(She is an MD from Pakistan or something, hasn't been certified to practice medicine in the states so is a school nurse now.)
I feel so......reduced.
Most schools with RN's or LPN's have protocols for such emergencies. The protocols include a plan of action and school nurses should develop a prearranged plan with contacts made in advance at a doctor's office or ER.
There is a degree of judgement call based on the students response to the injury and the mechanism of injury. If the student was calm, handling the pain, and additional assessment did not indicate circulatory or other problems, I would have applied ice and sent her to an orthopod immediately (with parental permission). If the students response was adverse or my assessment revealed additional problems, I would have called EMS for transport.
Parents must always be notified of injury, but if they are not available, treatment should never be delayed, especially in ortho injuries. Reducing the patella/joint should never be attempted at school by the nurse or any other school staff.