Inappropriate to ask teachers to stop sending kids after a certain time?

OyWithThePoodles, RN · Jan 19, 2018

I wouldn't placate the kid. No fever or vomiting with 30 minutes left in the day, you don't get to lay down, you go straight back to class. The kids (and teachers) may see that you are letting them lay and rest for the remainder of the day and are getting in a habit of doing so. Nip it in the bud.

I would be careful sending an email asking them not to send kids, if something happens they could use it to throw you right under that big yellow bus.

Flare, ASN, BSN · Jan 19, 2018

agree. i am careful about telling teachers not to send kids since that headache may be a raging fever - i check. if it's nothing quick drink and on your way - or better yet, "hit up the fountain for a nice long drink on your way back and tell someone when you get home if it's still bothering you." I get enough calls from irate parents that get their kids coming home with fevers that I haven't seen at all that day, why give them ammunition by putting a limit? I do think it's odd when a teacher sends a child a 5 minutes to dismissal on a friday for a temp check, especially when the kid looks at me perplexed and says they feel fine. But this is why they pay me the big bucks :roflmao:

OldDude · Jan 19, 2018

Oy and Flare give good advice...definitely don't send an email. It could lead to all kinds of ammo to be fired back at you. However frustrating it is, and I totally know how much BS most of it is, it's your lot in the school nurse life to make sure every one of those little darlings are ok while under "your" (school's) care.

One thing you can do is to "hold" the late visitors in your clinic and call the parent to come inside to pick them up or call and get specific approval to allow them to leave...all in the name of your concern for them feeling bad and your concern for them leaving school safely. Sometimes, the parents put a stop to this. Otherwise, smile and wave...

ruby_jane, BSN, RN · Jan 19, 2018

Scorched, you're in my head! I said that very thing yesterday as I saw a parade of "it hurt all day but..."

I do very little for someone who comes in the last 30 minutes of the day. Assess, let them rest, give them water, call a parent. If you feel that it's one particular teacher, I would have a pleasant conversation with him/her in person (leave no trace) and ask what, if anything, they think you can do for sweet baby at dismissal time? I run up against teachers who say "well s/he is just sitting with his/her head down." Aaaaand...that's a behavior issue if there's nothing medically wrong and I send them back.

Amethya · Jan 19, 2018

Exactly what Flare and OldDude said, don't send the email. Teachers tend to either over think emails or do things in spite, so if you tell them this, they will try to make your life worse.

I had this happen, but not for this reason. I made a spreadsheet for teachers to post what they need, i.e clinic passes, bandaids. The problem was they kept sending students to get stuff and it was getting a bit ridiculous. So I sent an email asking them to just fill it out and not send students. One of the teachers decided to be sassy with me and asked me to bring clinic passes to two rooms because he rotates because I asked him not to send any more students. I just smiled at him and left him two packs in each location and did what I was asked, he probably thought I would get angry or something, but nope. I still get some orders here in there on the spreadsheet, but sometimes they just send students for stuff.

What I do if I get someone at the end of the day, if they have a fever, then they stay in my room until dismissal and I inform parents. Nothing bad, then I just send them back and call parents when they left to let them know. Lots of my parents just tell them to go back to class because it's the end of the day and they can't come get them. We do have a no pick up the last 30 mins of school policy, UNLESS dictated by nurse. So there's that too.

denstar · Jan 19, 2018

I think that sometimes (and I'm not being sarcastic, I literally mean just sometimes), teachers send the kids at the end of the day if they are still complaining so that the kids don't go home and say they felt unwell and the teacher didn't do anything. This way the teacher can say, well I sent them to the nurse. Do most of your kids ride the bus? The kids at my school all get picked up (we're private-no bus service), and by 3pm, whoever is picking the student up is on the way and will probably get to school at about dismissal time anyway, so sending to my office after 3pm isn't really going to get the kid home any faster.

Also, do you have to take vitals on every student that comes in? I take temperatures very frequently, but only bp/pulse on occasion (and typically not for a mild stomach ache/headache without other symptoms).

ruby_jane, BSN, RN · Jan 19, 2018

Also, do you have to take vitals on every student that comes in? I take temperatures very frequently, but only bp/pulse on occasion (and typically not for a mild stomach ache/headache without other symptoms).

Everyone with "dizziness" or "chest pain" - full set of vitals, no matter what the time of day. But by the end of the day if it's not new onset, I'm more inclined to take extra vitals only if a parent is on the way to pick the student up. Because...they've survived all day.

WineRN · Jan 19, 2018

In our staff handbook there is a little paragraph with expectations for the nurse's office, and one of them is not to send kids in the first hour of the day unless they are seriously ill or injured because their parent's obviously wanted them here, or in the last hour because they will be home soon.

no one follows this.

I agree with everything above. I would make your office a revolving door at the end of the day. No sitting, no laying, just a temp check and back to class. I like to write on the end of the day passes "S/He will make it to dismissal" as a reminder for the teacher to what time it is.

JenTheSchoolRN, BSN, RN · Jan 19, 2018

Everyone with "dizziness" or "chest pain" - full set of vitals, no matter what the time of day. But by the end of the day if it's not new onset, I'm more inclined to take extra vitals only if a parent is on the way to pick the student up. Because...they've survived all day.

For me - chest pain, yes. But dizziness is a very common complaint and one I've seen so many of my MS kids use to get out of class as they know if they say it the teacher will always write the pass.

I start with some water and do my visual assessment to see if I need to get my BP cuff out. I've had dizziness resolve very often with water and rest within 5 minutes, especially when throughout this time the student is active, getting up and touching things on desk, and trying to engage in a conversation with me.

Dizziness in a non-FF can be a different story, though. (I also see dizziness as a frequent complaint with severe anxiety - there I do follow-up with a BP as it is a tool to assure my student and gives me a moment to help them calm themselves in a private space. Often BP is slightly elevated, but not alarmingly so)

SchoolNurseTXstyle · Jan 19, 2018

I agree about NOT putting that in writing. The key is to assess quickly and only keep them in clinic if absolutely necessary. I do this at both ends of the day as I get a mad rush as soon as 1st period starts also, straight from their mom's car. And sometimes, it is an actual fever so despite the silliness - at least we catch those.

Yesterday, I was a little irked that the basketball coach sent me a kid at 3:57. School lets out at 3:30 and I leave at 4:00 so this was an after school activity. And it was for cold symptoms. Nobody had he common sense to have student call mom and see if she could pick up early since practice ends at 5:15. Which is all I did after taking a temp. Kid had the cold 2-3 days already so it was not even new onset.

But, I was still here and it was within my contract time, so............................................

LikeTheDeadSea, MSN, RN · Jan 19, 2018

I sent an e-mail, after discussing it with admin and other nurses in my district. I specifically didn't say "No/limit visits"

I said something along the lines of:

FYI, No medication is given within 30 minutes of dismissal due to being unable to monitor the condition of a student post-administration. This includes cough drops, which become a choking hazard during transport.

This was more so to address the "my teacher said you could give me a cough drop/Tylenol"