Going home for cramps. Really?

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Yesterday I had a student come in c/o SA with nausea and "vomiting" (sorry, sister, if you tell me you threw up in the bathroom without a credible witness it doesn't count!). After asking several questions I figured out that she was having cramps and felt like caca. This is not something I send home for! If I have to be here when I'm bleeding like a stuck pig and having cramps so bad that I'm vomiting, then so do you! In a much kinder way I told the student this. She agreed it was fair and went back to class, (I thought). What she did was went either to the office to use the phone or to use her cell, and called mom. Mom came to pick her up. This morning, mom brought OTC med (per district policy, I can give this with mom's permission for menstrual cramps) and said, "she gets so bad she throws up, that's why I picked her up". :rolleyes: Really?! I wish I could go home for 1-2 days a month when I have cramps!

Specializes in School Nurse, Maternal Newborn.
I sure am glad that you are not my kids school nurse. Your attitude is terrible for the profession you are in. My own daughter gets severe back/abdominal pain during her periods and at one point got her menses every two weeks and had to be put on birth control to regulate it. I'm sure glad her nurse practitioner didn't have your rotten attitude. When that Mom came to pick the student up she should have told you nothing. I sure wouldn't have. I don't want my child any where near nurses like you, and, thankfully, she is not going anywhere near the nursing profession.

Now THAT was RUDE beyond belief. You don't know the personality of the child that she was dealing with, but I am sure that the OP does. Many of the kids I deal with will give ANY excuse to get out of school, and have parents that will always take the path of least resistance, or just plain don't care. We have a gazillion kids getting special ed services that would not need them if they would just attend school more regularly. In middle school, missing 1-2 days per month can make a HUGE difference in them keeping up with their peers.

As a school nurse, I feel that we have a responsibility to prepare our kids for the real world. Employers are not very concerned that we have dreadful bleeding or cramps. Work ethics matter! Do you really think that employers will stand for 1-2 days off for menses, no matter how miserable they may be? And before you flame me, I had the periods from hell when I was a kid, and treatment for such things was minimal in those days. Vomiting, often diarrhea, and cramps/backache severe enough to double me over. I changed my pad, used a hot pad, got a little TLC from he school nurse, rested, and BACK TO CLASS. I would never have expected any different treatment than that.

As I, like the original poster, work in a poor school, I see that many of the parents have not finished school, do not value education, and are keeping their children on the path to the same futures as they themselves have. Do we not owe it to these children to teach them SOMETHING about the world of academics and employment? :eek:

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I sure am glad that you are not my kids school nurse. Your attitude is terrible for the profession you are in. My own daughter gets severe back/abdominal pain during her periods and at one point got her menses every two weeks and had to be put on birth control to regulate it. I'm sure glad her nurse practitioner didn't have your rotten attitude. When that Mom came to pick the student up she should have told you nothing. I sure wouldn't have. I don't want my child any where near nurses like you, and, thankfully, she is not going anywhere near the nursing profession.

Mama Bear, put down the stick! :) It truly does depend on what the pattern of this kid is. If she's in there every blessed time she has a sniffle, not to mention when she's on her period, then the school nurse is absolutely correct in saying, "Sorry, you're not dying and I'm not calling your mom." If she is in the office infrequently, then I think it's appropriate to call mom and leave it to her to decide. Many kids in mid-school and high school DO take advantage of going to the nurse for every little thing they can just to get out of class. When the nurse has the a parent's phone number on speed dial, it's time to find a better way to deal with the issue. She needs further followup with her PCP.

I currently have the periods from Hades, and I bleed like a stuck pig, not to mention get homicidal and get horrible migraines. I feel for the girl, but she's got to get some help dealing with it as it is a chronic problem, and you bet any future workplace is going to frown upon her missing days at a time once a month.

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Specializes in ED.

Once of the first things I learned about pain was that pain is what the client says it is. Not what WE think it is. Fundamentals.....so simple yet something so easily forgotten.

