Note to teachers about visits to the nurse....suggestions welcome

Double-Helix, BSN, RN · Aug 7, 2012

Does your school have workshop/education days for teachers at the beginning of the school year? Maybe you could ask the school principal if you could have 30 minutes to an hour to present some education to the teachers regarding the nurse visits.

Outline your role as the nurse, what would constitute an urgent visit (vomiting, fever) vs what can wait until the end of the class (mild headache) vs what can be treated in the classroom (paper cuts, etc.). Discuss the form that they need to fill out and explain that students won't be permitted to see you without it. Perhaps you could also incorporate a checklist of some kind into the form. Such as "The student needs to see the nurse immediately because of.... and list some options. If the option isn't on the list, the teacher might think twice about sending the student out of class.

nurnan79 · Aug 7, 2012

I provide each of our classrooms with small "First AIde" baggies

which contain bandaids, Toothholders, vaseline tube and swabs

(for 'dry lips'), ice pack and small gauze pads. It cuts down on

many trips to the nurse.

Wishinonastar, BSN · Aug 8, 2012

This is tough. You don't want them assessing student injuries- why would they need a school nurse then? But sometimes it is just so silly for a hangnail or something. I tried the passes myself, only a few teachers would use them and like you I did not want to make any waves.

If they don't come in during class you will be inundated between classes and at lunch. I decided to let the teachers use their judgement. The stricter ones will make them wait or call me first. Others send for everything, but overall I would rather have the kids come in on and off throughout the day and let ME decide what treatment is needed than to have the teachers try to be nurses which is illegal and unethical.

I agree if you want to talk to the teachers about this it is fine, but in general that is why the nurse is there so don't shoot yourself in the foot by saying you are too busy with other things to be the school nurse that you were hired to be. If you do, they might look at the budget and decide maybe they don't need a nurse afterall.

craym58942 · Aug 8, 2012

One of the ways we 'attack' this issue is to show the offending teacher(s) how many times little Johnny or Janey has come into to see the nurse within the last week or month for the non-essentials. We also use Data Walls; each 9 weeks the school nurse posts how many visits were made by grade, gender, time of day. This can be posted in the teacher lounge. Can also show the numbers to the principal as the students are supposed to be in class learning unless they have a really good reason for being out. You can also meet with the faculty and make the point that if they all send one or two students at the same time, you have standing room only in your office. Hope this helps.

TexasDew · Aug 9, 2012

As a previous school nurse you are opening a bag of worms giving the teachers supplies for their classrooms. I tried this and it ended up costing me $$$ because the teachers use the supplies for nothing or for things that were beyond their skills. They wanted refills every week leading to the cost.

The forms...you should enforce the use of these..it does help. I had to do the same at one school and it caused a few issues you want to be careful of. One is that if the student is really ill the teacher will tell the parent you refused to see them if you send them back for the form. Maybe you should report to the principal teachers that are not adhereing the correct procedures. This way the student's do not suffer. Also, try triaging the students as they come in. Another trick is to call the parent every time the student comes to the clinic (especially for repeat students or teachers using the clinic as a break from the student). Tell the parent the teacher sent the student to the clinic and you can not find anything wrong...but you want to check with them. The parents will get fed up and get on the teacher. You have to be careful as these can backfire on you but using it with caution is a method. I had the principal at one school who had certain teachers that had to send the "ill" students to him before sending to the clinic because of her abuse.

Good luck!!!!

jennlg8 · Aug 12, 2012

You do need to take control of the situation. I work for a large city school district through the Department of Health and we have workshops to assist us with these problems. The most important part can be the passes since this can help the teachers keep track of the times and reasons for sending the kids to the nurse. Talk with the parents and principal when necessary.

roemerr · Aug 12, 2012

I was a high school teacher for over 15 years. Sometimes it is difficult to stop teaching, locate the proper pass (if you even have a supply of them), fill it out, and then send the student. Trust me, there are many times I would tell the student to wait a minute and the student wouldn't ask again because he/she really just wanted out of the room to meet up with someone. And in urgent, emergency situations, (diabetic needs for example) it was faster to just let the student go. Some schools I worked at gave students a planner and in the back of the planner was a log for passes out of the room. It made things quicker and more efficent. This enabled the whole school to see just how often a student requested a pass so trips to the clinic, library, locker, bathroom, etc didn't become a habit. Suggest this for your school and perhaps get a page designed specifically for the clinic. Most of the students' clinic needs were simple, bandaids, feminine products, ice, tylenol. I found it extremely beneficial to have bandaids in the classroom. Maybe the cafeteria could hand out ice bags? Maybe the front office secretary could have a bandaid supply? I have often given extra credit at the end of a grading period for any student who never needed a pass out of the classroom. This could be a suggestion you make to your teachers. It saves everyone time. Just remember, a teacher knows that refusing to send the student to the clinic could become a huge legal problem. So sometimes it is easierand wiser to just let the student go especially when adequate forms/passes are not supplied to the teacher.

newlife09 · Aug 12, 2012

I was a secretary at a K-8 school for 15 years, and I have seen all sorts of "abuse" of sending the child to see the nurse. Which oftentimes she was so overworked, no seats left in the nurses office that the duties fell to me. Our school district implemented a charting system, each child had a chart created, which was a piece of cardstock, labeled with demographics and then filed alphabetically in the nurses office, this record followed the child, if they changed school within the district, went to jr. high and high school, hence a complete record of their nurse office visits. We charted when they came in, the problem, our action, followup and time they left. When there was a problem with a certain child's constant office visits, we could inform the teacher with a verificable record of how many times they were sending a child to the office for frivolous things. Oftentimes when we informed and showed the parent, the parents were flabbergasted at how many times their child kept going to the nurses office, often times it was attention seeking, not all, but oftentimes. Of course there were true emergencies, med dispensing, etc. and these were obviously warranted. What I found a lot of the times though is that a child had a stomach ache during math class or right before PE. Also, what we found is that if a child came in for headache, stomachache which are very subjective symptoms, I would keep the child to "rest in the office" through their recess time. Once the word got out, if you went to the office you might miss recess, that cut the visits enormously for those reasons. If a child was truly ill, they didn't mind resting in the office through their recess anyway! Good luck!

rmgilb · Aug 15, 2012

Hi! I work in a school system that has enforced the nurse pass to be filled out before a student can come to the clinic. We give them to all teachers and replace their supply as needed. We had too many students (in high school) coming in between classes for nothing, and then using the nurse as a tardy excuse. So if they come in with out one, I send them back to class and tell them to get a pass from their teacher, so that way their teacher knows where they are! And at my elementary campus, we had kids that go to the bathroom, then wonder in to the clinic and there is nothing wrong with them, so we enforced the nurse passes there too! The teachers are very cooperative, and if there is a time when they start sending students without passes, then I send out a friendly email reminder! It is so that the teacher knows where they are, and it helps cut down on tardies and kids wondering around on campus as well! Of course, if it is an emergency, then the pass isn't required! :) We also don't require passes for scheduled meds, because the teacher already knows that they have to come to the clinic at that time every day! We give the teachers a bag at the beginning of the year with bandaids, and nurse passes in them. It works well at my campuses!

photomom · Aug 16, 2012

Just a quick question as a new school nurse sub. If a student comes asking for a bandaid because the one they had on fell off, do you need to fill out all the paperwork as if that was a full clinic visit or can you just give them the bandaid?