Middle School Clinic

nursetlm, ADN · Feb 3, 2017

This is an email I send out to all staff at the beginning of the year. I was new last year and did WAY TOO MUCH and I swore to have a better year. Thanks to this letter and some further communication with substitutes- this year has been awesome!

Guidelines for Nurse's Office

Reasonable Expectations for Self-Care in Classroom:

As the new school year begins, it is a good time to educate the students as to when it is appropriate to come to the nurse's office. This will help prevent students from misusing their education time by spending it in the nurse's office for minor complaints.

Our mission is to provide a safe, healthy learning environment in our school and to keep the student in CLASS for optimal learning. All students sent to the nurse's office MUST have a Nurse Referral Slip filled out with both first and last name, primary complaint and room number. We understand that emergency situations occur where this is not possible, but is the expected daily procedure.

Each classroom teacher will be given a Ziploc bag of gloves, band-aids, gauze pads and other items to allow for minor cuts/scrapes to be handled in the classroom. If you are in need of band-aids, gloves, etc please notify the nurse and she will provide them. Each teacher will be informed of students in his/her classroom with chronic health conditions or potential for emergent conditions.

Questions to ask students before sending them to the nurse's office during class: Have they used the restroom? Hungry? Tired? These are not emergent reasons to see the nurse.

Students should stay in class:

-Approximately the first 45 minutes of instructional time UNLESS they are vomiting, have hit their head, are having breathing issues (including known asthmatics), broken bones, pink eye, injury to eye, loss of consciousness or seizure, lice or bleeding profusely.

-When an old, healed abrasion (scab) is merely sore or itches. This is part of the natural healing process.

-When there is soreness from an old injury. If no bump, bruise, swelling or redness or it is more than 24 hours old- no ice should be given- it will not help at that point.

-If a student has a bandage that was applied by a physician-I am not able to reapply or change it (without doctor's written orders) I can only reinforce it.

-When a student regularly finds excuses to leave class and rarely has to go or stay home because of illness.

-When a student frequently asks to go to the nurse at the same time of day.

Reasons to call Nurse to site/location for assessment:

-Loss of consciousness

-Bone/Joint injury (possible dislocation/fracture)

-Seizure activity.

-Serious falls/accidents that involve head/neck/spine.

-Signs of allergic reaction: Swelling of mouth/lips, hives, vomiting, nausea, hoorificeness, and wheezing or abdominal pain.

Valid reasons for leaving class and coming to nurse's office:

-Vomiting (not just spitting up phlegm)

-Bleeding (minor scrapes can be handled in the classroom)

-Breathing difficulties (wheezing, shortness of breath)

-Bone/joint injury (I can also come to location if needed)

-Undiagnosed rash.

-Splinters- imbedded splinters cannot be removed, but will be cleaned/covered.

-Nosebleed- student should pinch own nose closed with Kleenex, breathe through mouth and walk to clinic.

-Suspected head lice/excessive head scratching.

-Human or animal bite.

-Injury to eye

*For students who complain of headache or stomachache, and it is close to their lunchtime (these symptoms may indicate thirst or hunger): 1. Give them a drink of water, 2. Have them put their head on desk for a minute or two (if possible) and when time, 3. Have them go to lunch. 4. If they continue to complain after lunch/recess, then they should be sent to the nurse's office.

kidzcare · Feb 3, 2017

This is an email I send out to all staff at the beginning of the year. I was new last year and did WAY TOO MUCH and I swore to have a better year. Thanks to this letter and some further communication with substitutes- this year has been awesome!

Guidelines for Nurse's Office
Reasonable Expectations for Self-Care in Classroom:
As the new school year begins, it is a good time to educate the students as to when it is appropriate to come to the nurse's office. This will help prevent students from misusing their education time by spending it in the nurse's office for minor complaints.
Our mission is to provide a safe, healthy learning environment in our school and to keep the student in CLASS for optimal learning. All students sent to the nurse's office MUST have a Nurse Referral Slip filled out with both first and last name, primary complaint and room number. We understand that emergency situations occur where this is not possible, but is the expected daily procedure.
Each classroom teacher will be given a Ziploc bag of gloves, band-aids, gauze pads and other items to allow for minor cuts/scrapes to be handled in the classroom. If you are in need of band-aids, gloves, etc please notify the nurse and she will provide them. Each teacher will be informed of students in his/her classroom with chronic health conditions or potential for emergent conditions.
Questions to ask students before sending them to the nurse's office during class: Have they used the restroom? Hungry? Tired? These are not emergent reasons to see the nurse.
Students should stay in class:
-Approximately the first 45 minutes of instructional time UNLESS they are vomiting, have hit their head, are having breathing issues (including known asthmatics), broken bones, pink eye, injury to eye, loss of consciousness or seizure, lice or bleeding profusely.
-When an old, healed abrasion (scab) is merely sore or itches. This is part of the natural healing process.
-When there is soreness from an old injury. If no bump, bruise, swelling or redness or it is more than 24 hours old- no ice should be given- it will not help at that point.
-If a student has a bandage that was applied by a physician-I am not able to reapply or change it (without doctor's written orders) I can only reinforce it.
-When a student regularly finds excuses to leave class and rarely has to go or stay home because of illness.
-When a student frequently asks to go to the nurse at the same time of day.
Reasons to call Nurse to site/location for assessment:
-Loss of consciousness
-Bone/Joint injury (possible dislocation/fracture)
-Seizure activity.
-Serious falls/accidents that involve head/neck/spine.
-Signs of allergic reaction: Swelling of mouth/lips, hives, vomiting, nausea, hoorificeness, and wheezing or abdominal pain.
Valid reasons for leaving class and coming to nurse's office:
-Vomiting (not just spitting up phlegm)
-Bleeding (minor scrapes can be handled in the classroom)
-Breathing difficulties (wheezing, shortness of breath)
-Bone/joint injury (I can also come to location if needed)
-Undiagnosed rash.
-Splinters- imbedded splinters cannot be removed, but will be cleaned/covered.
-Nosebleed- student should pinch own nose closed with Kleenex, breathe through mouth and walk to clinic.
-Suspected head lice/excessive head scratching.
-Human or animal bite.
-Injury to eye
*For students who complain of headache or stomachache, and it is close to their lunchtime (these symptoms may indicate thirst or hunger): 1. Give them a drink of water, 2. Have them put their head on desk for a minute or two (if possible) and when time, 3. Have them go to lunch. 4. If they continue to complain after lunch/recess, then they should be sent to the nurse's office.

