How busy is your office?

Flare, ASN, BSN · Mar 21, 2014

that does seem high - i see about the same number for a school of 800 and that does include my meds... granted it's taken a bit of time but i have trained some of the teachers to do things like take bandaids for the classroom or tell the kids to try the bathroom first or to get a drink before running to me for a scratchy throat or mild cough. Bless those souls that have listened and have common sense!!

abc123RN · Mar 21, 2014

2 hours + 17 kids = one nurse ready for a day OFF!!! 3 of them just keep coming back over and over and over.....Oh final bell please ring!

JenTheSchoolRN, BSN, RN · Mar 21, 2014

The frequent fliers that come back over and over...I feel your pain! Only a few more hours...

rbytsdy · Mar 22, 2014

I'm new but I've been logging about 30-50 visits per day plus the daily meds (inhalers, insulin, seizure meds and ADHD meds).

It's insane. The last nurse walked out (I wonder why!??) so the office is completely disorganized. The other nurses in the district tried to fix it up but it's still crazy. The district asked if any of the other nurses wanted my school before deciding where to put a new nurse. They all declined. I can see why. I'm trying to get some of them to visit here and there to help me get screenings done. The last nurse never bothered! So I have to screen 500 kids by June. Eeek...

Tina, RN · Mar 22, 2014

I'm new but I've been logging about 30-50 visits per day plus the daily meds (inhalers, insulin, seizure meds and ADHD meds).
It's insane. The last nurse walked out (I wonder why!??) so the office is completely disorganized. The other nurses in the district tried to fix it up but it's still crazy. The district asked if any of the other nurses wanted my school before deciding where to put a new nurse. They all declined. I can see why. I'm trying to get some of them to visit here and there to help me get screenings done. The last nurse never bothered! So I have to screen 500 kids by June. Eeek...

I walked into a very similar situation! My school went through 3 or 4 school nurses within 2 years before I was hired. I couldn't believe my luck, when I got the job. But, I quickly realized that none of the subs or other nurses wanted anything to do with my school. LOL I have about 370 students, k-6. I see about 40 kids a day, often 50. One day last week, I only saw 30 and it was awesome.

The main problem in my building is the staff. They rarely say "no" to a request for a visit to the nurse. They rarely even ask why the child wants to come, they just send them. They will not do the simplest things themselves. Ex: I supplied baggies of bandaids for the classrooms, and the staff doesn't use them. They still send them to me instead. Not to mention that I honestly must see at least 2-3 staff members a day, wanting temperatures taken, BP checked, etc.

It is exhausting. In a few years some other nurses plan on retiring, so I'm hoping to move on to a different building...

Massmagic · Mar 23, 2014

I hear all of you and feel your pain as I too see many students each day. They come off the bus in the morning directly into my office with complaints. They just do not want to be in school and the majority of the students can not take any discomfort at all. I moved to a building that I thought would be easier this year after a nurse retired. My former school had PreK to 2^nd grade and my present school is 3rd and 4^th grades. I see so many students in my small 3^rd and 4^th grade school of 176. The incontinence issues are far less than kindergarten, but the visits for “tiny things” seem to be more. Some teachers send their students for anything, and there are some teachers that say “no” to students when they ask to see the nurse and they tell me that they say “no” many times until they can’t take it anymore and finally send them. They tell me that they finally give in as they need someone else to tell them “no”. It is a problem and I too wonder if there is a solution to keep frequent fliers away. I do understand the teachers, as they have been burnt by parents. They say “no” to student and then that student goes home and vomits and the parent then complains to the principal that the teacher would not let them go see the nurse. So, many of the teachers have been reprimanded by parents, so they send students for just the asking.

It is a problem. I try to teach the kids that bruises and scrapes do hurt and that they will continue to hurt until they are healed – as this is the healing process. I have managed to cure some frequent flyers, while many are sill persistent and “try” to be sent home daily. I also tell them the school policy that I can not send students home unless there is evidence of a temp or if vomiting. (Of course there are exceptions, but for the frequent fliers I feel like I am a broken record). Another tick is to keep them sitting in the office until they begin to fool around, proving to me that they are feeling just grand, or get so bored that they beg to go back to class. If anyone has other suggestions I too would love to learn.

fetch, BSN, RN · Mar 24, 2014

On average, I have 45-50 encounters every day and have 480 students. That number does not include my scheduled medication visits.

