I don’t know if I like school nursing

[nursex23, BSN, RN]

Hello! I just started at a middle school and I have mixed feelings about school nursing. I LOVE helping the students that require nursing attention such as the ones with chronic conditions and the ones who have had injuries (so far they’ve been very minor except one possible leg break but ems arrived within minutes). I was surprised by how much my education and prior experience came together for my triaging skills.
Another part I don’t mind is the clerical work however the previous nurse left this office so unorganized it’s taking me forever to reorganize while still entering incoming documents.
The part that I feel would drive me away is the endless nonsense that I get from these kids. They come in packs and ask for things I don’t think warrant a visit to the nurses office. I have a girl who broke an artificial nail last weekend and has come in everyday multiple times a day this week for a bandaid and ice pack for her finger. I keep telling her she should just leave it alone already but she will not leave until I give her something. Endless students come in asking for an ice pack, many even go straight to the freezer and help themselves, and when I ask them what they want an ice pack for many say a headache. I suggest they try drinking more water and try to provide some education on why. Some listen and feel better but most look at me like I’m crazy and won’t leave without an ice pack. I have another girl that comes in everyday for an ice pack, she just goes straight to the freezer and says she has a headache. I’ve tried telling her to have water and lay down for a minute but she began arguing with me that she doesn’t drink water, took an ice pack and left. Am I the crazy one? Do we just give out an ice pack and do nothing else?
Some will tell me that they drink a lot of water throughout the day but they still have a headache and then I see it appropriate to try ice.
It seems like the last nurse would give any student anything they wanted when they walked in and everyone wants to come down just to leave with something.
There’s a bathroom in my office that students are allowed to use per the principal but I don’t like when they do because it’s a small office and I want to give those who need my attention some privacy.
I mostly wanted to vent to people who have experienced what I’m facing. I don’t know if I‘m complaining too much and should just let it go or what I should do.

I also maybe wanted to get some insight into if this is common with high school students as well. I’ve always genuinely liked teenagers and high school is what originally drew me to school nursing. Sorry if I rambled I just have so many emotions because I think I may have found a specialty that I could really enjoy but I dread the way many of these kids think my office is a fun way to get out of class and leave with a little prize.

[dosharn, BSN, RN, EMT-P]

Honestly, that's pretty much the way it is anywhere. After a while, you'll just become "immuned" to it, although there will always be times when something just gets under your skin and makes you want to run your head through a wall. When you have those moments just remind yourself of the work schedule, summers off, etc! If you find yourself still getting frazzled, pick up some PRN med-surg or LTC shifts. That will make you run to the school!

[Nurse2Kids]

This is my second year as a school nurse, and I honestly had no idea how much paperwork would slow me down. The documentation (mostly manual for me) is so time consuming!

As far as the frequent flyer, maybe try a different approach with her. Is the bandage a trophy to get sympathy from her classmates, is she coming numerous times because she just needs someone to care, is she coming at a certain time of day to avoid something or someone. Dig deeper on her. Sometimes that repetitive visit can just be a class avoidance ploy, but other times it can be something more.

I have learned to make "rules" this year. Before they had a school nurse, the students came and got ice packs randomly...no documentation of injuries, etc. I quickly put a stop to that! There's still the occasional student who'll run in the office to quickly grab an ice pack, then run out. Now, they don't get far. When I explain they need to remain in the office with the ice pack for monitoring, etc. they will often change their minds about the extent of their injury.

This group has been great to share with, and learn from!

[shark_nurse14, BSN, RN]

When I get frustrated with what seem like "pointless" visits, I ask myself why they might really be visiting the office...do they really think this problem requires a nurse and I can educate on how they can help themselves? Do they need a break from class, and if so, why? Are they struggling with curriculum? Are they having a hard time sitting still? Is there a social situation going on? Or, are they looking for someone to show them love, compassion, and attention?

I truly believe that every student that comes into my office is in there for a reason, it just may not always be readily apparent.

