I don’t know if I like school nursing

[nursex23]

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.

[Kooky Korky, BSN, RN]

You need to be the one to OK an ice pack, a bandaid, etc.

You are the decision-maker. I know you're new and trying to dig out from under the mess you found upon arrival. But start making some changes, laying down some rules, like you decide who gets an ice pack, who uses your bathroom, etc.

the girl with the nail is interesting. I wonder what's going on with her.

Good luck.

[arlingtonnurse]

I have found most jobs are pretty horrible in nearly every area the first six months or so. You are getting used to the job and the facility/ students and they are getting used to you. A lot will change as everyone adjusts to the new normal. The problems you describe do not sound insurmountable but one of the key remedies will be time and consistency on your part. Give yourself until March/April which is when a lot of schools starting thinking about next year's staffing either way.

[tining, BSN, RN]

Do not pre-make the ice packs for a while.

Pass, pass, pass you MUST have a pass.

Get a teacher speech ready for next staff meeting (I have a power point with cute pictures). I go over timed passes to nurse, 8 B's for office visit, communication - student cannot call home themselves if sick, emergency procedures - "nurse you will need AED . . .", medication - students cannot self medicate or carry their own unless epi/inhaler with MD note, stomach aches and vomiting - not all vomiting = go home, they need to notify you in advance of field trips, elevator/leave early/bathroom passes and the list goes on.

I also do random emailed quizzes with prizes - staff loves this. In fact I had an admin tell me this morning he is anticipating the next one.

Does the nurse have medicine, cough drops for staff and students?

A. Absolutely – come on down!

B. Booooo – No I don’t

Student states they are sick and want to call their parent.

A. Let them call their parent from your class phone or the student’s cell phone

B. Send them to the office to call

C. Send them to the nurse

D. All of the above

May the odds be forever in your favor!

[tining, BSN, RN]

I give rational since some still get answers wrong!

[BrisketRN, BSN, RN]

4 hours ago, tining said:

I also do random emailed quizzes with prizes - staff loves this. In fact I had an admin tell me this morning he is anticipating the next one.

I love this. What do you give for prizes?

[JenTheSchoolRN, BSN, RN]

I also created a "self serve" station for those simple visits. it is on table in front of me, equipped with Pads, tampons, bandaids, alcohol wipes, lip balm packets, cough drops, tissues, cups.

The simple visits haven't stopped per say (teacher turn over in the MS sometimes undos the works I've done previously), but this has helped me A LOT time-wise. I also have quick drop downs for documentation.

I handle a MS and HS. MS visits outnumber HS visits 2:1 and during some days 3:1. And a growing number are behavior related. Is that my realm? Kinda. My MS counselor is only one person, as is my principal and Dean and some days it is all hands on deck and I'm part of that team. I also set guidelines. If I'm feeling you came down because you needed that 3-5 minute break from class to reset? Ok, cool, but 3-5 minutes is what you get. No ifs, ands, or butts.

Also be honest. MS students can handle it. Honesty is the rule in my office. This works. I've had kids see me with a headache and I ask "true headache or short break headache?" And kids will be honest and tell me "break headache."

BUT, I've seen some of my FF MS kiddos develop coping strategies and/or began more independent managing their chronic illness and absolutely shine in HS. And they came back and say hi because it has been forever since they needed me. This might be the most rewarding part of my job. I know when you don't work both you may not see it but it happens.

[nursex23, BSN, RN]

I want to thank you all so much for your replies. The students made me feel like I was mean and crazy for not giving them any little thing that they wanted. A teacher told me that the previous nurse would have about a dozen students at any given time being rowdy. I put a stop to that right away and got tremendous push back at first and quickly got the reputation of being mean - a student actually told me this. Your responses assured me that I was doing things correctly and need to keep it up. I think I'm slowly getting the reputation of being another lame adult that's not going to let them participate in shenanigans. 2 of the students that I stopped from coming in all the time for nonsense came back with real (minor) injuries. I could see the surprise on their face when I didn't send them away and took care of their real complaints. I get WAYY less students with "headaches" and they all assured me that they've had plenty of water and just need a minute or that ice really helps their headaches. I feel like I'm gaining control of the office and I even straightened out all of the paperwork. I feel like school nursing could be my niche. I'm still nervous for bigger emergencies but I'm just going to continue to trust my training and experience. Thank you all so much for your encouragement! I look forward to having more discussions with all of you on this forum in the future!

[JenTheSchoolRN, BSN, RN]

10 minutes ago, nursex23 said:

I want to thank you all so much for your replies. The students made me feel like I was mean and crazy for not giving them any little thing that they wanted. A teacher told me that the previous nurse would have about a dozen students at any given time being rowdy. I put a stop to that right away and got tremendous push back at first and quickly got the reputation of being mean - a student actually told me this. Your responses assured me that I was doing things correctly and need to keep it up. I think I'm slowly getting the reputation of being another lame adult that's not going to let them participate in shenanigans. 2 of the students that I stopped from coming in all the time for nonsense came back with real (minor) injuries. I could see the surprise on their face when I didn't send them away and took care of their real complaints. I get WAYY less students with "headaches" and they all assured me that they've had plenty of water and just need a minute or that ice really helps their headaches. I feel like I'm gaining control of the office and I even straightened out all of the paperwork. I feel like school nursing could be my niche. I'm still nervous for bigger emergencies but I'm just going to continue to trust my training and experience. Thank you all so much for your encouragement! I look forward to having more discussions with all of you on this forum in the future!