Yikes! I have a similar size school, PK-5, and on average I see 20-25 kids (not including meds). Although at the start of the year it was usually 30+!

For teachers who won't give out bandaids -- I gave out baggies of them at the start of the year, but if someone "forgets" I send the student back with another baggie and a nice note. Most of them got the hint for that, and my "tiny scratch NEEDS a bandaid!" dropped significantly.

For those who get off the bus and go straight to the clinic, I started a policy that they HAVE to go to class first and get a note from the teacher (most of whom won't let them in their classrooms until 30 mins after the front doors open, so a lot of the kids forget). Of course there's exceptions - the kids who start vomiting in front of teachers when they get off the bus, or the ones who fall and are crying in breakfast, or bleeding (had one of these this morning in fact!). Everyone else I ask "what's up?" and if it's general malaise I tell them to try using the bathroom and then go to class.

For the "I bumped my leg two days ago can I get ice" kids, it depends on the child. For the really little ones, sometimes a sticker will make it all better, and sometimes they get a bandaid to cover the bruise. For the older kids (usually 3-5, but depends on the child's maturity) I'll explain to them that ice is only good right at first, and keeping ice on muscles can actually make them feel stiffer and hurt more. If it's soreness or general blah, I'll do some full-body stretches and deep breathing along with them, and end in "shaking it out," which usually makes them smile and feel more like going to class.

I have a few frequent flyers for falling on playground, etc: those guys get an assessment, and if I don't see/feel anything obvious, they go back to class without anything. When they do have swelling/a scratch, they get the appropriate treatment. Most of them have learned that it's not worth the bother to walk all the way down here with a badly faked limp when I'm just going to send them right back.

Hope some of those tips help!

JenTheSchoolRN, BSN, RN · Mar 24, 2014

I manage ~450 kids, grades 7-12, and I was curious, so ran a report through my EHR. I average about 25 visits a day, plus 13 medication visits. Given how ragged and busy I've been, I felt like I'd seen more. Then I realized this month (March in general I'd been told), I'm averaging 35+. Busiest days are always Mondays and Fridays.

I'm new this year, but been trying to train the teachers on gauging visits, though if they are on the fence, I let 'em send my way. Half my visits, I feel, are really mental health break related - a lot of stressed, overworked children and several children on IEPs or 504s that often need a 3 minute "breather" in my office. Of course, it can very hard to deal with those kids when the actually sick, vomiting child is in your office and you are trying to call home to get them picked up. I do not have a large office.

fetch, BSN, RN · Mar 24, 2014

Half my visits, I feel, are really mental health break related - a lot of stressed, overworked children and several children on IEPs or 504s that often need a 3 minute "breather" in my office. Of course, it can very hard to deal with those kids when the actually sick, vomiting child is in your office and you are trying to call home to get them picked up. I do not have a large office.

Yes! One of my frequent flyers really just needs a short break with some quiet, usually after lunch -- the volume in the cafeteria gets her upset and she just needs to chill out for a while, then she'll be back in class and good to go. It took a few months to realize that was all she needed though. "Next year will be better" is my mantra!

SnowyJ, RN · Mar 24, 2014

There are 600 children in my school and I see anywhere from 25-55 students a day. I do not count minor things like band aids for a paper cut, etc. in that count.

My main issue is staff sending children for EVERYTHING. The kids have also learned that saying they have a sore throat or feel nauseous will get them out of the classroom REALLY quickly. It's been a bad winter and the staff really want to avoid illness.

That said, MAYBE 10% of the kids I see are legitimately sick or injured. The rest just want a break. And some need it. We have an incredible amount of children with emotional issues. Often I feel more like a counselor than a nurse. But that has value.

NutmeggeRN, BSN · Mar 26, 2014

I log every visit, telephone call, meeting with parent or teacher, time spent working on 504 plans etc. Somedays I may only "see" 30 kids, but I have "worked on, with or for" another 15 or 20. I think it is important to document that time as it specifically related to our kids. It may be nothing more than a quick note (s/w Mrs. so and so re need to get physical for sports). It justifies my time and it also provides a digital trail. Obviously the notes are more dertailed when warranted.