How to spot fakers and send them to class quickly?

WineRN · Jan 8, 2018

15 mins IS a long time and a lot of missed instruction time.

I feel like the more you know your students the easier it is to spot fakers. And use your teachers too. When I notice a lot from a certain grade level I pop by the class to see what they are doing (is it math test day?).

My average visit length is 3 mins.

I can't fix a cough, so it's salt water gargle and back to class. I can't fix a runny nose, so it's a little TLC vaseline under the red nostril and back to class. I can't fix a headache so it's just 5-10 mins of laying down with water (unless you are one of my migraine kiddos) and then back to class. I can't fix body aches, so if there is no fever, you are learning to tough it out in class. Lots of little ones don't understand the difference between discomfort and pain, and I feel like it's a part of our jobs to teach them. Maybe that makes me a big meanie.

I've said it before, I HATE that they make you call for every visit (Ain't nobody got time for that). But honestly I don't think the parents will complain. If you have a frequent flier, imagine how she/he is at home, the parents would probably respect the fact that you are trying to get them back in class.

ruby_jane, BSN, RN · Jan 8, 2018

1. Stop entertaining them. You're busy. No coloring books. Lie there and get to feeling better. No cel phones (oh wait...that's my age group). Therapeutic boredom.

2. If they're staying more than 15 minutes, are they going home? Or is it because parent can't be reached?

If it's the former, can they safely wait at the attendance office? If it's the latter, and the student has no fever and is not throwing up in front of me, I document all that I did and send them back to class. Then when the parent does call, you can say what you did.

3. If it's a band aid and back to class (salt water gargle and back to class) - call those parents later.

Amethya · Jan 8, 2018

1. Stop entertaining them. You're busy. No coloring books. Lie there and get to feeling better. No cel phones (oh wait...that's my age group). Therapeutic boredom.
2. If they're staying more than 15 minutes, are they going home? Or is it because parent can't be reached?
If it's the former, can they safely wait at the attendance office? If it's the latter, and the student has no fever and is not throwing up in front of me, I document all that I did and send them back to class. Then when the parent does call, you can say what you did.
3. If it's a band aid and back to class (salt water gargle and back to class) - call those parents later.

Last week I had a lot of them going home for fevers, waiting for their parents. We don't have a. Attendance office, so all I can do is have them in my office. I let them lay down if they have headaches or fevers, but that's it. Mostly I get kids for small things and I just do what I do then send them back and call parents later. I'll try to reduce my time with them.

I have books and colors, but I don't let them yes them unless they are going home.

girliegirlRN · Jan 8, 2018

It might be a matter of needing to educate the teachers on what does and does not necessitate a clinic visit. And the fact that you have to call every. single. parent. of every. single. student. who comes in your office, is ridiculous. Speaking for myself, there is no way on God's green earth that I have time to call 30+ parents every day to let them know that Johnny and/or Suzy came in to see me for something that wasn't even noteworthy. Not unless, of course, admin would prefer me abandon my other job duties such as screenings, maintaining up-to-date shot records and health files, coordinating care for my chronically ill children, handing out daily meds, etc.

WineRN · Jan 8, 2018

Last week I had a lot of them going home for fevers, waiting for their parents. We don't have a. Attendance office, so all I can do is have them in my office. I let them lay down if they have headaches or fevers, but that's it. Mostly I get kids for small things and I just do what I do then send them back and call parents later. I'll try to reduce my time with them.
I have books and colors, but I don't let them yes them unless they are going home.

Do you have time in and out sheets that you can look at to see which little ones are taking up the most time? Anyone being checked out via me has to stay in my office (my front office has made it clear that NO ONE is to wait there except for emergencies). As long as you are moving the small things out quickly, that's all you can do. With that data in hand I would talk to my AP again and explain that besides kids waiting to leave you are moving them in and out as fast as you can

Amethya · Jan 9, 2018

I did check and what I saw mostly is that I tend to keep kids in my office just to talk to their parents. Not them, I mean me. So I'm planning to do is if it's nothing major and they don't answer, then I'll just leave a message and send the kid back to class.