I've dealt with this issue since I was 15. I even remember the first time I ever threw up, because we were in the middle of a hurricane, Hurricane Andrew, August 24, 1992. It was the worst pain I have ever felt in my life (aside from maybe childbirth) and occasionally it would be so bad I would vomit, and I am not a big vomit person (it really takes a lot for me). I can't say I ever missed school, or went home early and when I was older, I never missed work. But I know there were times where I did call in to say I would be late to work (my high school job). After high school, I can remember a time I was sent home from work because I threw up right in front of my boss as I was trying to run to the bathroom. Another time I was is such pain that I just went into one of my bosses' offices and laid on the floor until the pain was bearable. Once when I was waitressing, I was up all night in pain and had to be at work at 10am and I finally got to sleep at like 6am. Yeah, I went in still and was responsible, but that doesn't mean this is anything to scoff at. Not everyone can deal with health issues like that, I just happen to be the type of person who feels like they can't ever call in sick because the world will fall apart without them there.

Granted, I get that this particular girl could have been lying or exaggerating the truth, and I am sure there are plenty of girls out there that do and try to use this to their advantage. I'm just saying that dysmenorrhea, while some may "think" they have it, is very real and very, very painful. I have spent plenty of my TOM days lying in the fetal position. Again, though, pain is what the client says it is.

On another note, I never got help because I didn't know any better. During middle and high school, I lived with my dad who had no clue about these sort of things, except for the fact that I needed to be left alone certain days. My mom, who I did see regularly, and knew about my issues, never thought it would be a good idea to take me in to the doctor. When I was on my own, I guess by that time I just thought this was normal and left it at that. Once I got pregnant, my cramp issue has been resolved. I haven't had to deal with dysmenorrhea ever since, thank goodness. I know better now, and heaven forbid my daughter ever has to go through this, I will most certainly have her seen by the doctor for it, right away.

(By the way, doesn't the mom have the right to take her daughter out of school if she wants to??? Whether its right or wrong, she IS the mom and it IS her daughter.)

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Specializes in school nursing, ortho, trauma.

My usual protocol with regards to cramps is to allow them a little heating pad time (during a non-academic period or maximum 10 minutes during an academic period) or administer a PRN if ordered for the student. Most of the time the students will be fine with these interventions. If a student is really persistent on going home, i'll usually make then rest in the office for 10-20 minutes before that determination is made. If they start gabbing happily with friends or don't have the affect of someone in too much pain to stay in school they are sent back to class.

I can't stop a student from going to guidance to use the phone, using their phone illegally in the bathroom or requesting to call home, but i explain that it will be an unexcused absense.

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Specializes in School Nurse, Maternal Newborn.
Once of the first things I learned about pain was that pain is what the client says it is. Not what WE think it is. Fundamentals.....so simple yet something so easily forgotten.

I've dealt with this issue since I was 15. I even remember the first time I ever threw up, because we were in the middle of a hurricane, Hurricane Andrew, August 24, 1992. It was the worst pain I have ever felt in my life (aside from maybe childbirth) and occasionally it would be so bad I would vomit, and I am not a big vomit person (it really takes a lot for me). I can't say I ever missed school, or went home early and when I was older, I never missed work. But I know there were times where I did call in to say I would be late to work (my high school job). After high school, I can remember a time I was sent home from work because I threw up right in front of my boss as I was trying to run to the bathroom. Another time I was is such pain that I just went into one of my bosses' offices and laid on the floor until the pain was bearable. Once when I was waitressing, I was up all night in pain and had to be at work at 10am and I finally got to sleep at like 6am. Yeah, I went in still and was responsible, but that doesn't mean this is anything to scoff at. Not everyone can deal with health issues like that, I just happen to be the type of person who feels like they can't ever call in sick because the world will fall apart without them there.

Granted, I get that this particular girl could have been lying or exaggerating the truth, and I am sure there are plenty of girls out there that do and try to use this to their advantage. I'm just saying that dysmenorrhea, while some may "think" they have it, is very real and very, very painful. I have spent plenty of my TOM days lying in the fetal position. Again, though, pain is what the client says it is.

