Kids that you KNOW are faking it???

CrazyTrainRN · Dec 27, 2009

What do you do for...
The dramatic kid that constantly gets 'injured.' The one that 'twisted' his ankle & hops in to the office escorted arm in arm by 2 other students. The one that can't put any pressure on it, can't move his ankle up & down, can't do anything. No crying, no bruise, no swelling, no signs of anything!! Child is talkative & smiling & joyfully hopping around the office. And after rest & ice they still say they can't use that ankle??
- I send them home, & tell the parents that since they can't do any ROM or put any pressure on it they need follow up. But I really want to tell them I think they're faking it!!! I DON'T say it, but I think it. And of course the next day they are back at school running around & playing just fine!! Grrrr. What do you do?
The kid that says they threw up in the bathroom. Unwitnessed. Acting happy/ hyper/ talkative/ no fever. Looks great???
- If it's the first time I take their word & send them home. But it's my repeat offenders... ugh! I have given them crackers, let them rest & sent them back to class. But I know the teachers HATE that.
What do you do?
ps- I work in an elementary school.

If you think they are faking it and are acting fine but feel the need to call the parents, I would leave it up to the parents as to whether they want to pick them up or not. I call the parents, tell them what the child said happened, tell them my observations (no swelling, bruising etc. and also how the child is acting ie, smiling, laughing, etc) what I did about the situation (usually ice pack). Then I tell the parent that only an xray would be able to tell if it is broken or not. Do they want to wait to see how the day goes or pick up the child right away. You could also add that you think the child is fine, but it is up to the parents.

There are always those children who are constantly "hurt". Usually with these children I do my assessment and if I feel they are ok, I won't even call the parents and send them back to class. (If they need an ice pack, I might give them one, depending on the situation) After the child goes back to class and I feel it necessary, I may call the parent just to let them know what happened and that they should watch the child at home.

For the children who say they threw up but no one saw them, I picked up a trick from the other nurses in our district. We collect the large plastic buckets that ice cream comes in (we buy ours at walmart). We use these for barf buckets. (I think they are 5 quarts) When a "frequent flyer" comes in, I always take their temperature and document that. If no fever, I give them a bucket and tell them if they need to throw up, use the bucket. Then I send them back to class with the bucket. I tell them they are not going home unless there is vomit in the bucket. The older kids hate carrying around a bucket and usually make a miraculous recovery!! Send out an email to staff that you need plastic ice cream buckets and you should be able to collect enough buckets for the year. I write on the buckets "return to nurse's office."

We do this at the high school, too, and the kids called us sadistic. If they are fever free and have missed too much school or are frequent flyers, we give them a bucket and send them back to class. They hate us when we do that.

If you are going to do this, make sure it is okay with the principle that you do this. So far, I have only heard of one principle in our district who does not like the bucket. Those kids are just sent back and they throw up on the floor, which does not make sense to me, but whatever.

luvschoolnursing, LPN · Dec 27, 2009

I agree with CrazyTrainRN. One thing I often did in elementary school, like she mentioned, is call the parent AFTER you send the kid back to class. Once the kid gets their parent on the phone, they will become so dramatic, that the parent will almost always take them home.

A lot of this depends on the support you get from administration. I have had principals that would prefer I just send everyone home rather than risk a parent complaining that I didn't call. This occurs especially in high school, because if I don't call home, they just go to the bathroom and call their parents to pick them up, then the parent shows up to take them home anyways...

Purple_Scrubs, BSN, RN · Dec 28, 2009

I'm at an elementary school. After my first year, I made am unwritten rule that (for those without fever) unwitnessed vomit does not "count". If the kid says they vomited in the bathroom, I keep them in my office for 10-30 minutes (just based on in my judgment, how sick they look). If they do not vomit again, I send them back to class and tell them that vomit doesn't count unless I see it or a teacher sees it. I tell them that if they need to throw up, grab the trash can and come back to my office. Works like a charm, I have not had one return yet!

