New School New Overwhelmed

Morganalefey · Mar 30, 2013

I had a lot of missing files too. I made files, and put what I had in them. When I got to my office for the first time, there was a 3in stack of papers to file. Nothing had been filed since DEC. It was the first thing I tackled. Any time I had a free moment, I hit that stack of papers. I didn't feel like I could move forward until I had gotten that done.

I have a group of 4th graders who come at the same time every day to brush their teeth. They would try and all go in there together and close the door and play around. I put a stop to that real quick! I suggest when your 5th graders start acting like it's party time, that you take them 1 at a time, and make the rest of them sit down and wait. Then send them back 1 at a time. I would not deny a child their inhaler, but if you take the fun out of it for them, they may quit doing it.

Kafergie · Apr 1, 2013

I have also called parents to let them know their child is suddenly using their inhaler daily. Lots of times, the parents don't know because the child is never "needing" the inhaler at home/ on weekends. I express concerns about overmedicating if the child truly doesn't need to use an inhaler daily, esp if they do not appear in any distress and have great sats. I have so many kids with MD orders for prn inhaler use at recess/PE, it sometimes feels like a free for all around recess time in my clinic.

Flare, ASN, BSN · Apr 1, 2013

I'd be tempted to listen to their lungs and assess need before giving their inhalers. In you have a pulse ox, check their sats. I know that some kids can feel their s/s of asthma coming on before it becomes obvious, but if it's the same kiddos coming every day in a group, it's more likely that they just want to miss a minute of science or whatever they have right after recess.

As far as the paperwork goes.. just take if file by file. drop by drop. if you have missing info, then try and track it down. even if it's been a while. don't forget to check guidance or registration files for things like immunization files. sometimes that type of stuff just doesnt' make it to us. And try not to do double work. I was filing dr's absence notes until i realized that the main office was copying them and putting a copy in their perm file for attendence files. Now i only keep them if they have relevant info for major illness/ injury, vaccine info, out of PE, surgery, etc.

100kids, BSN, RN · Apr 1, 2013

A someone who came into a mess and had to work my way out of it (and I still am) my best piece of advice is not to stress about getting it all tackled and in order in a day, or a week or even by the end of the year. Find a system that works for you and start with that then each day use a little time to fix what isn't right from the past. Keep reminding yourself "this office is in better shape today than it was yesterday". If you can say that at the end of each day or each week then you are making great progress. It took me a good year to feel like I really had all the miscellaneous paperwork, etc in it's right place.

Frequent fliers-I always find it's good to keep the parents updated on anyone who you see "in excess". If an asthmatic is taking their inhaler a lot more than I have seen in the past I will send home a quick note or call to mom because really they need to know that so they can let their Dr know. If their asthma is controlled they shouldn't need their rescue inhaler at school everyday unless there's something else going on (cold, allergies, etc). Their Dr may want to change something else in the plan. I get a few "general malaise" frequent fliers. After a few visits they get a call or note home just to let mom know something may be up. That usually cuts down on the visits at least for a little while.

squidbilly · Apr 1, 2013

I think your story is such a familiar one for us school nurses. I was so very overwhelmed when I first started last August that I nearly quit. I am grateful for the easily accessable peer support that I have found here on AN. The commenters above have already said a lot of what I would tell you, so I will keep this brief. Spend a little time on the school nurse forum here and you will find that many of us know exactly how you feel. Click on any thread about an overwhelmed school nurse and you will find tons of tips and encouragement! Good luck, and congratulations on the new job!

rdsxfnrn · Apr 4, 2013

Nobody gets a prn inhaler from me unless 1. I have spoken with mom,or 2. i checked lungs sounds and they sound like crap. Then I give it and call mom. In this situation, I would have all students sit quietly, then have them call mom one by one. Puts the burden on the kid and mom is aware. I realize this takes more time but it does not happen again! The students at my school have tried this trick, and found out pretty quick it won't fly with me. The health room is not party central! ; )

NutmeggeRN, BSN · Apr 4, 2013

What rdsxfnrn said. I have an oximeter and use it, I also will listen to lung sounds. If not sympotomatic off to class they go, with the advise ALWAYS to return of they do not feel any better...sometimes I make the the call with the kiddo right there...have had some very enlightening conversations with parents!

I also make them sit quietly, no chit chat etc. I thing the group visit is very much a middle school thing.

PS Go REDSOX!