Parent FYI Calls

mc3, ASN, RN · Apr 5, 2014

Welcome to the world of school nursing! Yes we've all gotten yelled at for either calling, or not calling as the case may be. In this job it's important to remember you can't make every parent happy; it will never happen! I call home for: any cut on a face, any cut or scrape that's large or nasty looking. Definitely call home for any head bump, even it seems minor! I've never had angry parent question why I was calling for that. Remember, sx of a concussion can take up to 4 days to present, and you DO NOT want the parent unaware should something happen. I call for a first tme bee sting, even if an allergy isn't listed on their med info sheet. I had a child this year who was stung by a wasp. I called Mom to verify no allergy, and she did not exhibit any symptoms at all! The next day, Mom came in to thank me for calling her; her daughter did in fact present with hives followed by chest/throat tightness 4hours later and ended up in the ER that night. An epipen and benadryl are now in my med cabinet for her!Some other reasons....poopy pants that the child cannot clean up by themselves. I am never alone in the bathroom with a student without a witness present , which happens very rarely. I don't wipe at all, I hand the child wipes and send them into the bathroom themselves. I know it sounds mean but the last thing I want is some parent falsely accusing me of something..That happened several years ago to a nurse in our county. She was eventually cleared of any wrongdoing but went through a few months of he-- first. If there's that much poop, they'll probably need a bath anyway. Finally I keep a list of, umm, "overly emotional" parents in my mind that scream bloody murder if you don't call for Johnnie or Suzie's paper cut, and they're in 5th grade :)I'm sure I'll think of more, but it's always a good idea to err on the side of caution. And document, document, document! Oh, and cold,wet paper towels work wonders!Good luck!

mc3

rbytsdy · Apr 6, 2014

I'd love to read more tips!

I started 2 months ago and I'm still trying to figure all this out. I've started erring on the side of over calling. I had a kid come in complaining of his foot hurting because he tripped. I looked it up and down. Full mobility, no bruising, swelling, etc. But ice wasn't "enough" for him so I figure - what the heck and I wrapped it in an ace bandaid. I feel rather dopey for not calling and the parent called me the next day alarmed.

Sometimes I call for the complainers. I have one kid who is a little off and quite dramatic. He ran into my office screaming that he'd been electrocuted on his hand. I looked him up and down and sideways. I looked at both of his hands and he actually pulled his "non-electrocuted" hand away telling me it was the other one. I tried to explain that i needed to compare them. He would not stop raising a fuss so I finally called the parents and documented the conversation. I hadn't really thought to call for every bump on the head since a lot of times it's random little pokes but I should probably start doing that.

I'm not allowed to use heat so I use cold packs for everything. I think my kids (who are pre-K to 3rd grade) usually just want "something" so it's a band-aid, lotion, cold pack or cough drop.

The stomachaches and headaches are the ailments that really get me. I can't do anything for them other than allow the child to rest. Eventually they usually start getting fidgeting and I send them back but some start whining and crying that they don't feel good.

amnesiac1c · Apr 6, 2014

Of course there are exceptions but generally speaking, I call for head bumps, anything that would require some follow-up at home, if a child will "look different" when they go home (scratched face, bumped lip, etc), if they were hurt by another child (I have preK so sometimes there are bites, one was hit by another child, one poked another with a pencil, that sort of thing), persistent complaints like 3rd time to see me with a vague headache/stomachache.

I most often send a child home for fever/vomiting/diarrhea/pink eye symptoms. Also situations where I think they need medical care that day. Pooped pants generally goes home to get cleaned up because all I can do is send them to the restroom with wet wipes & clothes if I have them, which isn't usually sufficient.

bsyrn, ASN, RN · Apr 7, 2014

Other than what has already been said, I NEVER ace wrap anything. If the student needs an ace wrap, they need an x-ray. That is one thing I never waver on. just my 2 cents :)

AdobeRN · Apr 7, 2014

I agree with what has already been said. I Never ace wrap anything either - I would have kids in here all day wanting me to wrap something :)

Ice packs will just about cure everything too - My rule is that the injury had to occur at school - if kids come in looking for an ice pack for a bruise or for something that happened a few days ago - sorry - I tell them I need doctors notes or a note from parent.

I have a few "poop holders" in kinder - will occasionally have an accident. I will give parents a call before touching them and will clean them otherwise there will be poop everywhere and more of a mess for me. IF the kids are older - parents get called to come deal with them.

