I made a mistake... anyone left?

Posted
by JerseyTomatoMDCrab JerseyTomatoMDCrab, BSN Member Nurse

Specializes in med-surg, IMC, school nursing, NICU. Has 10 years experience.

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MaltyChick

MaltyChick

Specializes in Pediatrics, research, home care, infusio. Has 30 years experience. 19 Posts

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.

Edited by MaltyChick
Typos

MaltyChick

MaltyChick

Specializes in Pediatrics, research, home care, infusio. Has 30 years experience. 19 Posts

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

Kittery

1 Article; 171 Posts

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

1 Article; 171 Posts

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

JerseyTomatoMDCrab, BSN

Specializes in med-surg, IMC, school nursing, NICU. Has 10 years experience. 588 Posts

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

bell1962

Specializes in family practice and school nursing. Has 30 plus years experience. 345 Posts

you did fine.

BeckyESRN

BeckyESRN

1,262 Posts

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

cynmrn

Specializes in School Nursing, Telemetry. Has 2 years experience. 124 Posts

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!

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

Specializes in School nursing. 3,027 Posts

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." :banghead: 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

Specializes in med-surg, IMC, school nursing, NICU. Has 10 years experience. 588 Posts

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

Specializes in Peds, School Nurse, clinical instructor. Has 23 years experience. 810 Posts

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!