Feeling like I'm not treated as a professional?

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FYI This is my first year, just started in August. And the prior RN who retired was, well, a witch who did the bare minimum and apparently no one liked. So I'm trying to come in on her coat tails with people still having a bad taste in their mouth over the last nurse.

So my NP came and talked to me about her meeting with the administrator of the counselors and psychologists. She said their main concern in not sharing important health info with the health office was confidentiality because they "had heard of some stuff was being talked about in the lunch room or employee lounge or something." *_* She just told me what he said and to just watch what I say, like a heads up. I kinda already knew this though and he kinda told me the same thing when I talked to him... and he said it was my health aide (which is a whole 'nother issue). But still kinda bothers me... Like people think *I'm* some sort of gossip... i'm a flippin' RN not a gossipy secretary! I am just as much a professional as them, why can't they speak to me like it - they share info with each other! We have a meeting set for Dec 9th with all of us... of course I am currently full term, and could give birth any day so who knows if I'll be there then for the meeting.

Also, it makes me laugh because they (the admin) cited FERPA for confidentiality and I was like doh, that is not what you mean, you mean HIPAA lol.

Also, can my nursing judgement stop being constantly questioned?? For example, I get a kid in with a bad headache and some dizziness, do an assessment, think he's having a possible migraine (classic symptoms!) and call mom who is sending someone to pick him up, and also taking to the dr. I'm questioned on am i sure he doesn't need to speak to a counselor (because he's having vision changes which he called hallucinations so of course he must be psychotic!) And also, I need to call mom back to tell her he shouldn't be left home alone either. You have no medical training, stop telling me that it could be a psych issue. Also, he's her kid she can do what she wants with him after he leave here, I'm not gonna dictate what she does with her teenage son.

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Specializes in kids.

Also, it makes me laugh because they (the admin) cited FERPA for confidentiality and I was like doh, that is not what you mean, you mean HIPAA lol.

Well actually, FERPA is HUGE in education......

here is a great link Does the HIPAA Privacy Rule apply to an elementary or secondary school?

"Also, can my nursing judgement stop being constantly questioned?? For example, I get a kid in with a bad headache and some dizziness, do an assessment, think he's having a possible migraine (classic symptoms!) and call mom who is sending someone to pick him up, and also taking to the dr. I'm questioned on am i sure he doesn't need to speak to a counselor (because he's having vision changes which he called hallucinations so of course he must be psychotic!) And also, I need to call mom back to tell her he shouldn't be left home alone either. You have no medical training, stop telling me that it could be a psych issue. "

Well with kids, it never hurts to take a multi dimensional track when assessing...and NOT diagnosing...they may well have have hx of hallucinations and a psych HX.

You would do well to forge alliances with guidance counselors....just my 0.02.....

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Specializes in school nursing, ortho, trauma.

The first year as a school nurse is the toughest. The first year in a new district is pretty tough too, regardless of how long you've been a nurse. Your judgement will be called into question more times than you will like and people will be so accustomed to the way that the prior nurse did things that they will reject any changes you will make. The good news is that little by little the staff does adapt. It is unfortunate that they have lumped you in with the old nurse's reputation of being gossipy and also your health aide's reputation of not keeping the confidential items confidential certainly doesn't help. Obviously you need to find ways to separate your self from this reputation and stop info from leaving your office via the HA. Maybe because your health aide doesn't have the time invested and the lessons pounded into their head that we nurses do, it doesn't occur to them that no info can leave the office or that you should be making the call of which info is appropriate to disseminate to teachers (ie Susie broke her ankle and may need to be released from class 3 minutes early; Jordan has been visiting the office c/o headaches every day during 3rd period - asking teacher if there is anything going on, how grades are, etc...). Your health aide is really there to assist you and keep you on track with things like filing and office organization.