For the injury drama queens and kings, with the older kiddos, I give them "the look" that means I think they are faking. I will tell them my assessment, ie "your ankle is not bruised, not swelling at all, and I can see no sign of serious injury. Is it really as bad as you are making it sound". Usually they will make a miraculous recovery. I do call the parent after the child has returned to class, or I go in the office to call. If the child insists that they are in severe pain or cannot bear weight, I will call the parent and refer for an x-ray.

I have a window that lets me see whoever is coming into my office, and often I see kids that do not start limping until they get in my office, and I call them on that and send them back to class, LOL!

CrazyTrainRN · Dec 28, 2009

A lot of this depends on the support you get from administration. I have had principals that would prefer I just send everyone home rather than risk a parent complaining that I didn't call. This occurs especially in high school, because if I don't call home, they just go to the bathroom and call their parents to pick them up, then the parent shows up to take them home anyways...

Yes, we have one HS principle that thinks the nurses are "mean" because we don't send kids home for every complaint. I have discussed this with my supervisor and she always says, "Our job is to keep the students healthy and in school." When trying to decide whether or not to send a student home, I try to remember this.

If they can stay at school, they should. The minute the students (esp. HS) figure out they can go home for every little complaint, the nurse's office will become a chaotic mess. My general rule is if the student is afebrile and not vomiting (in the bucket or trash can in my office), they stay at school. Of course, there are exceptions, such as a sore throat that looks like strep throat, etc.

If in doubt about whether to call a parent or not, I err on the side of caution and call. Like luvschoolnursing stated, calling parents when the student is not around is also a good option for those who you think are "faking it" or you think they seem ok to stay.

As far as the HS students going to the bathroom and calling parents, that happens to us, too. Here is how I handle that: If I have decided that a student is okay to stay and they end up calling the parent on their cell phone to pick them up, I refuse to write them a pass to leave school. If the principle wants to excuse them to go home, that is their call, but as far as I am concerned, they are okay to stay and I am not going to give them an excused pass to leave. The principles at our HS are pretty good at backing us up.

CrazyTrainRN · Dec 28, 2009

I have a window that lets me see whoever is coming into my office, and often I see kids that do not start limping until they get in my office, and I call them on that and send them back to class, LOL!

I know the exact situation!

Or the student who is in the hall cutting up and laughing with friends and 15 minutes later they are in the nurse's office acting like they are "dying" and need to go home.

Yeah, right! "Get back to class!"

safarirn · Dec 28, 2009

Glad to hear my experiences are not unique. It seems to me that there are budding actors in schools across the globe! lol

Thanks for the advice! This has been the *most* frustrating part of the job so far! I get LOTS of this at my school.

Purple_Scrubs, BSN, RN · Dec 28, 2009

How long have you been at your school? I found that when I first started, there was a lot of "testing the limits" to see how much of a pushover I was. I was a little naive for a while, but I quickly caught on to their games. Although the kiddos still try it every once in a while, it has decreased a lot now that they know I am not going to let them go home because they supposedly puked once in the bathroom!

CrazyTrainRN · Dec 28, 2009

How long have you been at your school?

This is my 2nd year at my job full time (I was a sub the first year) I have never been a school nurse, although I was med/surg/ostomy/wound care/trauma/ortho in the past, this is a whole new game!! I am at a small elementary school 2 days a week and a larger high school (1400 students) 3 days a week. There is also a full time nurse at the high school who has worked there for 12+ years, so she has taught me a ton about school nursing. I also get pulled frequently to cover for other nurses who are out sick or on vacation. We don't have enough subs.

It is the high school kids that push the limits daily, even with the other nurse who has been there for years. Many of the frequent flyers don't even care that we know they are faking - they just want to leave school. Some of them scream and cuss if we don't give them a dismissal and sometimes they leave the school anyway. I am still learning to be tough with these kids and it is hard for me sometimes.

I never thought there would be so much psych involved with school nursing.

Any advice or suggestions are welcome!

How about you? How long have you been in school nursing?

safarirn · Dec 28, 2009

This is my first full year in this disctric, though I have subbed at other schools for many years before this school year.

You might be right. I HOPE you're right. They could be 'testing' the waters with me.