I had a MS student that was a FF call me mean. I said, "Yep, I'm mean. I was meanest person when I interviewed for the job and that was why they hired me." Said with a straight face. Student stared at me for a second, then laughed. But after that I was able to be way more firm with this student ;).

[tining, BSN, RN]

18 hours ago, BiscuitRN said:

I love this. What do you give for prizes?

It all started when a doctor's office gave me a dozen Nothing Bundt Cakes. I can't have that around so I did the quiz to get rid of them (I would never spend $ on that). I have bought the movie candy boxes at the dollar store and kolaches. I have 10-12 winners.

[ChristmasNurse]

When I started, I had kids running in to use the bathroom. The custodians even started locking the bathrooms the kids should have been using because the kids would just come to the nurse. I started passive aggressively by just closing the door and keeping it closed throughout the day. If a kid asked, I'd either flat out say no or told them "sick people have been using that and I don't think you want to". A few sweet kids, I even walked down to the hallway bathroom they had access to. It took a little but it worked.

As for all the frequent flyer nonsense visits, demand a pass for each kid and put an end to kids coming from the lunch room. If a para, teacher or administrator asks -- just tell them there were a ton of HIPPA violations going on when you arrived at this job and it needs to stop. You have students with chronic conditions and they are entitled to privacy.

BTW, if you have a mean reputation - then GOOD JOB!!

[Csn2016, BSN]

I swear I made a post very similar to this one when I started school nursing 4 years ago. I was drowning in documentation for the first year because the nurse before had papers for EVERYTHING. It took me a year to create documents I could keep on my computer and a flash drive and then I just print as needed. I cleared out SIX filing cabinets of useless papers, she had records from the 1970s yet, still had a pile of old glass syringes and needles (the type that used to be sterilized), and a ton of information pamphlets from the 1980s.

I did discover a Dunkin Donut gift card for 10$ too...didn't know how to get in touch with the previous nurse so figured it was my payment for cleaning up her mess haha. But I digress...I posted something similar here and took the words of encouragement with me and just worked at it one day at a time until I could find my system. It was impossible to even find a system in the state that the office was in and took me close to 6 months to straighten out (throwing in a maternity leave as well). I averaged about 50-60 kids a day.

Then the next year I had my system figured out, I was ready to hit the ground running, I learned who my frequent fliers were and could address them right from the beginning, I had to start giving tough love. My second year average daily visit was cut in half to about 25-30 kids a day. Each year gets easier, you figure out how your system works and what you need to change. As for the frequent flier ice packs, I make them sit in my office with the ice pack. That really cut down the usage (most of them like to take them back to class and 'play' with them or gain sympathy from peers-- if you remove that equation that eliminates a lot of the unnecessary ice pack visits.)

I also remind them ice packs are used for injuries involving swelling, if I see no swelling then no ice pack is necessary. If I have a student with repeat band aid visits for something so minor I'll give them an extra band aid to keep in their pocket (or better yet I sent a ziplock bag full of band aids to EVERY teacher at the beginning of the year which pretty much eliminated all paper cut/minor scratch injuries that do not require a nurse assessment.

[Kooky Korky, BSN, RN]

On 12/6/2019 at 9:14 AM, Csn2016 said:

I swear I made a post very similar to this one when I started school nursing 4 years ago. I was drowning in documentation for the first year because the nurse before had papers for EVERYTHING. It took me a year to create documents I could keep on my computer and a flash drive and then I just print as needed. I cleared out SIX filing cabinets of useless papers, she had records from the 1970s yet, still had a pile of old glass syringes and needles (the type that used to be sterilized), and a ton of information pamphlets from the 1980s.

I did discover a Dunkin Donut gift card for 10$ too...didn't know how to get in touch with the previous nurse so figured it was my payment for cleaning up her mess haha. But I digress...I posted something similar here and took the words of encouragement with me and just worked at it one day at a time until I could find my system. It was impossible to even find a system in the state that the office was in and took me close to 6 months to straighten out (throwing in a maternity leave as well). I averaged about 50-60 kids a day.

Then the next year I had my system figured out, I was ready to hit the ground running, I learned who my frequent fliers were and could address them right from the beginning, I had to start giving tough love. My second year average daily visit was cut in half to about 25-30 kids a day. Each year gets easier, you figure out how your system works and what you need to change. As for the frequent flier ice packs, I make them sit in my office with the ice pack. That really cut down the usage (most of them like to take them back to class and 'play' with them or gain sympathy from peers-- if you remove that equation that eliminates a lot of the unnecessary ice pack visits.)

I also remind them ice packs are used for injuries involving swelling, if I see no swelling then no ice pack is necessary. If I have a student with repeat band aid visits for something so minor I'll give them an extra band aid to keep in their pocket (or better yet I sent a ziplock bag full of band aids to EVERY teacher at the beginning of the year which pretty much eliminated all paper cut/minor scratch injuries that do not require a nurse assessment.

I am learning a lot here. Thank you all for sharing your knowledge and experience.

Old glass syringes, eh? wow, those sound really old!