Frequent Fliers

[nurse__ab19]

Hello! I recently took a new job as a school nurse at a technical school (grades 11&12). I have worked in the ER and critical care settings for the last 4 years, so I am very comfortable with emergencies and have a keen sense of being able to detect B.S and when I'm being played. However, I keep questioning my instincts with these kids. I am so afraid I'm going to make the wrong judgement call on whether to send a student back to class/home/ etc. I want these kids to like and trust me but don't want taken advantage of.  I'm taking over in the middle of the school year and the nurse before me was very lax about sending students home. My 3rd day I had easily 10-15 kids come in telling me they threw up in the bathroom and wanted to go home, none of them had fevers and none of them looked like a truly sick kid. I tried tums and crackers with them and sent them back to class, most never came back but the couple that did I did call home for them to be picked up. Was this the correct judgement call?

 I was just wondering if any more experienced school nurses could give me some of their advice, not just on that specific incident but in general. 

Thanks!

[k1p1ssk, BSN, RN]

What you are experiencing is the very common "Bigfoot Vomit". Most of us here have a "we need to see it to believe it" stance on vomiting, and in that age group, I generally feel that I would only send home if there were multiple bouts and a demonstration of not being able to hold down food/fluids before I sent home, unless the kid also had a fever or looked particularly unwell. So many things cause vomiting in that age group that are not contagious illness - anxiety, migraines, and taking meds on an empty stomach are probably the top 3.

And yes, you're right, most are looking to get out of something and when it doesn't work, they accept defeat. The ones that returned were likely either telling the truth or were so determined that I wouldn't have argued it.

Does your school have a 24-hours vomit-free policy? This can help with those kids who do get picked up - the parents will often sort them out once they realize they need to miss an additional day over a lie. 

So, from what you've said, it honestly sounds like you're doing great thus far! You will find that students and staff will respond (albeit it will take time) to how you run your office. It took less than a year for the nurse that took over in the MS/HS in my district to turn her office around from being a hang-out spot to a needs-only space - I'm sure you can do the same! Good luck!

[nursekoll, BSN, RN]

Yes, trust your gut! At my high school level, vomit needs to be witnessed/seen in order to be sent home for it. They also will figure it out really quick if coming back in multiple times gets them a ticket home, so I'm still very much a rule-follower on that as well. No fever, no vomit= back to class. If the return visits are excessive or if they truly don't feel well I'll offer to call the parent and say the student doesn't meet the criteria for being sent home due to illness, but if the parent wants to choose to pick them up as a personal absence, it is up to them.

Always wait 5-10 min to take temps, kids have been known to put something hot on their forehead or drink something hot right before walking in to my office to fake a fever.

Water challenge- give them a good 10-15 oz water and have them sit for 10-20 min. If they can keep it down, they are probably good!

It's a constant fine line between -trust me to take the student concerns seriously and keeping parents and teachers happy as well in keeping students in class as much as possible. Set your limits, be compassionate yet reasonable. 

[NRSKarenRN, BSN, RN]

Above members offered their usual great advice. 

Camp nurse chiming in --found that Peppermint puffs that melt in your mouth worked better than tums to settle upset stomachs/stop vomiting for older kids.

[SuzanneRNLA]

NRSKarenRN said:

Above members offered their usual great advice. 

Camp nurse chiming in --found that Peppermint puffs that melt in your mouth worked better than tums to settle upset stomachs/stop vomiting for older kids.

As a Pediatric RN for 26+ years, I've learned that the old fashioned lemon drops work very well for stopping nausea/upset stomach. We gave it to our chemo kids of all ages. (Works for me, too.)

[robinasq]

Sounds like you are doing great ! In my school system, anyone who vomits twice, at least one witnessed, goes home. Look at the history of the student. We use SNAP charting and can see every previous visit, this can be very helpful. I also ask what class they came from,.. does math class always make you vomit? Also nobody  (almost)  goes home during the first or last hour of the day .