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New To School Nursing, No EHR

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by NurseMiss NurseMiss, LPN (New) New Nurse

Specializes in Pediatrics, School Nursing. Has 2 years experience.

Hi! I am new to school nursing. I work at a private school for children with ASD. The school I work for has never had an EHR for the nurse to use. Almost everything has been handwritten for the last decade by the previous nurses. Since receiving this job, I have brought up obtaining an EHR to use as that would make me feel much more comfortable with my documentation. My efforts have been unsuccessful as it is approaching the end of the school year and I am still charting on something I made up on Word.

I have a meeting within the next few weeks to extend my contract for the Summer session and following school year. I am planning on bringing it up again. I was wondering if you all would be so kind as to give me your accounts on how helpful EHR's have been in your offices?  Not to mention, how they have saved you in unfortunate times? My worst fear is losing my license due to not charting something correctly.

As I mentioned, I am currently documenting on something I made up on Word that has the time in/out, student's name, chief complaint, sx noted, and treatment that is given. I print the paper(s) out at the end of the day, sign the bottom of each, hole punch them, and put them in a 3 ring binder that is in my locked drawer. I have previously needed to find documentation from months prior and had to go through every single piece of paper to find the one I needed. It took what seemed like forever. I am also horrified of losing a piece of paper or having something happen to the binder.

If you can't already tell, I am a Nervous Nelly and I am sure that does not help the situation. I believe my charting is very thourough--maybe TOO thorough sometimes, but it still worries me. I just feel that I would be much more comfortable if I had an EHR.

Thank you so much for reading. Please let me know your thoughts/experiences.

LikeTheDeadSea, BSN, RN

Specializes in School Nursing. Has 6 years experience.

I used to hand write charting at my previous school, so I feel you on this situation!  I didn't have a computer that could print, so couldn't even type notes. I learned quickly that my handwriting is terrible, and my regular substitute nurse's handwriting was even worse!

The  biggest change I noticed about getting an EHR is less about the quality/legality of my charting, and more about how quickly I have access to my student's alerts/history/office visits/orders for reference. This is especially important for children with chronic illnesses or those who are non-verbal and can't tell you what's going on. 

I would stress less about charting and more about student safety.  Having to flip through pages and find information on students that way is tedious and can easily miss things. EHRs with Alert boxes and easy ways to view student history allow you to provide overall higher quality care to students.  This will also result with the student returning to the classroom quicker and not missing as much class time.   Keep your focus on "how does the nurse having an EHR benefit students directly,"  as this is the main backbone of how decisions are made in education. 

 

BrisketRN, BSN, RN

Has 4 years experience.

Record storage is huge too.  In Illinois school records have to be stored for 50 years.  Paper records = warehouses of records.

laflaca, BSN, RN

Specializes in School Nursing. Has 7 years experience.

+1 for needing EHR to quickly identify health issues, allergies, care plans etc for kids who could need them in an emergency.  Also in my state vaccine records have to be stored FOREVER, which would be impossible with paper charts.

Also....another thing administrators love is data.  How can a school identify and respond to the most pressing health needs, when they're in paper files?  How do you know if anxiety complaints have increased 50% since last year, if overall visits have gone down or up, or how many minutes an average visit lasts?  What hours of the day is the nurse most needed? How will you track COVID cases?  How much class time are your serious asthma kids missing for emergency visits?  How many students are injured at school each month, and are there patterns that reveal safety hazards - are they happening in the same place, or at certain times of the day?  Are there students with very frequent visits, and how will you quickly identify them to evaluate their needs for services? 

You might have "gut feelings" about these answers with your paper charts. But with a decent EHR, a few clicks will get you actual answers (which are sometimes surprising!).

Plus, holy cow, writing by hand...I'm sure your teachers aren't tracking assignments, calculating grades, or doing IEPs on paper, right?  

Flare, ASN, BSN

Specializes in school nursing, ortho, trauma.

if cost is a factor, maybe look into CareDox.  I believe it's free to schools for use as an EHR.  

Edit to add:  I've never used Caredox, so I can't attest to the quality of it or ease of use.  

Edited by Flare

NurseMiss, LPN

Specializes in Pediatrics, School Nursing. Has 2 years experience.

Thank you all SO much for your responses. I definitely understand the importance of student safety. I meant to add that in but got way ahead of myself, as always!

What the administration uses currently, is something the founder of the program made himself. Which, props to him it's a lot, but none of it is nursing-related and it is difficult to navigate. 

I have a notebook started that lists everything I would like to bring up to administration during our meeting. This is my biggest topic. 

Again, thank you all so much! It is greatly appreciated. 

17 hours ago, LikeTheDeadSea said:

I learned quickly that my handwriting is terrible, and my regular substitute nurse's handwriting was even worse!

Yes!! My handwriting is HORRIBLE especially when I am writing quickly. 

NurseMiss, LPN

Specializes in Pediatrics, School Nursing. Has 2 years experience.

14 hours ago, laflaca said:

Also....another thing administrators love is data.  How can a school identify and respond to the most pressing health needs, when they're in paper files?  How do you know if anxiety complaints have increased 50% since last year, if overall visits have gone down or up, or how many minutes an average visit lasts?  What hours of the day is the nurse most needed? How will you track COVID cases?  How much class time are your serious asthma kids missing for emergency visits?  How many students are injured at school each month, and are there patterns that reveal safety hazards - are they happening in the same place, or at certain times of the day?  Are there students with very frequent visits, and how will you quickly identify them to evaluate their needs for services? 

