenings, during a period of relative calm? That way they would be accurate, right?
And maybe you could get parents to update them at least each semester with news from the home part of the students' lives.
What does being smarter, however you define it, have to do with being able to dial a phone?
Wouldn't it be smart to have some basic info ready for the emergency crew?
The school environment is so unique that if you don't work there, you really need to not give an opinion. There is no backup, you are it and most often, you are the only staff who has access to records. You can not render aid and go back to your office to get a concise report.
Well, recently I had a student with extreme stridor, Sat in the 80's, anxious...The more anxious he became, the more stridorous he became. And wide eyed, and resp rate increasing.
I had called mom who said she was going to "try" to get here in 45 mins. (Ummm..No.)
So I called it. I have been a nurse for 30 years...I know kid's airways can obstruct VERY quickly. And once it's gone, it's gone. I was taking no chances.
When EMS got here, they were very dismissive of his symptoms. They didn't even put O2 on him. They hesitated about transporting or not. He was in the ER for a few hours. MD said "viral." He was given albuterol neb.
I have ZERO regrets in calling them. But I was treated as if I was an alarmist.
A child's safe airway will always trump the inappropriate attitude of an EMT any day.
If you're the one on the scene, you have to/get to call it.
One of my own kids had an appy, peritonitis. Once back to school a few weeks later, he suffered a dizzy spell or felt weak or whatever - I don't remember at this moment. Got the call from secretary (no school nurse) asking if she should get an ambulance. I told her I'd be over in no more than 10 minutes BUT told her to please call 911 if she had the slightest doubt. I told her that she was seeing him and I was not able to see him at that moment. We wishy-washed back and forth a couple of times, then I ended up telling her to just call 911 as the safest decision.
He wound up being taken by ambulance to ER. Nurse there told me, when I arrived, that he was fine, he had "jumped down off of the ambulance", "the ambulance ride had been curative". She was a bit snippy but I really didn't care whether or not she liked circumstances or approved of them. She was not at the school earlier to see what had upset the teacher and secretary, so she didn't get to be the decision-maker. Also, those who were with him at the school were laymen. Outcome - my son is well today. And I didn't feel guilty that a few taxpayer dollars were spent on him. I pay my fair share so other peoples' kids can live. Why not my child?
Sometimes you're damned if you do and you're damned if you don't.
The school environment is so unique that if you don't work there, you really need to not give an opinion. There is no backup, you are it and most often, you are the only staff who has access to records. You can not render aid and go back to your office to get a concise report.
I have worked a few shifts at schools via Agency, so am not totally uninformed. Also, I have worked in places where there is "no back-up" (summer camps, jails). Plus the nurse in long-term care is expected to have X ray eyes re: patient falls.
I realize, after reading a few posts here, what the difficulty is in rendering aid and also trying to get some history together.
But the OP is a new nurse. She needs to understand, and likely does now after reading replies by other school nurses here, who gave her essentially the same answer that I did, that she does need to find a way to be able to give bare minimum info to EMS.
current VS
meds student takes
history of this event
major conditions/past illnesses (SZ, DM, SCA, asthma, 3 months pregnant, stuff like that)
She needs to utilize another adult to get the student's info, while she stays with the student, as recommended by at least 1 poster here. Or take a moment as she runs out of her office, to grab the little card that some schools utilize.
Or have someone get the parent on the phone right away, if at all possible, and have the parent give History. nurse can give VS and current event info - or this can be told by whoever observed it. The nurse's file doesn't have to be the only source of information about the student.
Once EMS arrives, nurse could return to her office and get the info if the school isn't too huge. EMS can do their EMS thing while nurse obtains this info.
The flip side of the coin can be true to, before RN I worked EMS and many times in the ED I didn't feel the love from staff. I have found there are some big big egos on both sides of the fence. Many times I would be giving my report and the RN would just start asking the PT's questions ignoring what I was saying so I would just shrug shoulders and leave.
Specializes in EMT since 92, Paramedic since 97, RN and PHRN 2021.
Ok , everybody needs to simmer down a little. Before everyone says nurses have more education and such, while yes it may be true in the form of classroom stuff, medics have two year degrees now and with most states requiring 18 hours of conED along with ACLS, PALS, PHTLS, CPR, Hazmat certs and other certifications required for the job, everybody needs to respect the others job and position. (Steps off soapbox).
As a medic in a nursing program right now I am seeing the responsibilities and knowledge required for nurses.
I have seen every type of call there basically is (20 years as a medic). The attitude that may be conveyed towards a school nurse probably isn't personally directed at the person who met the EMS crew but rather is slight burn out that they just took Mary Smith from the local nursing home 1/2 hour earlier because the LPN said the patient pulled her gtube out for the 90th time this year and has to go to the ER again, it gets a little old. Yes, i know it's part of the job, but in the same sense if the same kid came to the school nurses office every other day complaining of a hang nail, you would become a little desensitized.
I assure you that the medic isn't on the way to your school thinking to himself " oh this is a school nurse, I'm gonna be rude, disrespectful and ignore any information they may provide. That is just not the case. When a medic gets on scene they get so focused on the patient that everything else gets blocked out. While they may not acknowledge you or even look at you while you are speaking to them, I guarantee they are listening to you for key words: allergies, Pmx, meds.
Everybody is on the same team, to take care of the patient to the best of our abilities.
Lev, MSN, RN, NP
4 Articles; 2,805 Posts
As an ER nurse, I can think of a number of scenarios where EMS could have gotten a more secure airway (oral or nasal) instead of just sticking them on a nonrebreather mask. This patient is snoring - barely breathing - and unconscious and will clearly be intubated and you can't put in an oral or nasopharyngeal airway?
As a nurse you have far more knowledge to say - this person doesn't look good, than your typical EMT-B and even paramedic. We have much more fine tuned assessment skills which comes from seeing someone decompensate vs showing up when they are already decompensated.