Regarding FERPA and HIPAA, here's a link for you to follow: http://www2.ed.gov/policy/gen/guid/fpco/doc/ferpa-hipaa-guidance.pdf

there is a difference and for the most part we're guided by FERPA. HIPAA comes more into play if your a private school and possibly if you bill insurances (??? i am not positive about this since I don't do it ). We don't here so I won't say much more, but FERPA does hold just as strong confidentiality. Not just anyone, even the student or the parent can come in and look at the health record. Dissemination of info is permissible, but must be done for appropriate reasons and to appropriate persons.

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You are building those relationships one interaction at a time. If you're the only healthcare worker in the building you must be ready to be the lone voice sometimes. And you will not always be right, so you still need tact and diplomacy. You cannot rework the past, you can only be firm and in control for every student/staff interaction. In some ways it's simple, but not always easy.

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Specializes in School nursing.

Counselor relationships are important. They may catch things on their end and refer to you and vice versa. They also tend to be the people that know some children best, including if an emotional issue acts as trigger for a migraine. I love 'em; I'm in my first year as well and they have truly helped me understand some of my frequent fliers.

Of course, if I think it is medical issue, I state that and stand my ground; that is hard at first, of course. I didn't know them, they didn't know me. But by listening to their perspective on a kid, I found working together and considering their and mine evaluations works better for the student overall.

That being said, sometimes a headache is just a headache :).

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thanks everyone. Adjusting to this new position is a huge undertaking, and definitely a learning process, emphasis on process. I appreciate the advice.

Update: The asst principal (who is the admin of the counseling dept) pulled me aside today when I happened to be in his office and said he wanted to clarify something. Told me he thinks it's awesome how involved I am being, it really is compared to how things were, and he knows it's been tough for me at times. That he wanted to reiterate that there has been issues from BEFORE i was there... and those are what need to be resolved. So I know that I really should not take this personal and just work on solutions. I really don't think it's *me* but the aide (I don't like saying that because it sounds so blame-y but... I don't know how else to word it). I am seeing it more and more, as I get to know her better. I like her - but she IS nosey and DOES share info! That still leaves me in an awkward spot. I'm hoping that meeting in December really addresses that issue. maybe she just doesn't "get" it regarding confidentiality?

Oh and it's not the counselors questioning my judgement, I should have clarified in my OP... but my aide most of the time. Another issue lol

I actually feel like I do have a good relationship with the counselors, especially the psychologists. Especially one or 2 who I just click with really well. I don't have any major issues with any of them, and things are always professional and usually friendly. It's really just been this sharing of health info overall that has been an issue. Actually yesterday I felt a "change" too. I attended a meeting of our building crisis team yesterday that I am now a member of... and it went over a lot of the very issues I have been talking about here, and I was very much included in it all (nothing kept from me). I don't know if they had a mtg about it amougst themselves but they were just much more open with everything with me. We're going to keep a central file cabinet in the counseling dept with a key where we can access files on all those psych, personal issue, etc kids (i hate labeling them like that, but i'm just saying it for the sake of this post) because we decided having access to the students personal info via shared drives, computers, etc, is just risky when it comes to confidentiality. Also having the blank forms (like psych evals, etc) kept on the shared drive, and making a phone tree among us all. Really happy about that and just feel way more prepared, included, and educated. So there's a little positive update :)

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I am glad most things are settling down. This too is my 1st year as a school nurse, one I have planned for & prepared for for a couple years. I have been blessed with a fairly small school in comparison to some (225) but it is allowing me to 'break into this field a little easier than most. I am blessed with a great counselor, & wonderful new principal (this is his 1st year too). I too am following a nurse who was not well liked, l bit lazy in some things & a massive pack rat. The children & teachers are getting to know me, yes I have been compared to the 'old nurse', which is no comparison. I am thoroughly enjoying my new job, & will be sorry when I leave (must find a school closer to home, $400 a mth in gas is killing me). Just remember to make each day a special day, become friends with counselors/school secretaries. Visit the teachers, show your interest in what they are doing, & most important talk WITH them, not AT them. Some things do take time, but your new face, caring attitude will win them over. And enjoy yourself.

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