Fake Illness

Flare, ASN, BSN · Nov 19, 2008

I am a tough one to send a child home. The have to be feverish or have something unpleasant coming out of at least one end. I always ask what they are doing in class and run down the list of reasons why they might not "feel well"

hungrey, tired, upset, congested, avoiding class.

Frequent fliers have poor credibility with me. I am more apt to call a parent for a child i hardly ever see in my office for a stomach ache with a slightly elevated temp than for a child who i could pick out across a crowded room because they are so familiar to me.

BunnyBunnyBSNRN, ASN, BSN · Nov 19, 2008

i'm with fire on this one. i have so little sympathy for the frequent flyers, they have be really, really sick for me to call mom. on the occasions that i just can not redirect them, i'll call mom and let her know that there is no fever, no vomiting, etc and that i have a concern because they are in my office so much. i've gone as far as to suggest they may want to consult the pediatrian for the frequent "illnesses" that seem to plauge the child. (i've done that twice, haven't seen either one since).

JudithL_in_NH · Nov 19, 2008

Yes, I would say that something on the order of 50% of my visits are for extremely minor complaints in children (K-6) that are afebrile, alert, and with good color, and I'd guess the child is hoping the visit may net him a ticket home.

I always assess, advise them on supportive care for the minor sx, and explain that they can, indeed, get through the rest of the school day. I also assess if there are school stresses that might be contributing--some will come clean that it's missing homework or a test that's sparking their complaint--and we talk about strategies to deal with school issues more successfully.

What does drive me right up the wall, however, are those who appear dissatisfied with my decision to return to class, and start escalating their sx--"Well, my head hurts too, and my stomach, and my chest; I can't breathe and I saw blood when I peed an hour ago" --once I assess these sx, a phone call to a parent is usually in order. Often once they speak to mom or dad, all the sx vanish.

mustlovepoodles, RN · Nov 20, 2008

Frequent flyers just come with the territory, I suppose. They make me crazy . But even frequent flyers sometimes get sick, so I assess them anyway. I send them back to class if there is no fever, vomiting, or serious injury. I also email the teacher to let them know that John-Boy is coming to the clinic frequently.

Sometimes a child is very insistent about wanting to call home. In those cases, I call the parent and explain that Jose is in my office *again* with c/o (fill in the blank) and that I can find no fever, vomiting or evidence of injury. I let them know exactly how many times I have seen their Precious this semester and if it is truly excessive I strongly recommend that they have the pediatrician evaluate. If the PARENT insists, then I will put little Susan on the phone, but most of the time the parents take my word on it and decline to pick up their child. Most of my students' parents work and the last thing they want to to receive multiple calls from school.

Now, all that said, I realize that sometimes the situation is in the intangibles. Some of these kids have problems at home or depression or physical symptoms that they aren't comfortable sharing with me. Some of my female students operate under the cultural belief that they should go home when they start their periods, and their parents support that. Hafta tread carefully there. :nurse:

Aneroo, LPN · Nov 20, 2008

I agree with the others. I assess them anyways- my time in the ER taught me that the person who comes in three times a week might have a real complaint one day (like my psych patient who really was having a heart attack that one day, or the other time she got stabbed...).

I've started emailed teachers. I have a student who comes down here to ask questions. "My nose bleed last week and blood came out of my mouth- what does that mean"? She comes at the same time (second period), and that is a rotating class. She has a different teacher each week (math). Since it's rotating, the teachers don't recognize that she is abusing coming down here.

kidsnurse1969 · Nov 20, 2008

I am a former frequent flyer:lol2:. Now, as a nurse in the school, I sympathize with the desire/need to have a friendly face listen to my aches and pains and do things to make me feel comfortable:heartbeat. But I also realize that math class is not the appropriate time to meet those desires/needs:nono:.

I do what I can (depending on the day) to explore the problems and encourage the kids that don't get encouraged any where else:saint:. I encourage the teachers to send the kids to the sickroom at breaks and "free-times". Frequent flyers get set up with the counslor to help meet those needs and investigate the problem. I keep the parents informed so that (hopefully) they can make sure the kids are coming to school feed and taken care of before they leave the home. And sometimes none of it seems to make a difference:banghead:. So I have to pull out my stern mommy voice and keep the visits breif and to the point. Check'em out and send'em back!

luvschoolnursing, LPN · Nov 21, 2008

In high school if I don't send them home, they just go to the bathroom and call home from their cell phones and tell mom. :nono: I was told by my administration that if a child wants parent called to go home, I must call and let the parent make the decision. :uhoh3:I love my job, but this is the one thing about it that bugs me. Oh, well...

mustlovepoodles, RN · Nov 21, 2008

In high school if I don't send them home, they just go to the bathroom and call home from their cell phones and tell mom. I was told by my administration that if a child wants parent called to go home, I must call and let the parent make the decision. :uhoh3:I love my job, but this is the one thing about it that bugs me. Oh, well...

Well, I feel pretty strongly about this too. As a parent I feel that if my child needs to call home, then I expect to be called--by someone. As a nurse I respect that my middle school students know if they have pain or nausea. If they really want to call home, I make the call.

My older son was a frequent flyer. His nurse dutifully called me every time he showed up, even though we both knew he wasn't really sick. The nurse and I had an agreement that DS would be allowed to either lie down for a few minutes or call home( we had the counselor involved too.) We knew something was wrong and eventually mental illness reared its ugly head (bipolar disorder:cry:). My daughter, on the other hand, would rather eat her own hand off than go to the nurse. You bet if she calls, it's sumthin. :nono: I better not ever hear that a nurse denied her the phone call.

Aneroo, LPN · Nov 21, 2008

I wanted to add- if a student wants to go home, we call. I might tell them "I don't think this is something you need to go home about, but if you really feel that bad, then let's call your parents". A lot of times the parent will ask to speak to me and get my opinion.

One of my goals is to keep students in school and decrease absences, but I also understand you're really not getting much out of class if all you're thinking about it "God, I hope I don't throw up".

kidsnurse1969 · Nov 21, 2008

If an older student is complaining of an illness without objective symptoms, I will call the parents and give them my assessment first and then let the student talk to the parent. At least the parent has the opportunity know what is found clinically before hearing the student's version:scrying:. Often they still allow the student to leave school but at least I have tried. What else can we do? :confused:

I have occasionally told the student that their absence would not be considered "medically excused" if they leave. Of course the administration has to be on board for this.

luvschoolnursing, LPN · Nov 21, 2008

I was talking about the ones I send home 4-5 X/month, not kids I never see. I always call if I have to ask your name because I've never seen you. My problem is with the one's who have been taken to the Magestrate for truancy and told the only way they can have a legal absence is if the nurse sends them home, and that's what they tell me when they walk in my office.