I made a mistake... anyone left?

[JerseyTomatoMDCrab]

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!

[MaltyChick]

I'm new to school nursing and also find deciding when to call home the most difficult part of this job. I think your assessment was spot on and your findings all negative, besides the minor abrasion you bandaged. I would have done the same thing. I got burned a little last month with a kid with a hand injury. Assessment normal aside from some swelling at thumb knuckle, gave ice pack and sent him back to class. The next day I have admin calling me because mom called very POd because his thumb was fractured. I should have called since there was a possibilit of fx. And as I was typing this a girl comes in saying, "my hand is broken"!! It had no signs of a fx let alone injury! I did phone mom to inform of my assessment and her complaint. It can't hurt to call.

[MaltyChick]

I always say kids are poor historians and getting their hx out of them is like a maddening game of Blues Clues!!

[Kittery]

A few weeks ago I sent a student back to class with an ice pack after he got kicked in the foot. No swelling, full ROM. Came back with 2 fractures and a cast. Not only that, I didn't even remember that I had seen him for the injury (thank goodness I documented it. Must've been a whirlwind day ...) I'm still feeling bad about it. You're not alone!

[Kittery]

I also didn't call on it. If parents were upset, I haven't heard about it yet ...

[JerseyTomatoMDCrab, BSN]

A few weeks ago I sent a student back to class with an ice pack after he got kicked in the foot. No swelling, full ROM. Came back with 2 fractures and a cast. Not only that, I didn't even remember that I had seen him for the injury (thank goodness I documented it. Must've been a whirlwind day ...) I'm still feeling bad about it. You're not alone!

Like some PPs have said, if we called for every single thing, we would be on the phone all day!!!

[bell1962]

you did fine.

[BeckyESRN]

I had one last year that a mom was very upset over: 2nd grader said that she got hit in the arm by an empty swing, no swelling, no bruising, no redness, full ROM. Ice and back to class. She returned later (as was her well-established pattern) for more ice c/o of "soreness" again, but this time it was the opposite arm:sarcastic: ice and back to class. Mom calls the next day screaming at me because I should have called her. As it turns out, girl went home, went to gymnastics, then before bed c/o arm pain from jumping off the swing and catching herself with her arm extended. Mom demanded to be called for every injury, which meant that I called her at least 3 times daily for 2 weeks until she apologized and said I could stop:)

It sucks when this happens though. We always want to be able to recognize everything that walks through our door. I've caught a few fx and missed a few. We can only so much. Sounds like your assessment was spot on, but things changed later. There is no way to anticipate that!

[cynmrn]

I definitely understand the feeling--this has happened to me a few times and each time, I've felt just as terrible and second-guessed my judgment. I'm glad the parent was understanding--I've had the opposite more often than not. Sometimes, the signs really don't show up until much later. You did everything right with assessing him and encouraging him to return if he was still in pain later. If we called home for every fall off the bars, we would never get anything else done. Don't be too hard on yourself! You don't have x-ray vision!

[Kooky Korky, BSN, RN]

I guess I have always tried to err on the side of caution. I believe I would have called Mom just to inform her of the fall/seems alright/keep an eye on it/. Yes, it takes time, but it avoids the Mom in my office the next day looking grim.

You know for next time.

[JenTheSchoolRN, BSN, RN]

I always say kids are poor historians and getting their hx out of them is like a maddening game of Blues Clues!!

It is no different with teenagers or adults! I get teens that hide things all the time - especially concussion symptoms. I have referred out 6 (!) students after they ended up in my office this year complaining of a headache, only after a long round of questions to discover they hit their head recently and told no one because [insert want to do/go something they knew they wouldn't be able to do if they told someone]. All 6 were diagnosed with a concussion.

Broken bones are hard to predict. Kids compensate so well. I don't have an x-ray machine. On the flip side of things, I have parents that send me children that fell over the weekend on Monday, kid telling me that parent/guardian said "I should go to the nurse to see if it broken." I call that parent up and tell them I cannot diagnose a broken bone, my assessment and findings 9/10 telling them to pick up their child and take in for an x-ray. Most are not happy.

OP, I would have done the same thing with your findings. It happens to all of us. I don't have time to call every parent either!

[JerseyTomatoMDCrab, BSN]

Update!

Student came to school this AM with no sling or soft wrap and no cast. He says he took the wrap off over the weekend (with mom's help) and went to the carnival on Saturday night. Arm is totally WNL, no pain. Mom called, says student was playing on monkey bars (of all things!) yesterday and has no pain. Mom says student is permitted to participate in PE and recess.

So...

I don't feel bad anymore. That is all.

[bsyrn, ASN, RN]

My school is pretty strict. Anytime a student gets hurt at school I call home. It's a blessing and a curse. Don't feel bad, you did all the right things!