If it's something I do have to call parents for immediately, then yes the child will have to wait.

The reason I have to call is because I'm not a nurse and I can't make calls for anything, especially how parents are.

JenTheSchoolRN, BSN, RN · Jan 9, 2018

I did check and what I saw mostly is that I tend to keep kids in my office just to talk to their parents. Not them, I mean me. So I'm planning to do is if it's nothing major and they don't answer, then I'll just leave a message and send the kid back to class.
If it's something I do have to call parents for immediately, then yes the child will have to wait.
The reason I have to call is because I'm not a nurse and I can't make calls for anything, especially how parents are.

This is a good idea. Often if I have to make a FYI parent call (or a quick check-in) for a student and I hit VM when student is with me, I sign their pass and let them return to class. I can find a student and call them back to my office if needed and I tell the student exactly what I will be telling their parents. (But of course, I work with the older students and honesty is golden rule in my office.)

And yes to boredom. The only coloring sheets I have are for one of my severe anxiety students and that student does get a timer with them. I have also allowed private journaling for other students with anxiety to re-focus, but again a timer on it. Other times I've observed a kid for 5 minutes out of the corner of my eye as I do other work - they get bored quickly and there is no cell phone use in my office unless I've given permission for a student to use so we can contact a parent that won't pick up my phone calls. Unsurprisingly after 5 minutes, sometimes even 3, I'll sign their pass, hand it back to them and they'll return to class pretty easily.

SaltineQueen · Jan 9, 2018

I agree it sounds a lot like you need to clarify what should come to you with teachers. Can you give them all a big box of bandaids for the minor things? Coughs? Get a drink, deal with it (can you give cough drops?). I've got one right now & I'm managing to make it through my day.

Don't think of it as being heartless, think of it as teaching them that they can push through the minor things. I don't remember your age group. But even I talk with my K-3 frequent fliers that sometimes we just need to do our best to push through.

If someone comes to me who is on the verge...slightly elevated temp, just not looking well...those are the kids I am more likely to let rest a bit longer. If a temp recheck shows still WNL, back to class they go.

Can you come up with a note to go home instead of a call to every parent? That's got to take up a lot of your time.

AdobeRN · Jan 9, 2018

I am a meany - haha....No laying down unless it is an unusual circumstance or they are waiting to go home or returned call from parent. No books, ipads, coloring etc unless they are are again waiting for pickup or need to hang in my office due to medication or neb treatments - if they can read, play with ipad etc they can go back to class to do their work. I have a couple of chairs - if students need to "rest" for a few minutes ( I get it - sometimes we need to walk away from our work for a few minutes too) they can sit and relax quietly in a chair - I have an egg timer I use for the frequent flyers - after 3 minutes they go back to class.

My average visit is also under 3-5 minutes - give them what they need and send back to class.

My opinion it is just plain waste of time to call every single parent for every single thing - but hey I get it, you gotta do what admin asks of you. My kinders are high maintenence - teachers and majority of parents - I send home an email or I use a little note I made up up that I check a box for the visit and check a box for treatment & there is space to write a little something if needed - this little note has worked for the last few years for me, at the end of the day I deliver them to the teachers and they put them in the kids folders that go home everyday.

Flare, ASN, BSN · Jan 9, 2018

Why would the kids consider you entertaining? I can understand colouring books if they are waiting to a point, and I do have some in my office, but i use them sparingly. I tend to have my waiters sit and do their homework or read their language arts books. If they say they have no homework or no book, I sometimes call their class and see if they can get work they are missing or will miss.

As far as calling after every visit- I suppose i get their policy due to your title, but speaking as a parent, i would be annoyed to get a call that my child was seen for a minor cut or because she came in for a pad or whatever. I suppose there are parents that adore this level of communication, but i find it a tremendous waste of everyone's time. But i get it - not your policy - not your fight.

WineRN · Jan 9, 2018

Why would the kids consider you entertaining? .

Because the nurse's office always looks better than that math/writhing/spelling test and/or better than being outside with a bully.