I find it helpful to be pleasantly honest with my middle schoolers, if I don't think ice will help, I'll tell them and give them a reason. If they are insistent, and sometimes rude about it, I will refuse to give them one and if they have something to say about it, I direct them to the principal to share their concerns (luckily my principal is extremely supportive of my decision making).

I will also make comments like "This is your third headache this week, do you think we should call home about it so they can take you to a doctor?" I find that some kids will say no, and then I will stop seeing them for a while. The kids that say yes, their parents usually help control the unnecessary visits with a single discussion once the student is home.

Last year the number of visits to my office began to rise, with many unnecessary visits, in the winter. I made it a point to go to each lunch and explain to the kids that I am only one person, and I was having X number of visits a day. I reminded them that it's not just helping them that I have to do, but I also have to write about each interaction and it can be time consuming. I made a hard and fast rule that if I saw any student three times in one week, other than daily medications/chronic condition kiddos, I was going to call home. The kids were made aware of this. I also reminded them that "If it's not bleeding, you aren't getting a band-aid", which kids still quote to me regularly ?.

My last strategy I use is referring "frequent flyers" to our guidance counselors. Why is Cindy seeing me three times a day, for what seems like minuscule problems? Maybe your guidance counselor can see if somethings going on.

[NurseBeans, BSN, RN, EMT-B]

UGH--artificial nail nurse visits? Unless it's bleeding, and unless you are in fact a nail technician, that needs to stop now. She has had a week to take care of that at home and hasn't--so the visit is nonsense. Put a stop to that.

In general, any visit that becomes a daily thing, ask what they do at home or are doing at home for their issue. Frequently the answer is "nothing". So "nothing" is what should be continued. Call home and put a stop to it.

In my experience, anything the kids can help themselves to is abused. I keep as much out of their own hands as possible. We do a self-serve band aid, deodorant, pad/tampon station at the front of our office and tell the kids to grab and go. Those get abused a little but I'm never going to tell a kid she can't grab extra pads. Many of them don't have a supply at home.

Similarly, although I never tell someone they aren't having a headache or stomachache, I do frequently say "sometimes there's nothing to be done for this". It's the truth. Do you throw tums at every stomachache you have? Or tylenol at every headache you have? Probably not. They shouldn't either.

As far as refusing to leave without something, that's a behavioral issue and hopefully you have support from admin...the students should never tell you what you will do for them. I have heard more than once as a student was walking out the door "I HATE her!" Oh well. Still have my job ?‍♀️

[NutmeggeRN, BSN]

26 years in and sometimes I dont like it either!! LOL! Im trying to rethink using the expression of FF...there really is usually sonething else going on. They are like onions...ya just gotta keep peeling away, even when it makes you cry!

[SaltineQueen]

I agree that every student comes for a reason. But you need to put a stop to the true nonsense. It's your office now, you need to set boundaries - with everyone...kids, students, and even the principal. No way should kids be helping themselves to ice packs. If you're concerned about privacy with kids using your bathroom you need to communicate that with the principal. It'll get better as you start running things your way, just give it time.

[SandIsMyGlitterRN, BSN, RN]

We all go through these things. I try to lay down some rules with teachers and students. Politely have a meeting with the teachers to discuss what is appropriate to send to the nurse. When all else fails, turn that student away if no treatment is needed and they will get the hint.

[BrisketRN, BSN, RN]

Boundaries are so important, and I agree with much of what the others have said. I'd be very peeved by students helping themselves to things in my office. The only thing I tell them to come in and grab is tampons and pads (we really don't need to have a discussion). With frequent flyers, yes of course try to think if there's something bigger going on--sometimes stomach aches/headaches/tiredness because of something going on at home, sometimes class avoidance, sometimes avoiding peers. If it's something just silly like artificial nails I'll send an email home "Hi Mrs. Miller, I've seen Stacy 3x in my office this week due to a broken artificial nail. I'm always happy to help students with any injury, but I'm worried she's missing out on class time. I'm hoping you could speak to her about handling this in the classroom using bandaids from the first aid kit. If you have any questions please let me know!" Maybe that works better in my area because we're a pricey private school and parents DO NOT like kids avoiding class.

