Noncompliant Kids!

[mrsfoster601]

Hello fellow school nurses,

Have you all ever had to deal with noncompliant students that talk back and question everything you tell them or do? If so how did you deal with it? A 7th grade boy came walking into my office stating that he fell on the basketball court and hit his head on ground. He was acting like he was in a lot of pain so I checked him out gave him some ice and just told him to sit tight because I wanted to monitor him for a few minutes. Within 2 minutes he was ready to go but I told him to sit tight for a few more minutes. He was noncompliant about it starting yelling at me and telling me don't look at him and that I make him angry. Mom told me he has mood disorders and anxiety but wow...any suggestions

[WineRN]

I work with tiny ones so I'm not sure if these approaches would work

For K-3 if they won't follow any of my directions/are refusing to leave my office even though they are FINE, I call home explain the situation to their guardian and then ask them to speak with their child. It usually causes tears but then they do what I want.

For my 4th and 5th graders, if they are very disrespectful I let them know that I will be calling the counselor down if they don't calm themselves which will most likely involve a write up. This usually gets them to stop.

*I am a little more forgiving for my special ones, some times they just can't process pain like the rest of us and even tiny injuries can cause angry meltdowns. I've already been called a number of NSFW words by a few of my older ones who fall into this category but I don't take it to heart. ANY change in their body and/or schedule throws them for a loop, and them lashing out at me isn't about ME.

[Tencat12]

Hmmm. I have a couple of kiddos like that. I usually stay calm and get 'the look' going as I calmly explain that xyz just happened and this is what needs to be done. If it's too intense, I get the social worker or the counselor involved, but usually I can get the kiddos to come around. I also tell them "I understand that you feel (happy, sad, scared, mad). But right now I need you to....(sit, drink, lay down, etc.). " I am a firm believer in limits being set if need be, and I will be happy to set them for students I work with. A lot of the troubled kids I see have reasons to be difficult, but that is NOT going to be an excuse for not listening and being respectful. I actually kinda like those kiddos who are full of piss and vinegar, but that's just me.....

[NurseBeans, BSN, RN, EMT-B]

I only have K-4, but I have quite a few times told a student that it's either we do this my way, or we do this in the principal's office. I then shrug and say "her office is nicer, so it doesn't matter to me". Usually gets compliance.

I don't know, sometimes I worry I will start to lose some of the therapeutic nurse-patient relationships that way but I am an adult, I am a school staff member, and I need to have their respect and compliance. I don't really care if I have their affection or admiration. I got my own kids for that.

[MrNurse(x2), ADN]

There are times that a student becomes defiant, mostly when they have their hearts set on going home and they don't meet criteria. I often tell them that right now they are getting into disciplinary territory and we may be going into the office. I know all my students, so I know when they are personally going into disrespectful mode.

[Farawyn]

I work 7-12. Most kids are great, because they know my son will kick their butts if they aren't (He's a senior. He really won't.)

Those that are truly non complaint are sent from my office to the AP. I don't mess around.

"The Nurse" doesn't have time for that.

[Flare, ASN, BSN]

I have one or two that think they run the show. I've learned over time which approach to use with which kid. Some need the "my office, my rules" type approach. Some need the Burger king - Have it your way approach - lest the simple visit for a bandaid turns into my office getting trashed because I suggested that the student use one large bandage instead of 4 regular sized ones or i will just mae the call home to the parent if the student asks when I know the kid is dodging because when I send said child back to class for his complaint of a stuffy nose, he's just going to run to the main office, call home then complain about how terrible I am. Let's just cut out the middle man - Call from here- If you still want to go the office to complain, be my guest.

[ruby_jane, BSN, RN]

9-12th and every day I get my share of eyerolling.

I am assuming that you felt this was the kid's baseline, right? Not personality changes due to hitting his head? I would document that the student voluntarily got up, stated relief felt and declined reassessment; when you gave your opinion he became verbally abusive. Then I'd call parent, review the incident, review your head injury protocol, and tell her that he declined to stay. THEN I'd fill out an injury report, documenting my merry way into making sure that everyone knew the kid left without my consent but that he was alert and oriented when he did so. If the kid had a standing pattern of being super-rude I might also include his AP in this chain.

I can't make an almost-grown student stay in the clinic. Most are more than willing to stay as long as I let them, though!