First week as a school nurse- advice needed

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Hi everyone,

I started my first school nursing job this week (came from the icu). Overall it went well- still figuring out where everything is, policies, etc. I love the school, kids, staff, and schedule!! However- I had one negative experience which I can't get out of my mind!

My second day, a little boy (2nd grade) came in from recess because he slipped (not witnessed and couldn't get a good story of mechanism). His wrist was hurting- not swollen, full range of motion. I applied ice and sent him back to class. I attempted a call home (no answer on mom or dad cell) and left a message. When he came back to drop off his ice pack, I assessed again. This time it was slightly swollen, pain was minimal but still full ROM. I called mom again, this time she answered. I told her what happened- described the swelling and suggested X-rays if the swelling continues. I also Sent a note home with the boy restating this.

2 days later I hear from my principal- turns out it was a buckle fracture! She didn't call me, but called him to tell him how angry she was with the "new nurse." She was upset that I kept him in school and "didn't try to get a hold of her sooner." I explained the whole story to my principal. Now I feel like he thinks I am incompetent and I am second guessing everything! I see 50-60 kids a day, many of which present with similar stories. Should I send a kid home anytime there is swelling? I feel kind of lost!

Thanks for reading. I think I just needed to vent!

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Specializes in School Nursing, Public Health, Home Care.

Quit beating yourself up over this one! You will have opportunities to look likes genius as well. Here are two phrases I always include when talking to a parent in a situation like this: 1. We never can be sure without an x ray. 2. It's up to you as the parent if you want to take him in right away.

If they flat out ask what would I do, I usually respond that I would wait and see how things look by morning (or maybe by later the same day) and then decide if it's worth taking in.

Unless you develop x ray eyes, you will most certainly have this one again.

Enjoy your new job! Most of us here love it!

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Thanks for the reply. I think I need to toughen up a bit- people are (rightly so) protective over their kids & a broken bone can be a stressor for this student & mom. I think I just took it personally because I was trying so hard to do everything right! In the ICU I got yelled at by families all the time, but the next shift they were gone. Being in the school I have to form relationships with students and families that will last years. Lesson learned and I will take it day by day! Thanks for the encouragement :)

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I don't get it, you DID call her!

Maybe she was just stressed and took it out on you but I don't see how you could've handled the situation any better

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Thanks. She felt I should have sent him home as soon as he came in. It wasn't an obvious fracture, so without an X-ray there was no way to tell. I appreciate the support! Ready for week 2..

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Thanks. She felt I should have sent him home as soon as he came in. It wasn't an obvious fracture, so without an X-ray there was no way to tell. I appreciate the support! Ready for week 2..

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I don't get it, you DID call her!

Maybe she was just stressed and took it out on you but I don't see how you could've handled the situation any better

I agree. The only thing I can add, though, is that it's sometimes hard to tell by quick exam with fractures of the wrist and ankle, so it's never wrong to err on the side of caution in these cases and encourage they get x-rayed.

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You did the right thing as far as I can tell! I think what people often forget is that we see these kids 1 minute after an injury. There may not be any swelling or bruising yet. I probably wouldn't have even called home after he first came in. You will find there are some parents you will NEVER please. You either call to often or too little. You assessed and handled the situation as it presented and then reassessed and made new decisions. That's all you can do. Hang your head high, be confident in what you did and just keep moving forward. Document it all well and keep going. Sorry you had to deal with that in your first week. We have all had it happen. I missed a broken finger about 3 months in. I felt terrible but we don't have xray. If a child presents will no swelling or bruising, there's no bone sticking out and they have full ROM how many would guess it's broken?

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Specializes in kids.

What 100kids said!! hang in there! 20 years later and I still **** people off.....

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Specializes in Peds, School Nurse, clinical instructor.

Don't beat your self up...every day you will learn something new. Any time it comes to injuries, I always err on the side of caution and suggest an MD assessment and x-rays. More often than not, it has been needed. You have chosen an awesome career.....I hope it all works out for you :laugh:

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Specializes in school nursing, ortho, trauma.

Amen to that! You did make the call. I mean what were you supposed to do, send out the SWAT team to look for her? How about she answer her danged phone when the school calls? You called twice (actually you called both parents so you made multiple calls)! I agree with 100kids - i probably wouldn't have called with the first visit and probably would have given the FYI / CYA call after the return visit only if the kid bothered to return. Heck, my ice packs don't leave my office, so i may not have gotten that opportunity. Especially if i had gotten tied up with 50 other visits. Your principal needs to lighten up on you just a bit, and you need to be just a bit kinder to yourself too.

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thanks everyone for the support. I spoke with another nurse in the district this morning and she said the same stuff you guys are. I have moved on from the "guilt" and realized I did what I should have, and from now on I will call that mom with every bump and bruise (and loose tooth and scratch). Thanks again guys- this site is a big help for a field with little resources!

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