Purple_Scrubs, BSN, RN · Dec 28, 2009

I am on my 3rd year, and overall it does get easier, although every day is different and it certainly has it's challenges! Let's hope they are just testing their boundaries and once they see they cannot push yours, things will settle down. I do tend to get more that try to get the ticket home on Mondays, Fridays, and just before and after holidays.

mustlovepoodles, RN · Dec 28, 2009

I came into school nursing in mid-spring semester. The old school nurse had basically given up and had allowed kids to just "hang out" and talk, drink juice, etc. The staff had a saying--"If you're looking for your problem students, check the clinic." :angryfire The first 2 months I was seeing 130 kids PER DAY! It took my about a year to retrain the staff and students, and I still had certain teachers sending over 20 kids A WEEK for inane things (chapped lips, torn pants, broken glasses, and the ever popular "female trouble") I really had to come down hard on the staff, going so far as to keep notes on individual teachers and turning them over to the principal. Even so, I could never get my volume under 70/day, no matter what I did. And administration was perfectly fine with that. (That was over 10% of the population every day and I only had 4 students who took daily meds at school.)

A couple things I do--I require that students come to the clinic with a special pass. No pass, no see-um. Unless, of course, they are bleeding,actively vomiting, have suffered a head injury, fainting or not breathing right. There are exceptions to every rule. There is NO "dropping in" to visit the nurse on your way to class. Get a pass and come back. This move eliminated about 40% of my students.

When I spot a trend, I keep notes. If a student has come to me more than 4 times in a 4week period I call the parents about it to make sure there is no unidentified condition(a lot of my parents don't want to let the school know about asthma, diabetes, depression, and ADHD.) Then I lower the boom--I email all their teachers and the principal with my findings, so everyone knows whats going on. I am in middle school, so the kids change classes. They are experts at figuring out which teacher will cave. They will ask each teacher to go to the clinic until they find the soft touch.

I always assess--even frequent flyers get sick. I had one kid, a little fat 6th grader who had pretty severe asthma. His mother had always babied him, picking him up at the drop of a hat. And if she couldn't get there, she'd send one of several aunties. He would come over and over with "difficulty breathing." I always listened to his chest. When I would ask him to take deep breaths he would hold his breath and make whooshing sounds with his mouth. I never said anything, but I would listen for at least 2 minutes. He could only hold his breath about 30 seconds that then he'd take several enormous deep breaths. :lol2: Then I'd have him use his inhaler. I found out quickly that he didn't know how to use the inhaler--no wonder his asthma was so severe! Once we got that out of the way and he figured out that I was NOT going to call his mother unless I couldn't get the lungs opened up, he stopped trying to pull that stunt.

Vomiting--if a tree falls in the woods, does it make a sound? If nobody witnesses teh vomiting and they can't manage to vomit in my clinic within 15 minutes they go back to class.

Fever--it has to be over 100. I had one kid who would go into the restroom and gargle with hot water. Too bad that only raised his temp to 99. :bugeyes:

One of the biggest problems I have with my school is that over half the students speak Spanish as a first language. The majority of their parents don't speak English and I don't speak enough medical spanish to communicate with them. We have no interpreter so I am forced to let them call parents if there is a question of whether they are sick or not. Of course, they get on the phone and cry and whine and next thing you know here comes Mamacita and Papi.

Finally, teacher education is imperative. I send out a monthly newsletter with short, informational paragraphs about common illnesses. Like how to manage stomach aches in the classroom, how to recognise a real emergency, and when NOT to send a kid to the clinic. I always include some funny anecdotes and questions that come from the kids(and sometimes the parents.) LIke the kid who told me she had been sick all night and still had a bad stomach ache. The cause? "I watched "Saw IV" and I've been ill ever since.":uhoh3: Or the parent who sent her kid to school with a rash and told her to "go to the nurse and see if this is Chicken Pox.":down: Not chicken pox, impetigo. Pass Go, collect nothing.

I enjoy working with middle school kids for hte most part. I didn't enjoy working for my principal, nor working in the particular school I was in. I never got used to the extreme noise level(screaming, cursing, threatening almost constantly), or the gangs, guns, and violence inside the school. So I quit. I'm now in between jobs and hoping to find something a little less intense.