Help With "Needy" Teachers

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I'm a fairly new school nurse so I don't have the tools or background to know how to address the teachers when they send students to my office for EVERY little thing. My school is an inner city Pre-K with 300+, "high risk" 3 and 4 year olds. The majority of our teachers are brand new to teaching and are very young (meaning very few of them have kids of their own so little bitties are somewhat foreign to them). When school started I was never availed the opportunity to meet with the staff to lay down some ground rules regarding the Health Office, so subsequently my staff calls me (yes - I go to them to see the kids when they can't leave their classroom) for hang nails, lashes in the eye, dry skin, scratches that happened last week, runny noses, temp checks, kids who look like they don't feel good, "pink" eye that is so not pink I never even know which eye they want me to look at, nausea, etc. A teacher favorite (because I leave at noon) is to bombard me with students at 11:45 because they know I'm about to leave OR come in as I'm leaving and say "This kid has looked sick all morning...".

My boss said it's my responsibility to train them to be independent and to know which situations can be handled in the classroom but: 1. I'm still too new to this to know what would be appropriate for a teacher to handle in the classroom, and 2. I feel like I'm pawning my job off on them and creating more work for them if I limit what types of things they can call me for.

How do you seasoned school nurses deal with teachers who think every bump, bruise, or scratch requires a medical assessment?

I would love any advice or tips for helping my staff know what they can handle!

Thank you!!!

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I sent out these guidelines to my teachers. I have pre-K (3/4 year olds) through grade 3 so you may need to modify things a bit. I also wrote up some information on what I can and cannot do. I don't diagnose disease. I don't assess injuries that happen outside of school. I'm not covered for that and I am not an urgent care clinic or primary care provider. I sent out school exclusion guidelines (vomit, fevers, eyes with pirulent drainage, open sore, etc). Sometimes you really need to be firm and put your foot down on things. Otherwise the teachers default to calling you for everything.

I try to make sure my role is not de-valued as bandaid brigade. I am there to ensure the safety of our students. I care for diabetics, kids with asthma, seizure disorders, etc. I perform yearly assessments. I update medical records and ensure students have necessary vaccinations, physicals, etc to be in school. I also explain that my practice is guided by a district doctor who oversees the standing orders (which I explain as well).

AUTOMATIC VISITS TO THE NURSE

  1. Vomiting/diarrhea
  2. Significant bleeding
  3. Students with a history of diabetes, asthma or seizures
  4. Fainting/dizziness/change in level of consciousness
  5. Suspected allergic reactions
  6. Urinary or bowel accidents

HEADACHE

  1. Get a drink of water (dehydration); Eat a snack if no breakfast
  2. Nurse has a limited supply of snacks available
  3. Put head down for 5-10 minutes
  4. See nurse if headache is bad enough to interfere with classwork or has difficulty moving head/neck

STOMACHACHE

  1. Go to bathroom (bowel movement, gas)
  2. Drink water; eat a snack (if no breakfast)
  3. Wait 15 minutes after using bathroom and drinking water/eating to see if pain eases
  4. See nurse if pain persists

SORE THROAT

  1. Drink water
  2. Wait 15 minutes to see if pain persists
  3. See nurse if pain is persist or accompanied by fever, chills or difficulty swallowing

NOSE BLEED

  1. Pinch bottom of nose firmly using tissues

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Tilt head forward slightly

  1. Send student to nurse

MINOR CUTS/SCRAPES

  1. Student should wash wound with soap and warm water
  2. Apply band-aid from class band-aid supply for light bleeding
  3. Send to nurse with significant bleeding, infected, dirty wounds or puncture wounds

MINOR BURNS

  1. Cool water with cold water or cold wet cloth. Do not apply ice!
  2. Send to nurse

RASHES

  1. Send to nurse if the sores are open or student is scratching

PINK EYE

  1. Send to nurse
  2. Remind student to wash hands after touching face/eyes
  3. Cool compresses/cold packs may provide temporary symptom relief
  4. Students will excluded for purulent or heavy discharge

HEAD INJURIES

  1. Send to nurse. Please report any loss of consciousness or vomiting associated with a head injury to the nurse

OLD INJURIES/CHAPPED HANDSS/LIPS/MISCELLANEOUS

  1. Students who need chap stick frequently should be encouraged to bring it from home.

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[TD]Call the nurse to the scene for:

  1. Seizure activity
  2. Fainting
  3. Suspected fractures
  4. Falls resulting in head or neck injury

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Specializes in retired LTC.

Not a school nurse here, but might you be able to attend one of their staff meetings (I'm guessing that they have some)? You could then present info en group, rather than individually.

Just a thought ...

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Specializes in school nursing, ortho, trauma.

The practice of them knowing that a student "hasn't been himself" or has been sick all day and bringing them to you as you're walking out the door needs to come to a stop. Have you asked them why they waited all morning to the point that you are ready to walk out the door for an assessment? They probably don't realize that's it's not "just a quick check" for you. That it also means charting, perhaps a call home and depending on your school policy, holding you over-time to wait for the parent if the student is sick enough to be picked up. I can see a teacher letting it go for a little bit to see if the student perks up after snack or playtime, but knowing exactly what you are talking about because i see it ALL. THE. TIME. it's often not the case.

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Specializes in School nurse.

You should be invited to faculty meetings and can present guidelines and training there. You are not pawning off work when it entails minor first aid. Kids are in school to learn, not to spend the better part of a week in the health office unnecessarily. You create less work for them when you factor in that the teachers (especially in school age groups) have to figure out what work is missed, look at and grade extra assignments, remediate students who are falling behind, then possibly attend I&RS or IEP meetings and create and implement action plans etc. To be honest, they are unaware of and probably don't care just how much extra work they are creating for YOU. It's a lose lose until it gets addressed.