Beautiful. Thank you!

foggnm · Feb 4, 2017

How big of a middle school is it? That's a lot. If you're seeing a lot of the same kids every day then you can cut down on their visits by speaking with their parents ("Suzy has been in the nurses office 20 times this year for xyz"). You can also communicate with the teachers that certain students are leaving class too much and send them a list of your top offenders. You can also like other said give the teachers basic first aid supplies so they don't come for minor stuff. Ultimately I think the abuse of the nursing office is very reflective of the teachers and administration. The more lax the administration, the more kids get out of class for minor reasons. We just had a principal change and already all the problem kids are making their way to the office more often. I'd really ask for help from your teachers or administrators to cut down on the unnecessary visits.

nursetlm, ADN · Feb 6, 2017

I should have prefaced that the letter is helpful for me because I have 500 KGers and First graders. LOL

May have to tweak a bit to fit middle school.

KKEGS, MSN, RN · Feb 9, 2017

OMG I could kiss you for posting your letter! We saw 150 elementary kids in the health office on Monday and Tuesday of this week. My health aide and I have HAD IT with unnecessary health office visits. We got the go ahead from our lead district nurse to send an email to the teachers laying out when to keep the student in class and when they legitimately need to come to the nurse. Your letter is an AWESOME jumping off point. May I use it?!?

grammy1 · Feb 9, 2017

OMG I could kiss you for posting your letter! We saw 150 elementary kids in the health office on Monday and Tuesday of this week. My health aide and I have HAD IT with unnecessary health office visits. We got the go ahead from our lead district nurse to send an email to the teachers laying out when to keep the student in class and when they legitimately need to come to the nurse. Your letter is an AWESOME jumping off point. May I use it?!?

150 kids???? How big is your school? That is absolutely ridiculous. It sounds like an administrator needs to set some teachers straight. We have 700 kids in our school, and if we see 50/day that's a lot (and rare).

KKEGS, MSN, RN · Feb 9, 2017

Our school is only about 600 kids (K-5). It's getting out of hand.

MrNurse(x2), ADN · Feb 9, 2017

Our school is only about 600 kids (K-5). It's getting out of hand.

Are the teachers that bad that 25% of their kids will come up with a reason to leave? Really, I would approach administration with this angle. What are teachers doing to disengage the student body from class to the point they make up a reason to go to the nurse? This is an indictment on the teaching staff. I frequently send students back with the instructions to return if necessary and our teachers engage them that they forget their complaint.

BeckyESRN · Feb 9, 2017

Our school is only about 600 kids (K-5). It's getting out of hand.

WOW! When my visits were at their worst, I averaged out the amount of instructional time being missed each day-in your case if every visit takes 5 minutes from leaving the classroom to returning to the classroom(probably a low end estimate really) then your building is missing out on 12.5 hours of instructional time. You could even break it down by classroom or grade. My principal really took notice when presented with "instructional time missed" numbers. Sometimes you gotta speak their language to drive home the point.

nursetlm, ADN · Feb 10, 2017

Of course! I took it from another nurse and made it fit my kid's ages. It should help you quite a bit.

WineRN · Feb 10, 2017

Last year, I made a chart of all the visit reasons and number of visits from a certain classroom- once the teacher saw that, on average, her class was missing 300minutes of class time per week!!!

This is genius. I also see between 40-55 kids daily.

I had to tell the teachers Tuesday that because we have confirmed influenza in the school, only really sick kids should be sent to prevent exposure and if I send someone back to class, they should not be sent back to me unless their symptoms change.

They looked at me the same way my dog does when I start talking to him. But he at least tries to follow my instructions.