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Discussion

Interesting question for school nurses

I just started my first school nurse job at a high school. I have critical care background. Wanted something with less stress! Haha I have a health clerk in my office that assists me with certain things and does a lot of the paperwork side of things, immunization records, etc. The nurse there before me was there for several years. I noticed that the curtains around the exam tables are see through - they're navy but there thin enough you can see through them easily. And I said "let's put in a request for new curtains - For me, I would never feel okay having to undress or pump (for new mothers) behind one of those! And the health clerk said "Oh we don't do naked in here! If a student has a rash or an insect bite or something on there thigh or buttock I tell them to go to the bathroom, take a picture of it, and bring it out to show me." And I told her I found that interesting.. I said "I would have no problem examining something like that on a student with you here in the office with me. As a nurse, I would want to see it with my own eyes to give a proper assessment. And I want the students to feel comfortable and not ashamed." She said "That was just the other nurse's policy. I don't know why but that's what she always said." I'm going to check and see if it is a school policy or something, but have any of you heard of such a thing?? I guess I don't think twice about a patient being naked in front of me, I mean, we're nurses!! What is the policy on this at your school?

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    Of course, I am a guy, and on the elementary level, but I do not do any examinations that would require the removal of clothing from the torso part of the body - unless my initial assessment was the situation was emergent or could lead to an emergency; for instance a kid in from the playground covered with fire ants. I'll have a kid roll up a sleeve or pant leg or remove a sock for various complains but that's about it. Otherwise I contact a parent, report the situation, and invite them to come to school to look at what the student is complaining about. If they ask me to look, and the complaint is above the waist, I'll get a female staff member as a witness. I would never examine genitalia, regardless of parent request, unless I thought it could be an emergency.

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    I do the same as OldDude.

    Except, my nursing office is at the D.O. and I rarely see a student there.

    There are 11 campuses in my District. Two elementary schools, two high school, and then all the special ed and continuations campuses. I roam from place to place and don't have an office at any of the schools.

    I had one child a couple of years ago at an elementary school come to me with scratches on his hands. He had on a long sleeved shirt, long pants. I rolled up his sleeves to get a look at his arms and he was badly bruised. I did end up lifting the back of his shirt after asking his permission and he was badly bruised there too. Called the sheriff and CPS.

    It was child abuse.

    But no, I don't do physical exam for the most part that would entail taking someone's clothes off or looking at "private zones".

    The only emergencies I've come across are asthma exacerbation or diabetic issues. No need to remove clothes then.

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    How many breadtfeeding high schoolers do you have?

    Very few school nurse assessments require disrobing. Even scoliosis screening don't mandate disrobing. School sports physicals don't require disrobing. Students that need toileting assistance or catheterization use the restroom not a curtained area. I don't think sending a student in the bathroom to take a cell phone photo of an issue whether a lump in the buttocks or an itch on the abdomen is the best choice either b

    I could see a private area to discuss personal concerns of high school students.

    The only true genital emergency I can think of (aside from assault and that's beyond school nurse, either police or CPS are needed) is testicular torsion and that requires emergent assessment & intervention by a urologist. Even when I worked ED the triage protocol for suspected torsion was to call urology stat

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    Yeah, I forgot to mention I was wondering about that too . . . .we don't have any breastfeeding teenage moms in my district.

    We don't do scoliosis screening anymore because the state lacks funding for it. However, I do assess if I suspect something. Then just call the parents to follow-up. That's only happened once though.

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    Scoliosis screening is mandated by state regulations in my state and is done with the nurse & PE teachers during class as theoretically it's easier when the students middle school & up are in tshirts and sweats/shorts. Also at all sports physicals MS & HS. However some children are missed. Hence why it's also supposed to part of standard annual well visits.

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    Scoliosis screening is mandated by state regulations in my state and is done with the nurse & PE teachers during class as theoretically it's easier when the students middle school & up are in tshirts and sweats/shorts. Also at all sports physicals MS & HS. However some children are missed. Hence why it's also supposed to part of standard annual well visits.

    It was a mandate here as well but went by the wayside due to funding at the state level.

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    It was a mandate here as well but went by the wayside due to funding at the state level.

    I believe it.

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    I do not disrobe my students......for any reason. I don't want to look 10 pounds heavier on camera.....when the local news station shows up at my house or work with inappropriate accusations from a parent. No thanks. :-)

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    Here is the link to the National Association of School Nurses. You can find sound advice, research, articles, and up to date recommended policy/procedures. I am a member. I love the resource.

    https://www.nasn.org/

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    It's not the issue of whether or not WE'RE uncomfortable-it's whether it's appropriate being in a school setting and having the child possibly be uncomfortable. It's not up to us to diagnose anyway so if a student has iffy symptoms in private areas it's just better to refer them and let the dr figure it out. Kids should not be uncomfortable at school worried we're going to see them naked. Even if it doesn't bother one kid, that kid could tell other kids that's what the nurse does and so some other kids may now be afraid/uncomfortable seeing the nurse for any reason and that's not good. It's not a hospital setting where we're responsible for charting every little bump on a patient. Unless it's an emergency it's better to avoid any possibly controversial situations.

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    I worked as an ER nurse prior to this job, so I was used to CUTTING clothes off patients and sticking tubes into various orifices. Here at school, I don't look at anything that would be covered by a bathing suit. I have examined many belly button piercing that are "oozing stuff" and low back issues so I have looked at a few areas on the torso.

    I can think of one exception: I had a girl get beat up once off campus, and then come to school. There was a police report involved, so I measured a few wounds/bruises on her thighs. She was wearing tight pants, so I had an female ed tech come with me as a witness while I examined her. That was an unusual circumstance, though, and in my day to day interactions with students I don't even go "there".

    And if I had a breastfeeding student, she would need to go to a room a lot more private than mine to pump, although I would fully support that and help find her a decent area in which to do that.

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    I the way it was said above: if a bathing suit would cover it, I don't look. Generally if the complaint involves that area I can figure out what needs to be done with a symptom list and would call the parent if I felt follow-up was needed.

    I have lifted shirts to look at a torso, etc with student permission, but not really lifting up more than a few inches. I have done scoliosis screening with students wearing tank tops in my office one at a time with another adult present. But there are limits in school nursing and I respect 'em. I also want to avoid being on evening news :).

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