Help me please New substitute school nurse.

GdBSN, RN · Feb 23, 2016

Honestly, you have to get tough with them, and the teachers, that if they don't meet the criteria to go home, then they do not need to keep coming back to the clinic. They need to stay in class. Most stomach aches and headaches can be addressed with food and water. Explain to the teachers that if the students do not meet the criteria to go home, do not send them to the clinic.

Flare, ASN, BSN · Feb 23, 2016

so it sounds to me like the admin has given you a green light to play the hard line. I, by the way, can be found most days camped out by the hard line. I keep a nice easy chair there and they bring me lemonade on the hour .

I tell the kids that I totally get that they don't feel well - but that I don't have any reason to send them home. Encourage fluids, handwashing, remind them not to touch their faces (i usually tell them cute little face and that gets a smile 95% of the time) or to chew on their pencil or put their hands in their mouths. Then end by telling them if they don't feel well to let their parents know and to stay home if they spike a temp.

That diatribe will usually be enough to satisfy them. If they ask about coming back later if they still don't feel well - tell them I tell them i don't work with "what if's" (which i don't remember who on here provided that fabulous pearl, but i strung it on my necklace and wear it proudly - so thanks again!! and speak up and take credit!!)

Also - remind them of how much time is left in the day - if the day is half over, 2 hours left, an hour, whatever.

JenTheSchoolRN, BSN, RN · Feb 23, 2016

Play hardball. You're a sub. The kids are testing you big time.

At that age, I will tell kids why they need to remain in school. I've also e-mailed teachers with a head's up. Teachers get busy and don't always realize a kid has been in my office x number of times today, but when they see the e-mail, they get wise and often get on my side. The kids? Well, when they realize I am not fooled, they move on. I hate what-ifs. You might vomit? Huh. Well, unless you truly look like it to me, show me the puke! I work with 7th graders and the previous nurse in the 5th/6th grades had been more lenient. One kid told me that word had gotten around to the 7th grade that I do not send many kids home at all. I take pride in that :yeah: .

If I call home for a "check-in" after I have seen a student 2 times or more within a short time frame that I feel does not need to go home, I call with a simple: "Johnny has been to see me x number of times today, complaining of y. In my medical opinion, he does not need to go home, so I thought a quick check-in might get him on track to remain in class today."

Parent gets the message of their frequent flier and usually sets them on the path back to class (A). If they get a pick-up out of it, I will code it non-medical and let the parent know I am doing so (B). Luckily, more often than not A happens vs B. And when B happens, usually nothing I can do with that one.

Cattz, ADN · Feb 23, 2016

Good morning Yulie- I hope your day is off to a survivable start. Hopefully, waaaay better than that. I have to chime in and say to be tough as well. If you stay consistent, the kids and adults will know what to expect from you, and your days will start to roll along more smoothly.

This quote from abc123RN said it great, from a thread yesterday- "Any kid I see in the first hour after the bell, unless projectile vomiting in the hall, spurting bright red blood, looks like a smurf or has a bone that is visible, will return to class and come back after lunch. Unless any of the above is observed." Of course, there are always going to be exceptions, but this is as short and sweet.

Is there a chance that you can have a staff meeting? If so, own that moment!! You are the medical person. Let the teachers/staff know that you will take care of medical needs, and they can take care of teaching the little lovelies. Don't be afraid to look them in the eye, and speak firmly and with confidence.

Please let us know how you are progressing.

Huggggs to you, and hang in there.

tonih79, LPN · Feb 23, 2016

my schools is k-6 and I we have a 20minute or less rule after 20 minutes you are either going home or back to class and if you don't meet the criteria to call home you go back to class and for stomach aches without fever I give them an apple or banana or crackers to settle stomach the quicker you send them back the more unlikely they are to return. I have some older kids that no about the 20 minute rule, I still send them away if it is not necessary. I will let students with a history of headaches or migraines rest in office sometimes longer then 20 minutes if i can keep the area quiet and dark for them.