On another note, I never got help because I didn't know any better. During middle and high school, I lived with my dad who had no clue about these sort of things, except for the fact that I needed to be left alone certain days. My mom, who I did see regularly, and knew about my issues, never thought it would be a good idea to take me in to the doctor. When I was on my own, I guess by that time I just thought this was normal and left it at that. Once I got pregnant, my cramp issue has been resolved. I haven't had to deal with dysmenorrhea ever since, thank goodness. I know better now, and heaven forbid my daughter ever has to go through this, I will most certainly have her seen by the doctor for it, right away.

(By the way, doesn't the mom have the right to take her daughter out of school if she wants to??? Whether its right or wrong, she IS the mom and it IS her daughter.)

NO ONE IS DENYING THAT THE CHILD IS IN PAIN. I think you are drawing heavily on your own experiences in this issue. Don't assume, either, that ALL people with dysmenorrhea stay home for 2 days per month, curled into a fetal position. Many of us have had it, I ended up with a hysterectomy at 32, in part due to excessive blood loss. The pain, nausea, vomiting and cramps did improve tremendously after my first child was born, but the bleeding and clotting problems did not.

Yes, the mother can take her, ANY TIME SHE WANTS. Don't forget, though, that the attitudes about missed school/work often come from the parents anyway. I deal with a lot of parents that keep children home for every little sniffle, and it isn't usually the parents that have work ethics or much education that do this. Parents with education and a strong work ethic often expect the children to learn to cope with aches and pains, not teach by example that every little ache and pain needs to be addressed by staying home or going to the doctor.

FLAME AWAY. :devil:

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Specializes in School Nursing.
Once of the first things I learned about pain was that pain is what the client says it is. Not what WE think it is. Fundamentals.....so simple yet something so easily forgotten.

Please don't become a school nurse if you stick with this mentality. Your school would be half empty on a daily basis. If I did not ASSESS (first step of the nursing process, remember) each student for signs of illness and went only based on what the "client says it is", I would be sending kids home left and right and would probably lose my job. As a school nurse, my job is to support the education system and remove barriers to education. This is not accomplished by sending kids home for every minor discomfort.

I trust the OP's assessment. She knows the student and family and was the only one of ALL of us who actually laid eyes on this student. In her judgment, the student was not sufficiently ill to warrant a trip home. People can bring up their own experiences all day long, that has no bearing on the case at hand. We did not see the kid, the OP gave no indication that this student was writhing in pain, there was no indication of multiple episodes of vomiting (if she even vomited once...I am like the OP, if I don't see it, it doesn't count). Based on what she has told us, I would not have sent the kid either, and I would not have excused the absence if the student decided to call mom and she took her home. This is the real world of school nursing, until you have been there with 30-40 kids a day all looking for the free ticket home, please withhold your judgment.

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Specializes in ED.
Please don't become a school nurse if you stick with this mentality. Your school would be half empty on a daily basis. If I did not ASSESS (first step of the nursing process, remember) each student for signs of illness and went only based on what the "client says it is", I would be sending kids home left and right and would probably lose my job. As a school nurse, my job is to support the education system and remove barriers to education. This is not accomplished by sending kids home for every minor discomfort.

This is NOT by any means, a MINOR discomfort. And I was not casting judgement. I never said the girl was telling the truth. If you read what I had said in its entirety, you'd see I said she may not have been. My point was, which it seems some of you have missed, was that this is a very REAL and very PAINFUL problem and shouldn't be taken lightly. I never said it was in this situation, but the OP said because no one saw the girl vomit and she couldn't "smell" vomit on her breath, then the girl didn't vomit. Sorry, but I would rinse my mouth afterwards with water. I personally don't like to have vomit sitting around there in my mouth.

You can be snarky if you want to, I always remember to ASSESS first, as yes, it is the first step in nursing. Thanks, though. I'm not sure what I would have done without your reminder.

