I made a mistake... anyone left?

[JerseyTomatoMDCrab, BSN]

I made a mistake yesterday and now I need to talk it out with whoever is left.

One of my kiddos came in yesterday saying he fell off the monkey bars onto some grass earlier in the day, landing on his R side and arm. Full ROM in the arm, positive pulses, capillary refill

This morning, he and mom are in my office. R arm is in a soft cast. Mom said they are following up with orthopedist to determine if it's a fracture or a sprain. The arm swelled up last night so mom took him to urgent care. Turns out, the student didn't fall right from the bars, he jumped from the platform and tried to grab one of the further bars and fell from there. He also didn't tell mom that he fell when he got home because he had a basketball game last night and he didn't want to miss it. It broke my heart because HE kept apologizing to ME for not telling me "the whole story" when he was here. Poor kid.

Anyway, I told mom my assessment from yesterday and apologized for not calling home. She didn't seem angry or upset but I still feel terrible. Determining when to call home has been one of the steepest parts of the learning curve for me since taking this job. It didn't even occur to me to call, he really seemed okay to me. I usually call if there's even any doubt. Anyway, the principal followed up with mom after she left my office and said mom was fine with everything which made me feel better but I am still sad and feel guilty.

I just wanted to sound off to you guys. Sorry this is so long. All my posts are too long!

[DEgalRN]

I absolutely understand the feeling! It's so hard to know when to call and when not to. And every parent is different in when they want to be notified about something!

You did the best you could with the information you had. It's all we can really do in our jobs. We don't have x-rays or labs, rapid strep tests, or antibiotics. We don't have providers who can diagnose or prescribe! (Except for those few luckys who have good wellness centers on site!)

Everything we do is a learning experience. You did a great job!

[JerseyTomatoMDCrab, BSN]

DEgalRN- Learning experience is right! I told a student once that I learn more than the students at my job. She thought I was crazy, of course. Thank you for reassuring me. It's just such a tough call sometimes!

[Farawyn]

Agree with DEgal. Since you couldn't whip out your Xray machine you only have assessment, both subjective and objective. Both can change.

Don't beat yourself up. Your follow through was impeccable.

[RatherBHiking, BSN, RN]

Don't feel bad. It's happened to me as well. It doesn't seem serious esp after the assessment and you tell them to come back if it get worse and 9 x's out of 10 that's the end of it. The kid was old enough to tell mom his arm was starting to swell and why so she could get it looked at. We aren't an urgent care clinic and we don't have x-ray vision. You did everything right. I don't have time to call about every single fall from the playground and I'm guessing neither do you. I made up a blank form note for injuries due to this reason. It basically says "your child _____, was injured at school today by _________. It did not seem serious at the time and a treatment of ice and/or bandaids were provided but if any pain, bruising, swelling, etc gets worse or bad enough to interfere with normal activity please follow up with a dr. " I've had to remind parents that even dr's can't always tell without an xray if something is broke so if they are coming concerned or worried in any way to just get it checked. That way even if it's a sprain they can get a dr's excuse to not play gym or other activity restrictions. You said the mom wasn't mad so don't beat youself up. (Even if she was mad you'd have no reason to beat yourself up.) You did nothing wrong and is was beyond your capabilities to diagnose. The kid was old enough to tell mom what happened if it got worse so no harm done. Have a good summer!

[Flare, ASN, BSN]

That's one of the biggest barriers in this job - incomplete info from the kiddos, especially when the kids have a master plan. Don't dwell upon it. The student perhaps was really trying to tough it out to get to their game and may have been afraid that a call from you would have foiled their plan. I've been in the same situation before.

[SchoolNurseTXstyle]

I probably would not have done anything different myself and I have been doing this 10 years now!! We are not an ER. Like someone else we do the best we can with what we got and that is very little. Also, 90% of how ANY MEDICAL PROVIDER makes a decision on how to move forward is based on history. And here we getting convoluted half stories from kids..... C'MON NOW, stop beating yourself up over this!!

[JerseyTomatoMDCrab, BSN]

You guys are so wonderful! I feel better already.

[SnowyJ, RN]

Don't feel bad, I have been there too.

When you don't get the whole story, it is hard to fully assess the situation.

[NutmeggeRN, BSN]

Seriously, you did just what all of us would do. I HATE when they are not honest, especially when it comes to head injuries. It is so frustrating!!! And anyway, who knows what ELSE may have happened that no one else is aware of!

[Jedrnurse, BSN, RN]

This is sort of a rite of passage. Mine involved a kid in a sped class whom staff said "was complaining of leg pain." Didn't see anything particularly out of sorts, kiddo was non-verbal with me, so I didn't call home. Turned out the staff neglected to tell me he fell prior to this- sort of an important detail, yes?

Fx tibia, casted for 6 weeks.

Ugh.

[GdBSN, RN]

You didn't make a mistake, you assessed the situation and symptoms with what you were presented. We could spend all day second guessing ourselves, but that wouldn't change anything. This student didn't give you all the facts, or even tell his parents what happened. Parents have to understand (as it sounded like this one did) we have limited resources and work with what we are told and presenting symptoms.