Super great point!! Another thing on my list to talk about are a few safety concerns (that have already been spoken about and solved on a case-by-case basis but I believe should be implemented systematically). This is something where this data would absolutely be beneficial. While, as you said, I have a "gut feeling" -- I would also have the numbers to back me up. 

WineRN

Specializes in NCSN. Has 4 years experience.

I might throw in a little scare tactic about security. Word docs are not a secure form of charting. If anyone gets access to your computer or if a virus attacks your computer those files are at risk and FERPA is a BIG deal. Or if the computer crashes and you lose an entire day of charting, recalling a whole day of assessments from memory can lead to incorrect record documentation. 

That being said it sounds like you are doing your best in a pretty tough situation so the above is NOT a judgment on you! 

As other's said, frame this in a student safety lens. EHRs allow for better data collection so you will be able to really support the students you serve while maintaining safe and secure documentation. 

On 4/27/2021 at 2:04 PM, NurseMiss said:

Hi! I am new to school nursing. I work at a private school for children with ASD. The school I work for has never had an EHR for the nurse to use. Almost everything has been handwritten for the last decade by the previous nurses. Since receiving this job, I have brought up obtaining an EHR to use as that would make me feel much more comfortable with my documentation. My efforts have been unsuccessful as it is approaching the end of the school year and I am still charting on something I made up on Word.

I have a meeting within the next few weeks to extend my contract for the Summer session and following school year. I am planning on bringing it up again. I was wondering if you all would be so kind as to give me your accounts on how helpful EHR's have been in your offices?  Not to mention, how they have saved you in unfortunate times? My worst fear is losing my license due to not charting something correctly.

As I mentioned, I am currently documenting on something I made up on Word that has the time in/out, student's name, chief complaint, sx noted, and treatment that is given. I print the paper(s) out at the end of the day, sign the bottom of each, hole punch them, and put them in a 3 ring binder that is in my locked drawer. I have previously needed to find documentation from months prior and had to go through every single piece of paper to find the one I needed. It took what seemed like forever. I am also horrified of losing a piece of paper or having something happen to the binder.

If you can't already tell, I am a Nervous Nelly and I am sure that does not help the situation. I believe my charting is very thourough--maybe TOO thorough sometimes, but it still worries me. I just feel that I would be much more comfortable if I had an EHR.

Thank you so much for reading. Please let me know your thoughts/experiences.

I think you should keep one binder by date, with original records. But also have a second binder as well. 

Make a second copy for a second binder or file, so that you can have one copy of the month's students who came in, alphabetized, and the other binder can be kept using just the added by date system. You can then look up your students name in the alphabetized binder and if you needed to access the original record, you can use the date listed on your alphabetized copy, and find it easily. This would cost you about 40 seconds of added effort per student, and would make is much easier to find their records. 

As far as word goes, IDK how secure your machines are, but Im glad you have a means of typing the forms up. Perhaps creating a pdf that is editable would be useful too. That way you can tab your way through the documentation, and even allow room for added charting and comments. 

Maybe you can find some example pdfs online and not have to put all that extra effort in to it. 

Im sorry you don't have a better system. Wish I could be more helpful about this, but I am hoping that this helps you with the organizing aspect. 

Sounds like you have it pretty well under control, but yeah that sounds very frustrating. 

JustJai, ADN, LPN, RN, EMT-I

Specializes in Oncology, Med/Surg, Correctional, and School nursi. Has 27 years experience.

Greetings,  Old school method...years ago I made a paper record for each student and documented on their individual record.  I'd have a record of how often they were seen, the reasons they came, etc.  This doesn't help if you need overall stats, but it gives you a broad picture of a specific student rather than searching through days and days of records.  I also kept a daily, handwritten, record of names of students I saw each day.   Fortunately, we went electronic shortly after that.  

NurseMiss, LPN

Specializes in Pediatrics, School Nursing. Has 2 years experience.

21 hours ago, WineRN said:

That being said it sounds like you are doing your best in a pretty tough situation so the above is NOT a judgment on you!

Thank you, thank you!! I appreciate this a ton. 

NurseMiss, LPN

Specializes in Pediatrics, School Nursing. Has 2 years experience.

11 hours ago, Gillyboo said:

I think you should keep one binder by date, with original records. But also have a second binder as well. 

Make a second copy for a second binder or file, so that you can have one copy of the month's students who came in, alphabetized, and the other binder can be kept using just the added by date system. You can then look up your students name in the alphabetized binder and if you needed to access the original record, you can use the date listed on your alphabetized copy, and find it easily. This would cost you about 40 seconds of added effort per student, and would make is much easier to find their records. 

As far as word goes, IDK how secure your machines are, but Im glad you have a means of typing the forms up. Perhaps creating a pdf that is editable would be useful too. That way you can tab your way through the documentation, and even allow room for added charting and comments. 

Maybe you can find some example pdfs online and not have to put all that extra effort in to it. 

Im sorry you don't have a better system. Wish I could be more helpful about this, but I am hoping that this helps you with the organizing aspect. 

Sounds like you have it pretty well under control, but yeah that sounds very frustrating. 

 

9 hours ago, JustJai said:

Greetings,  Old school method...years ago I made a paper record for each student and documented on their individual record.  I'd have a record of how often they were seen, the reasons they came, etc.  This doesn't help if you need overall stats, but it gives you a broad picture of a specific student rather than searching through days and days of records.  I also kept a daily, handwritten, record of names of students I saw each day.   Fortunately, we went electronic shortly after that.  

These are both really great suggestions for the time being. I will likely start doing something like this. Thank you!!