Enforcing Restrictions for Orthopedic Injuries

[k1p1ssk, BSN, RN]

On Monday, a student was body-checked at recess and fell hard onto his left shoulder/clavicle. He is generally considered a tough kid, and so when he did not get up right away and was found with tears, clutching that shoulder, I was called to the scene. He was unable to move his shoulder/upper arm and had extreme tenderness at the lateral aspect of his clavicle. 

I immobilized his arm and got him inside and called his mother who came and got him within 10minutes. She refused to bring him to the ED but I insisted that he needed xrays to rule out clavicle fracture or shoulder dislocation (less likely, but still). He came in to school late the next day with sling and a note and he reported he fractured his collarbone. I got a letter from the doctor stating that the fracture was "suspected" and gave the typical restrictions for 6 weeks, with the allowance to remove the sling when comfortable. 

Well, today, a mere 4 days later, guess who is outside without the sling, playing soccer again, carrying his heavy backpack, stating he is pain free? I got multiple calls from the recess monitors asking about the restrictions because the kid is adamant he does not need to have any since he is feeling fine. I tried to have a conversation with him about it, but he brushed me off like I didn't know what I was talking about: "They said I fractured it - it isn't broken!" were his exact words to me. 

I have contacted the MD office asking for clarification. But it's already happened twice this year where they state "at least 6 weeks" for restrictions and end up removing them after 2. This happened previously with a clavicle fracture AND an ankle fracture that almost required surgery. All because the kids' mom whined to the MD that the kid wasn't having any fun. 

I'm at a loss. I'm feeling like school is becoming more and more of a hospitality business, much like healthcare. The customer is always right, even if it means their orthopedic injury isn't going to heal right and cause more problems in the future. 

[NutmeggeRN, BSN]

Frustrating

Get that documentation in writing from MD.  It is on them.