Object inside the ear

[Elixer]

So today I got a call from the early years principal regarding the building nurse removing an object from one of the student's ear. The nurse successfully removed it and no further harm was caused.

My question is, are school nurses should be allowed or are you as a school nurse allowed to remove an object from a students ear if in your judgement, it is not necessary to take the child to an emergency hospital just to get it out?

I would have acted the same.

The principal's concern is that, if the child moves and accidentally pushes the object further in, more damage will be caused.

Any thoughts?

[fetch, BSN, RN]

The principal's concern is that, if the child moves and accidentally pushes the object further in, more damage will be caused.

Any thoughts?

What damage is the principal afraid of? Most kids put beans, seeds, nuts, etc in their orifices -- round objects that cause discomfort but hardly do damage unless left for an extended period of time.

If a child puts, say, scissors in their ear, I think most school nurses would be on the phone with 911 pretty immediately.

Other than that, if you try to get it out and only push it in further, you're not really in a *worse* situation than before, just a slightly different one.

ETA: I realized as soon as I published this why the question annoys me. It's an attempt to remove nursing judgement and scope of practice. The principal doesn't trust their nurse to know whether or not it's safe to attempt to remove an object? They want the nurse to send every kid with a broken crayon in their nose to the ER? Not necessary.

[NutmeggeRN, BSN]

In NH a nurse can use a Q tip to remove wax but it is NOT in the scope of practice as defined by the BON to use a curette. I would be careful and check with your individual state practice act.

[Kittery]

I think I would approach it the same way as a splinter---if it's right there and protruding enough that I am confident I can safely remove it, yes. Otherwise, no.

[Farawyn]

Right. I won't go digging, but if it's RIGHT THERE how can you not grab it?

[Elixer]

ETA: I realized as soon as I published this why the question annoys me. It's an attempt to remove nursing judgement and scope of practice. The principal doesn't trust their nurse to know whether or not it's safe to attempt to remove an object? They want the nurse to send every kid with a broken crayon in their nose to the ER? Not necessary.

Exactly! In my email I told her I would have done the same thing. I wouldn't want to send a child to an emergency hospital unless a pencil or anything sharp is embedded in the ear and if in my judgment I couldn't remove the object(paper ball in this case).

I did the same thing in another school last year and had no problem with it.

As a school nurse, I would like to limit unnecessary trip to the doctor or to the emergency hospital.

Nurses are in the school for a reason, if we call ambulance or send them to hospital every tiny little thing student gets, they wouldn't need a nurse. The secretary can do it.

[fetch, BSN, RN]

In NH a nurse can use a Q tip to remove wax but it is NOT in the scope of practice as defined by the BON to use a curette. I would be careful and check with your individual state practice act.

That's so funny to me, because I would NEVER use a Qtip to remove wax in my clinic! I don't even have the regular Qtips available - I have wooden sticks with a bit of cotton. If a child has wax, I just let the parents know and they can use Qtips at home or wash it out with water. Ear wax is not exactly a foreign object in my opinion -- certainly nothing I would remove at school. (Crayola wax, that's another story. )

[Leader25, ASN, BSN, RN]

Q tips tend to push wax in further and leave cotton debris mixed with wax.

[coughdrop.2.go, BSN, RN]

I think it depends. I had a kinder put a bead up her nose. I was able to visualize it, but it was in a position where I could either safely pull it out or push it in further. I also did want her to try to blow her nose incase she accidentally inhaled it. I called the family to pick her up and the physician removed it I believe. I had another case like it, but it wasn't as far inside so I removed it. Just give it your best nursing judgement and check your State's Practice Act. Keep in mind, your administration doesn't understand YOUR license. Educate and document goes for Staff and Admin too.

[NutmeggeRN, BSN]

Sometimes if it soft enough and with very gentle movement, I can get enough out to A: relieve pressure and B: visualize the ear field better. If it is rock hard and not moving, nope. But on occasion, it can be manipulated enough to get a better look. Any discomfort and I stop.

I always use this as a time to educate them about not doing it blindly, I am using the otoscope to visualize.