[Flare, ASN, BSN]

It takes a little while to make "your rules" stick. Start with easy things. No pass, get ye back to class. This is easily enforceable, especially with the ms crowd. The other enforcable thing is to make complaints that can wait do just that - wait. If it's your friend with the nail, have har come back during har lunch or recess if they have one. I worked at a ms that didn't have recess, but did have a "free period" where the students were expected to read, catch up on homework, etc and I'd tell the students to return to ice their 3 day old bumps and re-bandaid their invisible boo boos then. 95% of the time they wouldn't return.

[ihavealltheice]

2 hours ago, SaltineQueen said:

I agree that every student comes for a reason. But you need to put a stop to the true nonsense. It's your office now, you need to set boundaries - with everyone...kids, students, and even the principal. No way should kids be helping themselves to ice packs. If you're concerned about privacy with kids using your bathroom you need to communicate that with the principal. It'll get better as you start running things your way, just give it time.

This!!!

My first year, I was walked all over by the students-just like you are now. I was seeing between 70-100 per day. This is NOT normal. My second year, I switched schools and while I'm pretty hard, I typically only see students that need to be seen now.

My suggestions:

Only see students if they've come with a pass from a teacher-so many of those students were coming to me during passing period because they knew I'd have a line, they could miss a chunk of class because they'd have to wait, and get an excused pass from me. I'm still friends with some of my old coworkers, the year after I left, there was a no passing period nurse visit rule, they also set up a google sheet system, teachers will check students in via googlesheet, when the nurse is ready to see them, they'll call into the room-that system cut my 70-100 visits per day down to about 30 per day-in a 1,000+ student school. GENUIS!!!

Email the teachers reasons to visit the nurse (you can find the 7 B's online). Get them on board...make sure they know the longer their student is visiting your office (for stupid reasons), the more class time the student is missing and the more time they have to spend to catch the student up. Make it a convenience for THEM...you're thinking about THEM ?

If you state that treatment is not warranted, end of discussion. Get admin involved if you have to for refusal to go to class. Just the threat of admin will get 99% of their booties moving.

Along the same lines, students do not treat themselves without an assessment by you. The ice is a treatment and it needs to be off limits to students helping themselves. I'd have a talk with them, warn them that you'll write them up or contact administration and if they don't comply, follow through with the write up.

Frequent flyers-try to find out why they're coming so much. Do they have a hard home life? Do they have anxiety? Or are they just being middle schoolers and trying to get out of class? Frequent flyers get a phone call home (hi mom, I'm stating to grow concerned because little darling has visited my office every day this week for xyz). That usually puts a stop to those that are just trying to skip class or you get a little background of what's been happening in little darling's life-to which you can either sympathize or act on to help.

As far as your bathroom, have a discussion with admin that it is for health office purposes only. 1-for privacy 2-for infection control. Does admin really want healthy students/staff members/etc catching something because they "needed" to use your bathroom? Probably not. Also, you wouldn't walk through their office or a teacher's classroom to use something of theirs, would you? I mean, that's just basic courtesy.

It's hard, I know, but once you start laying down the ground rules and following up, you'll have more time to start sorting through that mess of paperwork. The first year is always tough, but you will start to develop a system. Also know that 99% of your visits won't be emergent and some days, you'll feel like a glorified babysitter. BUT, you get all of the coveted time off around the holidays and during the summer-something that everyone fights over in the hospital ?

[scuba nurse, BSN, MSN, RN]

Are these students coming with a pass? Do the teachers know they are coming down this often? I would make sure each student has a pass as well as maybe send an email to the teachers about frequent use of nursing office and what is appropriate. Also, when students come in, have an expectation for them: wait your turn in line, do not touch anything....etc..