I don't do well under pressure. Pls help

BunnyBunnyBSNRN, ASN, BSN · Dec 11, 2018

First, you need to breath. I remember my first year, I was completely overwhelmed and so unsure of myself. Who am I kidding, I am still unsure of myself 98% of the time!

Take it one kid at a time. If you have two (or three or ten) kids, have them have a seat and triage - remember airway is always first! Take them in order of importance and chart as you go. At the end of the day, as long as noone died, you're good. (I realize that sounds flippant, but there is some truth to it.)

You will learn and gain confidence as you go.

JenTheSchoolRN, BSN, RN · Dec 11, 2018

When a kid enters, I tell them how many students are ahead of them and to take a seat unless a glance up and with my quick visual scan I see they are more urgent. A kid may say "but I just need-" and I'll shake my head and point to a chair. And during this time I'm doing a quick visual scan to make sure they can wait.

Remember that half of the assessment we do is really when we take a actual glance up and down at the kid - the way they stand, mood, expression, etc. Sometimes this tells me more than vital signs do. And you can fine tune that glance up and down. I still am and I'm not new to the game :).

Guests · Dec 11, 2018

Just remember there is only one of you. You have to trust your triage skills and prioritize and everyone else has to be patient. I just had this scenario in the last hour. I had a student in here with a stomach ache and a teacher runs into my office in a panic because a student "threw up". Kid looked a little pale and glassy-eyed, but otherwise stable. I told them to have a seat in front of the trash can and I would be right with them. Teacher was like "but she just THREW UP". I said "I understand that and I will be right there". So teacher leaves. Finish with stomach ache kid and bring throw up kid into my office to get actual VS on. In comes a sore throat kid. I tell her she needs to wait. Throw up kid starts throwing up again. In walks another throwing up kid. I send sore throat kid back to class and tell her to come back later. Then in walks kid in the middle of an asthma attack. So trowing up kids had to wait while I dealt with him. It's always a juggling act when there are more than a couple of kids. Take a deep breath. 99% of what we see is not emergent, and even the emergent ones are not true medical emergencies, thank god. Teachers and students think everything is an emergency, LOL . If possible, try to tune out the other students if that is what is flustering you. Hang in there- you will get used to it.

OldDude · Dec 11, 2018

All excellent advice...just remember, you're the only one worrying about it.

Flare, ASN, BSN · Dec 11, 2018

Triage is key. I find that these kids just come up on me and expect to be seen and serviced NOW. But, they have to remember that if they were in a doctors office or even and ER they would have a wait so they 3 or 4 minutes they have to wait for me to free up is nothing compared to the "real world". These kids don't have the skill of waiting and patience. I try to teach just a little of that.

Eleven011 · Dec 11, 2018

Its rare that I get an actual emergent kid (throwing up is NOT emergent in my book), so I actually triage backwards most days. If I start to get backed up with kids lined up, I'll say to all of them "who here just needs a bandaid or ice pack or other such quick thing". Usually that weeds out half of them in 1-2 minutes and I don't have a kid waiting 15 min to get a bandaid on their hangnail. Then I'll quickly ask what each of them need and take one at a time and ask the others to wait outside. I think the most important thing (other than of course treat the emergencies) is to NOT have them all in your office staring at you. Have the majority wait outside and call them in when your ready.

Flare, ASN, BSN · Dec 11, 2018

i do that as well sometimes. i sometimes stop and ask what kids need -if it's quick, self serve like band aid, ice pack, etc then it's a quick point and back to the 5 minute story about the stomach ache that's been going on for 4 days.

SaltineQueen · Dec 11, 2018

What is it that stresses you out? Just the sheer number of kids? Are you concerned that teachers may criticize how long they're out of class? As others have said...there's only one of you. Triage and then go in order of importance. If they're all minor things go in order of arrival. I have 2 beds. Threre have been times where I have a kid in each bed, someone in the bathroom, a kid in a folding chair in the clinic and kids sitting out in the office waiting. It all worrks out in the end.

ruby_jane, BSN, RN · Dec 11, 2018

Its rare that I get an actual emergent kid (throwing up is NOT emergent in my book), so I actually triage backwards most days. If I start to get backed up with kids lined up, I'll say to all of them "who here just needs a bandaid or ice pack or other such quick thing". Usually that weeds out half of them in 1-2 minutes and I don't have a kid waiting 15 min to get a bandaid on their hangnail. Then I'll quickly ask what each of them need and take one at a time and ask the others to wait outside. I think the most important thing (other than of course treat the emergencies) is to NOT have them all in your office staring at you. Have the majority wait outside and call them in when your ready.

That!! Vomit is not an emergency. I wish Davey Do would make me a meme....

EnoughWithTheIce · Dec 11, 2018

Triage is key. I find that these kids just come up on me and expect to be seen and serviced NOW. But, they have to remember that if they were in a doctors office or even and ER they would have a wait so they 3 or 4 minutes they have to wait for me to free up is nothing compared to the "real world". These kids don't have the skill of waiting and patience. I try to teach just a little of that.

Same here!!! I ask them this question - "When you go see your doctor, do you have to wait to be called back? Do you interrupt the doctor when he/she is with another patient?" Well, then I expect you to have the same respect in my office.

Problem is, the staff is such a bad example. I had a coach get between me and a parent this morning because he wanted ice for a student that jammed her finger 3 days ago. I told him it could wait, not emergency.

nursekoll, BSN, RN · Dec 11, 2018

I don't like it when I have more than one at a time either. I feel like it violates any confidentiality of the student I'm focused on. Also, especially in the younger kids, they seem to "absorb" one another's symptoms. Kid #1 has a stomachache, and ends up with a peppermint, then kid #2 adds a "stomachache" to his initial complaint of cough so he can get one too. Kid #3 with a headache, starts coughing because he heard kid #2 coughing, etc. I find it's best to ask a quick "What are you here for today" and then have them wait outside the door on chairs, so there is some privacy and I can focus on each one individually. If they just want a band-aid, I either hand them one or tell them their teacher has band-aids. If teachers or aids accompany the kids, I hand them the thermometer if all they want is a temp check.