Going home for cramps. Really?

Purple_Scrubs, BSN, RN · Nov 1, 2010

I think many of the posters who are contributing have no idea what it is to be a school nurse where 95% of your population is looking for a free ride home. No, we should not send a student home for c/o "cramps" without some objective data (i.e. witnessed vomiting, or obvious severe discomfort). Based on the OP's assessment, the student had neither (case in point, it took "several questions" before the real issue being cramps was identified. If this student was in obvious, severe discomfort to the point that she needed to be sent home, I would think this would be apparent without playing 20-questions with the girl).

I would encourage anyone questioning the nursing judgment of the OP to go sub for a day in a busy school nurse's office. Oh, and make sure the student population knows you are a rookie sub nurse. Wear your roller skates, you'll need them!

mmmc2 · Nov 1, 2010

HeartsOpenWide, I am with you sister. I have suffered from this same horrible affliction since I had my last daughter (10 yrs ago)...Periods so heavy that I could swear to God I was bleeding to death and unbelievable pain! And my daughter has months like this too. And you know what, I let her stay home from school if she can't get relief from Advil. Sometimes just staying still helps!

Chiefswife - You are jaded, too bad. As previously mentioned, pain is what the patient says it is, not what you determine it to be!

GabbsRN · Nov 1, 2010

This is why this thread is hilarious to me. My intent was to shed some light on the matter based on my own personal experiences to shed some light on the matter but apparently posters here can't seem handle that. I never said this girl was experiencing what I experienced, and I never said she wasn't. I just said dysmenorrhea itself can be very debilitating because I experienced it. Take from that what you will. I'm sure someone will turn it around and say I said something else.

Been there,done that, ASN, RN · Nov 1, 2010

Did you forget? Pain is whatever the patient says it is? Cramps can indeed be too painful to function and cause emesis. You are comparing Your past experiences to a young girl in pain? You should have offered advice and comfort!!!

You are the school NURSE, not the hall monitor.

SchoolNurseBSN · Nov 1, 2010

sunraygurlRN2B - This is a place for school nurses not for nursing students with no experience to junp down our throats for being rude!

DO NOT flame us for doing our jobs which is to "remove medical barriers to learning and help kids succeed in school." We do what we do with limited supplies, limited time, limited support so that we can support children in their education. We ARE NOT band-aid pushers who do not know how to assess darling! Not only can we perform a nursing assessment but we can also look at the BIG picture for our students. We also take into consideration, school climate, socioeconomic status, time of day, student's family situation, etc. There is the NCLEX world and then there is the real world!

School nurses develop a sixth sense about which kids are really ill and which ones need attention or just plain want out of class. We all have had that kid that acts as if they are dying one minute but the next are picking at the posters on our wall, playing with our blood pressure cuff, and asking a zillion questions about the kid in the next cot! If we went by what they said ONLY, we would have schools that are completely empty on a daily basis!

Do we sometimes come across as mean and uncaring? Heck yes! because we cannot please all of the people all of the time.

And yes, a parent does have the right to get their child at any time. Feel free to do that, but I only write the pass when I see a TRUE medical need. Otherwise, mom is on her own when she gets called to truancy court!

Walk a mile in our shoes (or as another person stated, roller skates) before you judge!

Artistyc1 · Nov 1, 2010

Did you forget? Pain is whatever the patient says it is? Cramps can indeed be too painful to function and cause emesis. You are comparing Your past experiences to a young girl in pain? You should have offered advice and comfort!!!
You are the school NURSE, not the hall monitor.

NO school nurse would ever write something like this. At least not an experienced one.

First and foremost, a school nurse must help to support the educational process. This involves assessment and investigation of complaints from the students. Often, pain can be attributed to stress. Some abdominal pain can be due the fact that many of the very young do not spend enough time in the bathroom to allow for proper elimination. This does not mean that there IS no pain, but that it may take some encouragement to continue in class in spite of it, after offering a little TLC, warm pack, and a little rest, and a little more time on the toilet.

If I followed your advice and sent everyone home for cramps, (YOU diagnosed dysmenorrhea, the OP seemed to be alluding to routine cramping) the numbers of absent girls would skyrocket.

In your great wisdom, you will have to remind me again, how does this support a child's educational objectives? A school is NOT a hospital, "where the pain is what the patient says it is". Many of us get "frequent flyers" with an express agenda to GO HOME NO MATTER WHAT. We have to be very perceptive to weed those out from those that are truly suffering.

I looked at most of the profiles of posters that think not sending a student home for a condition many of these students will have to deal with for many years to come is a hideous, cruel concept. None of them are school nurses. They don't seem to understand that everything that walks through our office doors daily is likely to want to go home. Many have made the decision of exactly what the school nurse is to do for them before they even get to us. Some have legitimate reasons, most do not. I would be remiss in my duty to these children's educations to not question "what have you done to help relieve your discomfort?" I will often contact the parent and ask if there has been any investigation into this problem, to see if it can be alleviated in the future to avoid unnecessary absences.

In my experience, which is fairly extensive, many of these young women have mothers that don't teach them that they may have to suffer occasional aches and pains in their lives. That there is not always an easy fix for everything. Many have mothers that did the same thing when they were young- and all too many of the mothers I see have very little regard for education in the first place, and few have even finished high school themselves. This does not negate the student's pain, but it does teach them that sometimes, this is a part of the human condition.