SnugglePuggle, MSN, RN · Feb 23, 2016

I agree with other posters that you have to be tough. I love the hard line because within a month or two of the start of school, I generally only see students who truly need my attention, with a few exceptions of course. That being said always be on the lookout for potential serious medical issues. Don't let frequent flyers or pressure from administration cloud your judgment.

Firm but kind is my motto. Word does get around and you do not want kids to think you are their "Golden Ticket!" I have 7th and 8th graders who often benefit from a "time out" on the cot - 10-15 minutes. More often than not, once they realize that I am not calling home, they volunteer to go back to class.

Cattz, ADN · Feb 23, 2016

I agree with other posters that you have to be tough. I love the hard line because within a month or two of the start of school, I generally only see students who truly need my attention, with a few exceptions of course. That being said always be on the lookout for potential serious medical issues. Don't let frequent flyers or pressure from administration cloud your judgment.
Firm but kind is my motto. Word does get around and you do not want kids to think you are their "Golden Ticket!" I have 7th and 8th graders who often benefit from a "time out" on the cot - 10-15 minutes. More often than not, once they realize that I am not calling home, they volunteer to go back to class.

Yes. Those who are truly not sick seem to get bored really fast, and volunteer to go back to class. (Especially when they are left laying there on the cot, after I am sure they are ok, and I go back to whatever it is that I am working on).

SnugglePuggle, MSN, RN · Feb 23, 2016

Yes. Those who are truly not sick seem to get bored really fast, and volunteer to go back to class. (Especially when they are left laying there on the cot, after I am sure they are ok, and I go back to whatever it is that I am working on).

This also gives you the opportunity to observe them. Give them a cracker and a cup of water and see if they keep it down. Are they bolting to the restroom? Looking a bit green and doing a lot of swallowing? Curled up in a ball with eyes closed? Or......are they readily chatting with students, nurse or other staff? Do they claim a SA yet ask for a piece of candy that you have strategically placed on your desk? Do they claim a debilitating HA, yet find it possible to text their friends? Observation can be a powerful tool!

kidzcare · Feb 23, 2016

More often than not, once they realize that I am not calling home, they volunteer to go back to class.

Yes. Those who are truly not sick seem to get bored really fast, and volunteer to go back to class. (Especially when they are left laying there on the cot, after I am sure they are ok, and I go back to whatever it is that I am working on).

I think it was on here that I got the term for this: therapeutic boredom. No phones allowed and if you are well enough to read/draw then you are well enough to be in class. Buh-bye. The really sick ones will fall asleep. The fakers will grab their belly if they think that I am turning in their direction.

This also gives you the opportunity to observe them. Give them a cracker and a cup of water and see if they keep it down. Are they bolting to the restroom? Looking a bit green and doing a lot of swallowing? Curled up in a ball with eyes closed? Or......are they readily chatting with students, nurse or other staff? Do they claim a SA yet ask for a piece of candy that you have strategically placed on your desk? Do they claim a debilitating HA, yet find it possible to text their friends? Observation can be a powerful tool!

Yep, yep, and yep!!

Yulie · Feb 24, 2016

Thank you all so very much. Today I did it by the book and stuck with it. It was mostly good, and once they figured out that if they didn't meet criteria I wouldn't be calling home the office cleared out. I also checked every single kiddo for a nurse pass. I had thought I was keeping a pretty good eye on this, but more were getting through than I thought. I had a couple get upset that I wouldn't see them without a pass, but that is ok because the rule is that they must have a pass. Doing things this way gave me a lot more time to deal with the things that really needed my attention. Thank you all so much for the advise and encouragement. I still have tomorrow at the same school so hopefully it will go smooth also. You guys are great! Thank you so very much. :nurse:

Cattz, ADN · Feb 24, 2016

YaaaaaY for Yulie!! Good work. It's so good to see your post having a positive tone. Waaay to go! Keep us updated!! Huggggs to you!!