Looking for some insight. Maybe a bit of a vent, too!

[Tina, RN]

I started my first school nurse position in September. At first, I loved it! Now, I am getting pretty burned out, to be honest. It is an elementary school, grades K-6. There are approximately 350 students. I was told during my interview that this school was very "needy" with lots of "frequent fliers". I also knew that this particular school has had a really high turnover of nurses. I believe it was something like 3 nurses in a year. I was up for the challenge, not knowing exactly what to expect, since I had never worked in a school before. Other nurses in the district told me, "You'll see..."

I receive approximately 65-70 visits every day. This isn't even counting meds or doing fingersticks/insulin coverage with my diabetic student. Many of the visits are from the same students, who come to see me 3-4 times per day. Every day! Does this seem excessive?? Teachers have said to me, "Well, in teaching school, we are told that if a child says he needs to see the nurse, we have to allow it." I have no idea what it'll be like when cold/flu season really starts up, and I am dealing with kids that are actually sick, instead of fooling around.

Then there is the bathroom issue. All students at lunch come to use the bathroom in my office. Apparently, this is the way it's always been, since mine is the closest to the cafeteria. At any given time, there is a line of 2-3 kids waiting to use the bathroom. In addition to this, there are several kids that are permitted to use my bathroom *only*, since they "can't be trusted to use the regular bathrooms". Apparently, they dawdle and fool around too much. So, somehow, walking to my office to use the bathroom is a better idea? Don't they still get to stall that way, since they have to walk farther?? Am I nuts here?? LOL One of these students actually comes to my office 8 times per day to use the restroom! Yup, I keep track. Again, as it is the sick kids in my office can't get into the bathroom. And cold/flu season hasn't even fully begun!

Each teacher seems to have a few kids that drive them crazy. So, they send them to me for every little thing in order to get few moments of peace. So, I get them from the whole school! My office is like the dumping ground for all of the kids nobody wants to deal with!

I have not taken a lunch break in 2 months. The flow of kids is constant, and between sick visits and bathroom visits, my office is never empty. My day begins at 8:50, but kids start coming in to my office even before that! How will I ever get my screenings done?? In theory, I love the job, but the reality of it is so frustrating. I'm planning to take my concerns to the principal (who is also new to her position). But in the meantime, I wanted to get your thoughts.

Thanks!

[schoolnursejennie]

WOW. i would institute a policy where students are not allowed to use the bathroom unless they are 1. sick in the office or 2. have a legitimate medical reason. for the students who use the bathroom 8 times in one day, i would place a call home to the parents stating that i am concerned that their child has an overactive bladder and/or dumping syndrome and should be seen by their physician immediately. that may be enough to deter the student from abusing your bathroom just from the sheer embarrassment of the conversation with the parents. it sounds like there are some boundary issues at your school with teachers and students not having limits set when it comes to you and your office. maybe try going to a faculty meeting and letting them know that this is unacceptable and it is impeding the care you need to give to the students that actually have legitimate medical issues. anyway, that is what i would do. best of luck to you!!

[Purple_Scrubs, BSN, RN]

I would definitely set some boundaries with the teachers and students. I don't expect teachers to assess illness or injuries, but I expect them to use common sense. An invisible paper cut does not need a bandaid. You can also give them interventions to try first for things like headaches or stomachaches, ie have the student put their head on their desk for 10 minutes, go to the bathroom, drink some water. If these fail, then they may send them down.

With the students, you are going to have to get strict. Quickly assess, and if there is no medical intervention needed, they go straight back to class. If you are seeing the same students over and over again with no medical issues noted, a phone call to the parents explaining the situation and that you are concerned about the amount of class time their child is missing can work wonders. There have been a few students that I have had to sit down and strictly explain to them that they are wasting their time and mine and if I see them in my office again, it better be because they are truly sick or injured. I do not do this often, and I make sure there are no underlying issues first (like trying to avoid a bully or a class that is too hard for them), but if no such issues are found and it is truly a case of school-itis, they get a lecture from me.

My kids see me as tough but tender when needed. If someone comes to me ill or in pain they know I will bend over backwards for them. If they abuse the privilege of my office, they know I will come down hard. I overheard a conversation once where one student said he was going to ask the teacher to go to the nurse. Another student said "You aren't sick. If you don't have fever, she is just going to send you back to class!" :)

My first few months of my first year I averaged over 40 visits per day. Now I am closer to 20 on average and I have some really slow days, like yesterday. I saw 4 students for illness/injury! I had time to screen two classrooms! Once they know they are not going to get a ticket home for crying wolf, the visits will slow down.

[cav5]

I started sending little notes home every day-a generic note that said you child XXX was treated inthe health office today and sent back to class. (3 notes in 1 day would get their attention pretty fast) At first it was a bit of time waster but in the end it did wonders-I had kids that would say "no, my mom says I can't have no more notes!" He obviously didn't get what she meant by that! I saw about the same number of kids in a day but I had about 750 kids-not 350. I tried to also set aside 1 hour of the day for screenings (usually the first hour). Some days it worked and some days it didn't. Also, they always needed to have a pass from the teacher-sometimes filling out the pass stopped the teacher from sending them. Good luck!

[Tina, RN]

Thanks for the ideas, everyone!

Another nurse (my mentor) and I developed a pass to the health office. We showed it to the principal, and I will start using it soon. I'm really hoping that using the passes will stop some of the more ridiculous visits. Hopefully, it'll also control the "incidental visits" from students that just stop by on their way past my office.

We also spoke to the principal and will be keeping a bathroom log for a while. The kids will need to sign their name, time, and room number when they come to use the bathroom. It'll be a pain in the tush, but then at least I can show the principal exactly what kind of traffic the bathroom creates! Today, for example, I had 48 kids come into my office just to use the bathroom! That's in addition to the 60 or so kids that came in for actual visits.

I am hopeful... At least there is a chance that my office can become somewhat sane! My mentor really helped me out. She has been a school nurse for a long time. So, having her opinions on my office helped sway the principal, too.

Thanks again, all!

[mycsm]

Tina,

I was worried about "stepping on the teachers toes" my first year, then I realized they need me ALOT more than I need them. Triage quickly and send them back asap. Many teachers of little ones, tend to send down very quickly. Put your foot down....send a mass staff email explaining that the bathrrom will not be used unless the student's are "patients", just because its close to the cafeteria. If they think the kids dawdle and cant be trusted then they need to get a bathroom monitor and NO it cant be you!!

If you word your email as such...I do not want healthy kids to be exposed to the sick kids (that are really sick in your office) maybe they will cut down on the amount of visits toyour office.

good luck!