I love to see the empathy in today's nurses. Great job!

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Specializes in school nursing.
This is NOT by any means, a MINOR discomfort. And I was not casting judgement. I never said the girl was telling the truth. If you read what I had said in its entirety, you'd see I said she may not have been. My point was, which it seems some of you have missed, was that this is a very REAL and very PAINFUL problem and shouldn't be taken lightly. I never said it was in this situation, but the OP said because no one saw the girl vomit and she couldn't "smell" vomit on her breath, then the girl didn't vomit. Sorry, but I would rinse my mouth afterwards with water. I personally don't like to have vomit sitting around there in my mouth.

You can be snarky if you want to, I always remember to ASSESS first, as yes, it is the first step in nursing. Thanks, though. I'm not sure what I would have done without your reminder.

I love to see the empathy in today's nurses. Great job!

Sometimes "empathy" is being able to stand up and say that the right thing for a student is the right to an education. And you cannot receive an education by staying home for every little thing! Also, please do not flame the OP, we come here to vent and let out hair down not to be attacked by our colleagues.

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Specializes in School Nurse, Maternal Newborn.
This is NOT by any means, a MINOR discomfort. And I was not casting judgement. I never said the girl was telling the truth. If you read what I had said in its entirety, you'd see I said she may not have been. My point was, which it seems some of you have missed, was that this is a very REAL and very PAINFUL problem and shouldn't be taken lightly. I never said it was in this situation, but the OP said because no one saw the girl vomit and she couldn't "smell" vomit on her breath, then the girl didn't vomit. Sorry, but I would rinse my mouth afterwards with water. I personally don't like to have vomit sitting around there in my mouth.

You can be snarky if you want to, I always remember to ASSESS first, as yes, it is the first step in nursing. Thanks, though. I'm not sure what I would have done without your reminder.

I love to see the empathy in today's nurses. Great job!

You know, for someone that isn't even a nurse yet, MUCH LESS A SCHOOL NURSE, you seem to have all the answers that none of us seasoned RN school nurses do. (your posts are JUST as "snarky" as this one is.) I think I am finished with this thread, as I think we may have a troll.

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Specializes in School Nursing.
This is NOT by any means, a MINOR discomfort.

How on earth do you know if the student's discomfort was minor or not? You did not assess her? That is my whole point! You are projecting your own experience onto this student's with absolutely no knowledge of her or the situation. You need to learn to be objective and leave your own personal feelings and experiences out of it.

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Specializes in ED.
You know, for someone that isn't even a nurse yet, MUCH LESS A SCHOOL NURSE, you seem to have all the answers that none of us seasoned RN school nurses do. (your posts are JUST as "snarky" as this one is.) I think I am finished with this thread, as I think we may have a troll.

I was only snarky in my last post in response to the snarky attcks on my first post. I guess some of you missed the posts from others sharing their experiences with dysmenorrhea and asking where the compassion was because I seem to be the only one attacked. And I'm the troll? Glad you're done with the thread. You can't come to an accurate conclusion about me when you don't know anything else about me or what I did for a living before nursing school, so you are no better than me.

Purple scrubs, you didn't assess this particular patient either so you can't say her pain was minor any more than I can say it was major. I can certainly look objectively at a situation. I was sharing my own experiences HERE to bring to light the fact that while some people may experience dysmenorrhea, they may not experience it to the same extreme as the next person. It can be debilitating,but again I never said that was the case with this girl.

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once of the first things i learned about pain was that pain is what the client says it is. not what we think it is. fundamentals.....so simple yet something so easily forgotten.

"after asking several questions i figured out that she was having cramps and felt like caca. this is not something i send home for! if i have to be here when i'm bleeding like a stuck pig and having cramps so bad that i'm vomiting, then so do you!" seriously?!! that's what i took sunraygurlrn2b above post to be addressing. pain is subjective and the op clearly stated she assesed the girl as having cramps and feeling like caca... so send her home!! just because op is able to suck it up and stay at work, dosen't mean someone else should have to as well.

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