Judgement being questioned

[GertieGrantRN]

Hi all, this is my first year working in the schools. Much like everyone else, I've been seeing a lot of students sent to my office by teachers for stomach ache/headache etc who I often end up sending back to class (no fever, no vomiting after monitoring in my office- usually a rest here with water and they feel better). Today my principal (also new this year to the school) came to me and said that one of the teachers wants to discuss with the school's leadership team how students are sent back to class from the nurse's office. This same teacher came into the main office a few weeks ago and informed the secretaries that all of the students being sent to the nurse's office should be sent home from school (this was in the middle of a huge increase in flu-like symptoms, and I had already been sending kids home way more than normal). I explained to the principal after hearing about the teacher's comments that I have to go through a process - assessing the student, communicating with the parent if need be, etc and that I can't just send every student home. She is supportive so far, and hasn't ever questioned my judgement.

My feeling is that I'm going to hear from this meeting that I'm not sending students home often enough. I try to communicate with the teachers about why I'm sending students back to class, and have tried implementing a "nurse's office pass" that teachers can use to send a student to my office, and I use these to write a quick note back to the teacher. Many teachers still don't use these when sending students though, so I'm not as in practice writing notes as I'd like to be. If it seems like unusual symptoms or I've seen the student twice, I'll definitely call the teacher/write a note. I've gotten emails this year from teachers questioning how I was dealing with kids who have lice with comments like "we've never seen this before" (really, she's never seen kids with lice in school?). We also implemented new rules to deal with food coming into the schools for birthdays mainly (to address food allergies and all of the cupcakes/treats trotted down the halls), and teachers have been pretty vocal about not liking this either.

I'm concerned that the teachers have decided not to trust my judgement, and I'm worried that this will lead to more problems. Has anyone dealt with this in the past? It could be just the combination of a new front office team and longtime teachers with the school who aren't willing to accept that change in staff (or any change). My overall feeling after hearing from the principal today is that the negativity at this school is wearing on me, and if I can't win their trust this might not be the right job for me.

[jess11RN]

Just now, GertieGrant said:

It could be just the combination of a new front office team and longtime teachers with the school who aren't willing to accept that change in staff (or any change).

AddThis Sharing Buttons

Share to FacebookShare to TwitterShare to PinterestShare to LinkedInShare to More

This is exactly what I dealt with when I started my position here. I was the first nurse in the district, so a lot of my judgement and my new rules were met with A LOT of push back. (NO! You can't keep your ice cream in the health office freezer!) I was even asked to take down a cutesy "privacy matters" sign because it offended some of the staff. The sign was directed more towards the students and simply asked nicely to not ask kids why they're in my office, not touch my stuff, and to wait patiently and quietly while I'm on the phone. I spent many days almost in tears out of frustration.

This is my 3rd year here now and it has improved drastically since then because people now have gotten to know me and trust me. Many actually advocate for me and stress that I need help (I go between 2 buildings). I'm not saying all is perfect, but at least now I know that most of the staff have my back.

The longer you're there, the more opportunity you'll have to get to know them and vice versa. Then, maybe a lot of the angst will go away. I'd try to stick it out through next year, see if you can build those relationships and see if things change. If you have to move on, then at least you tried. Try not to let the negativity get to you (easier said than done, I know), keep your head held high, and know that YOU are the medical professional.

[beachynurse, ASN, BSN]

You aren't sending kids home often enough? Really? I don't think I would worry about that. I consider it important to keep kids that are not sick IN school, and send the really sick ones home. We use our assessment skills and professional judgement to determine if a student is ill. Little ones will complain of stomach aches for attention, or will vomit at or after lunch from eating too fast, swallowing too much air from talking too much while eating, which does not nmake them ill. Teachers don't understand that and once they see vomit, thats it, out and home. Just continue to educate them, encourage the use of the clinic passes and eventually they will get used to it.

[BrisketRN, BSN, RN]

It sounds like your principal trusts your judgement and wanted to discuss the "problem" with you and move on. I think most of us have at least one of these teachers at our school who want to take over our job and send kids home left and right. The truth is that we are here to keep kids in school and safe/healthy while they're here. We are doing a disadvantage to the student and the teacher when we send a well child home (disrupts class time, student is behind, teacher has to work to catch the student up, can even lead to funding issues). You can try to explain this to the teacher, but they probably still won't like your answer. It's her problem, not yours.

[RatherBHiking, BSN, RN]

Yep, been there done that many times! It's VERY frustrating. What I've learned is-the teachers will try and push you around until they learn they can't because it won't do any good. Some schools are better than others about this. If the teachers are used to stomping their feet and getting their way then it's worse. Your goal (which should be theirs too) is to make sure kids are in school as much as possible so they can learn. You've been trained on symptoms to watch for and without concrete evidence a simple "I don't feel well" is not criteria enough to go home with. Kids are fickle. How many times have they acted like they are dying and then all of a sudden for recess they play soccer? Also, if you start calling every single time for a parent to pick up kids that aren't really sick those parents are going to start complaining to the principal that when they took their child home they were fine. I hate to make a parent have to scramble to find someone or leave work early if it's nothing major. Bring these points up to your teacher and principal and hopefully that will help. Also for those teachers that like to throw in my face the student I sent back that got sick later, I tell them I'll forgive them for sending me kids that are faking if they forgive me for missing the fact a child was going to get sick in an hour. Finally, the ones that don't send passes, send the kid back to class to get one before seeing them. In other words, act like a teacher. Stand your ground and insist on all things medical be done your way! You are not their puppet. However, I've learned that teachers really get mad if you say the phrase, "I won't tell you how to teach if you don't tell me how to nurse." Yeah, don't do that! It may make you feel good in the moment but in the long run will not help. To get teachers to trust your judgement takes time and it also helps when they get to know you some.

[LikeTheDeadSea, MSN, RN]

I think this is similar to many of our first-year experiences in a school setting. I've talked with other new nurses that it's almost like your building is trying to test how far they can push you. If they can take advantage and get a student causing disruptions out for a day, some people will use whatever they can to make it happen.

Hold your ground - sounds like your administration is on board with you.

[pedi_nurse]

Do you have a school or district exclusion policy? It's always great to point back to those policies.

These other comments have been great as well.

[GertieGrantRN]

Yes, I agree, thank you so much everyone! It's very reassuring to know that this isn't unique and I'm not alone! I'm going to look at any exclusion policies we have too, that is also a great point.

[LikeTheDeadSea, MSN, RN]

Also,

ONE OF US! ONE OF US! ONE OF US!

Welcome to the School Nurses forum ?

[EnoughWithTheIce]

What does your school policy list as excludable conditions? It is listed clear as day on our website and is based on local health department protocols.

This is your guide and back up for running your school nurse practice. Sure, there are grey scenarios - that is where good ole nursing assessment comes in.

I have shut more than a few teachers down by directing them straight to our list. Sometimes, they think everything is just at our discretion and it opens their eyes to see there ARE actual guidelines in place.

[Flare, ASN, BSN]

Teachers can be such germophobes. Uh... you work with tiny snot factories (and some not so tiny). Yes, you may get sick. Take some echinacea, wash your hands and keep swimming. Go use your prep to drink some herbal tea and think about how the school nurse doesn't get her "contracted" preps. ?

[ruby_jane, BSN, RN]

Oh my bananas.

In your corner, you have your medical judgment, the district's illness policy, and the attendance policy. In high school it was 3 absences a semester without a medical excuse (or other limited reasons, like jury duty, court, etc.) that would make you attend Saturday school.

Here in elementary, we still give perfect attendance, so...you know. The illness policy and attendance policies should support your medical judgement. Good luck!