Do you chart every visit? If so you can run reports that show how much academic time is missed. If some kids are always in your office they might as well be absent. Spin it towards test grades. This a hot topic for teachers because many have their raises and evaluations tied to scores. We know that kids who are healthy and stay in class learn better. By teaching the teachers you are actually advocating for the kids.

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Thank you all so much for the input!!! Rbytsdy those guidelines are a great starting point!!!

I am supposed to be part time (8-12) and staff meetings are always held after school so I never get a chance to address the teachers as a whole. I email them important updates and information but I know they don't read them because I have had teachers ask me the very question I addressed in my email messages. When the school year started our school was in utter chaos - it might have been the worst first day/week/month of school ever. We have a new principal, a new director, and the majority of our teachers are brand new to teaching. In fact - when school started admin was still hiring teachers so we had several subs for at least a month. Our students are rough, their parents are scary, and we have a building full of newly hatched staff trying to figure out how to deal with the mayhem. I never had the chance to address the staff before school even started because the school staff was frantically trying to prepare for the turnover. Next year i am absolutely going to take 30 minutes of their time to discuss all things health related.

As far as the last minute visits right before I leave - it's the new teachers who do it and I think they freak out knowing that for an hour and a half I won't be there and they're going to have to manage the students on their own. I'm trying to put myself in their shoes and I can understand their panic. For many of our students I'm probably the only medical person they get to see, their parents are young or in jail so they are sent to school sick because nobody can stay home with them, and our parents would love to have a freebie reason to sue the school ($jackpot$) for any minor oversight that might have caused their child the slightest bit of discomfort. I think the teachers are scared and I think they probably don't understand that there's a whole lot more work that I do after the kid leaves my office so their last minute dump is costing me much more time than they're aware of. They have no concept of documenting a note or that when I have to call their student's parent it can literally take me an hour to hunt down a working number because they are all either disconnected or don't accept voice mails (and if you want to talk about what angers me and lights a raging fire inside my brain - parents of small children who have no working numbers, no transportation, or who take 4 hours to come pick up their sick kid! I had to resort to calling an emergency contact for a kid and the person asked: is this an emergency?...me: no but we've gone through 10 phone numbers and none of them work.You're number 11 on the list and the child is very sick....them: if it's not an emergency I'm not coming (click)......I've also been threatened by parents and told I am going to be sorry if they get down to the school and their kid isn't sick; I'm dying to tell them that I wouldn't have spent an hour of my time trying to track them down if their child was fresh and healthy.And I can't even tell you how many times a parent will come into my office, completely ignore me and ask their 3 or 4 year old if they're sick....and when little student says they're ok despite having a fever and chunks of green snot dancing out of their nose, the parent will look at me and say "he says he's not sick")....ughhhhh but i digress - that is a whole other topic that makes me want to bang my face against a hard surface....

Ok well I've lost all track of my thoughts and now the teachers dumping kids on me at noon isn't looking as bad as it did an hour ago :facepalm:

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Ugh!!! I'm not in an inner city school but I do work in an at-risk district. About a month ago, I did something I have absolutely refused to do (for safety/legal reasons) - I stripped a child down and bathed her. She was a non-verbal kindergarten child who had terrible diarrhea. Parents had no working phone numbers. I tried giving her clothing and explaining how to wipe herself. She literally couldn't get it. She got her pants down to her knees. We called the police and they went to the house. Mom wouldn't answer (she told us later that she was afraid when she saw the police at her house). After 2 hours, I finally gave up and decided this kid needed assistance. A female administrator came to witness me. All because a parent couldn't be responsible enough to be "contactable" for her kid. Oh, and mom admitted that her daughter had diarrhea all weekend... and then dad came the next morning demanding to know why we called the police on them.

The non-working phone numbers make my blood boil too. It kills me that parents don't care about whether or not the school can get a hold of them in an emergency. I've had to threaten ambulances and/or police to get messages through to some parents. And, yes, these are the parents that are always looking for a lawsuit or evidence that the school isn't doing it's job (since schools are highly effective without parental support).

You are in a tough job, especially with such little kids. But you are not a safety net or outlet for the teachers. Your job is just as valuable.

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One of my schools is Title I and we have the same problem - NO working phone numbers! Literally "out of service" or the voicemail isn't set up or it rings twice and then is just dead - what does that mean? It's absolutely frustrating to think that in an emergency these parents wouldn't know where their kid was being transported until the police show up at their door - if their address is correct - and then they still don't answer because they are afraid of police?! Ridiculous. And when you try to get these kids FREE glasses with the FREE medical care - and the parent is adamant that they "don't need glasses" despite having been referred 4 times this year - and you finally convince them to just drop in to the optometrist around the corner after school because you've literally set up a walk-in appointment for them after making multiple phone calls and asking for (and getting) their insurance information based on their name and birthdate (probably a violation of some sort there, but grateful it happened) - and lo and behold the parent doesn't take them?? Wow.

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I hate to say it, but the school nurse is truly the dump site in a lot of buildings. If a staff member cannot figure out what to do or where to send the kid, they end up with the nurse. Some days, this infuriates me because dealing with a lot of nonsense does take time away from kids with valid medical needs.

However, maybe we should take it another way - they know the nurse is THE SMARTEST person in the building and only she (or he) has the critical thinking skills necessary to solve any problem!!!

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Specializes in kids.

I'm not is an "at risk" district, actually probably the opposite. My unreachable parents are at the gym, playing tennis, out to lunch.....

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