Flare, ASN, BSN · Nov 2, 2010

to put it in it's simplist form - I have close to 900 hundred students in my school. My office is, suffice it to say, very busy. Since Friday was a "fun day" with the Hallowe'en activities, I saw almost no students. Come yesterday, Monday and business as usual - my office is again packed with sore throats and stomach aches.

point is, have we become jaded and cynical as school nurses? Yes, probably to some degree, but it we weren't we'd be sending kids home for every little thing.

To put it in another light - especially helpful if you have school aged kids - imagine if your child's school nurse called you every time your kid came in with a complaint. The first thing you are going to tell me is "My little Sarah/ Steven loves school and hates to miss classes." Yep, sure - then tell me why it's only november and he/she has made 9 visits to my office, mostly for stomach aches -never once vomitting, having diarrhea or a fever. Tell me why he/she argues with me over the fact that he/she is "way too sick for school" but then i see him/her happily trotting down the hall when it is time for lunch or the computer class that he/she actually does enjoy. Now if you were called for a pick up ( and had to leave work) each of those times, i am sure you'd start to wonder if the school nurse was giving any type of assessment at all. Our job is assessment and judgement of symptoms. If they fit a certain criterion (which is a gray area, not black and white, mind you) then they should not be in school.

Anyone can say they're in pain. And yes, pain is what the patient says it is, but when you are in a constant struggle to enhance the academic performance of beings that would much rather be home on the sofa and watching TV rather than working, you have to think a bit deeper than taking their subjective complaints at face value. I am much more apt to believe the student i rarely see that they are too sick for school rather than the frequent fliers. I (somewhat tongue in cheek) tell my students that it's only november. If i know their name and they are not one of my scheduled daily visits (meds, diabetic) that it's not a good thing.

Bottom line is that in school nursing it's all about knowing your students and making judgements on what you see.

GabbsRN · Nov 2, 2010

Flare,I appreciate your civilized response. Thank you for your insight.

bergren · Nov 2, 2010

" The peak incidence of dysmenorrhea is during late adolescence and in 20s. Although it has as high an incidence as 92% in adolescents, it can be seen in later ages too, as shown in our study. ...In an epidemiological study, Klein and Litt reported that 14% of dysmenorrhea cases could not attend school due to severe pain. ... Another study carried out in the United States showed that 10% of women with dysmenorrhea had to discontinue work because of severe pain, and the annual economic loss incurred there upon was estimated at 600 million work hours and 2 billion US dollars. The decrease in quality of life brought about by dysmenorrhea has a remarkable impact on professional productivity and academic performance".

Full text of article: SpringerLink - Archives of Gynecology and Obstetrics, Volume 280, Number 4

Here is a full text article that evaluated the degree of pain with uterine changes on X-Ray.

Dysmenorrhea: Evaluation with Cine-Mode-Display MR Imagingâ€"Initial Experience1 â€" Radiology

This Wikipedia entry on Dysmenorrhea was well referenced: Dysmenorrhea - Wikipedia, the free encyclopedia

" a survey in Norway showed that 14 percent of females between the ages of 20 to 35 experience symptoms so severe that they stay home from school or work. Among adolescent girls, dysmenorrhea is the leading cause of recurrent short-term school absence in this group."

The evidence of intense exercise for relief of symptoms is mixed. A large randomized controlled trial is needed to evaluate if exercise is effective in reducing dysmenorrhea and related menstrual symptoms

Artistyc1 · Nov 2, 2010

I doubt that ANYONE on this board will argue the problems and pain associated with dysmenorrhea. However, many of us are seeing girls that seem just fine when out and about in the building or socializing, but then will decide that they are in too much pain to remain in school when math class time rolls around.

Also, what good is it to just continually send a child home for this, when the parent isn't following up to find out what the problem may be? Severe menstrual pain is NOT always only due to uterine problems, there are also the issues of PCOS and endometriosis to consider- (worked 25 years OB-GYN before I was a school nurse) and these, when not identified and treated, may cause future infertility. I am certain that any of the school nurses on this board encourage parents to seek medical advice if a child is missing several days of school per month for painful menses. But, how many parents are actually doing it? :confused:

2ndgenschoolnurse · Nov 2, 2010

I will say, this thread is very disheartening. I have worked on many different units, for different companies and schools. I have always felt we as nurses are the first to throw eachother under the big yellow bus. This has always been a pet peeve of mine. Yes, pain is personal...especially if you have been there, but to say someone you have just "met" through reading a post is not empathetic and wouldn't want that person to be my child's nurse...really, you are so good at being empethitic that you cast such judgement via a message board? Hmmmm....I am not so sure people in glass houses should throw stones. I would hope that we would be more empethetic to our counterparts before letting a quick vent/rant open such a thread. Oh well, I guess I will watch what I put up here, as I wouldn't want to feel attacked! And to the original poster, Hugs, as you did not deserve all of this! As some one else said we weren't there, didn't see, smell or otherwise asses, so who are we to say! I hope your day is better than yesterday!!

lylenrn · Nov 2, 2010

This reminds me of a school nurse we had in high school (ms K). The only thing that students got sent home for was if they had a high fever. Any other ailment got the same treatment. The student was sent down to cafeteria for oatmeal, given tylenol and instructed to lie down. Maybe this had something to do with the fact Ms k was an old army nurse and figured tx for anything else was "walk it off". In most cases, since students knew they werent going to go home early and didnt want to spend the day laying-in with Ms K, we either carried our own med supplies or stayed home from school.