JenTheSchoolRN, BSN, RN · Apr 7, 2014

I only help re-wrap ace bandages that students come in with - usually with a doctor's note. But I work with grades 7-12, so ace bandages are seen a lot during certain sports seasons :). I send home or call for many of the same reasons listed above.

I, too, have a list of parents I know I need to contact for everything. I also created a "seen today in the nurse's office" letter that I send home with some kids to cover the "mom wants to know" factor, but it was minor and did not warrant a call home on the spot. It has worked rather well, actually.

100kids, BSN, RN · Apr 8, 2014

I always call for things that a parent will notice when the kid gets off the bus. I'd rather they have knowledge of it from me than getting emotional when they see it. I also call for anything I think a parent should keep an eye on (especially if it's right before a weekend or break). Especially if it is a sign of something that has been brewing in the school recently. I will wrap with an ace bandage but I am very picky about which injuries I will do this for. I have only done it 3 times since I started school nursing. All 3 times this was an injury where I recommended a parent take them to get an x-ray if the pain/swelling, etc had not subsided by the next morning. I call my frequent flyer parents from time to time to try and get their help in decreasing visits.

Ice is your very best friend in the school nurse's office. Many of the kids just want some attention and to feel like you are doing something to help them. My students know I don't send home easily and the parents appreciate it. I send home for fever, vomiting, pink eye. But sometimes you'll see a kid and just know they are sick and need to go home, especially if it's a kid you NEVER see. If I have a student visit me multiple times in a day for 1 reason I call home and often enlist the parent to talk to their child. I tell the parent I don't want to ignore their child's complaints but I will be honest about what I think and let the parents take it from there. I have a very strong relationship both with the students and the parents so this really helps. Build up your relationships with the parents and this will help you a lot in my opinion. Good Luck!

jsundhausen · Apr 8, 2014

I too agree with everyone else that has posted. As a first year school nurse this year, I too had this same issues at the beginning. My rule of thumb for calling is: anything that would leave a significant mark, anything in which I think a parent might question (odd story from a child, etc.), and anything that I think may be brewing (seeing a student for earache, ear slightly red, but not enough for me to insist on appointment). Regarding head injuries: if I don't see anything or feel anything, as well as if the child is fine (not crying, not concerned, neurologically okay, etc.) I don't call.... Sometimes if its a questionable one I will send home a head injury form that gives signs and symptoms of concussion, etc. If it is swelling up at all, then I call immediately, and offer for parents to come get. If it is swollen and child is off, I insist child is taken home and recommend dr. Ice packs are my best friend, and well as band-aids. Ear ease for earaches when there is no redness or anything. Mints for sore throat, also for stomach aches as well. If they rest and don't feel better, I send them to class. 9/10 they are fine the rest of the day, the other 1/10 will then throw up and I send home. I DO NOT send home every child that vomits. I send home the ones that vomit multiple times, throw up in the room everywhere, and the ones obviously sick. I have too many that throw up because they overate, they didn't like their lunch, or they have all that drainage causing them to throw up (and when I look at it, its only mucus and a few food particles).

I have found the parents that get mad that I didn't call for something, I tell them that I will make note to call you anytime I see your child... I do that and they quickly tell me, "well if it isn't that big of a deal then send them back to class". We can never win!!!

schoolnurse64 · Apr 9, 2014

Thanks everyone for all of your advice! I guess I'll have to get my student and parent body better, and until then air on the side of caution.

Songbird,RN · Apr 14, 2014

I am in Missouri, and we have the Dept. of Elementary and Secondary Education manual for managing school health! Does your state have such? You might contact your Association of School Nursing and ask. This manual has so much wonderful information for you! On the subject of head injury, we have changed our protocol. ANY and ALL head injuries are taken seriously enough to contact the parent and send a letter home with symptom list. NOW we do a checklist put out by the CDC. You can get the free materials to assist with concussion assessment for free from : www.cdc.gov/Concussion. If the student has one of more signs of concussion on this list, they should be referred. I have found 3 concussions using this tool, that if I went by the normal school assessment, the student would not have been referred to the urgent care of ER. You can use this tool even if the student was hurt at home or elswhere at a previous time. I think you will love this checklist, as I do, and won't be without it for assessing head injury!

T-Bird78 · Apr 15, 2014

Have any of you school nurses ever told a teacher to not send so many kids to the office? My son, who was in 5th grade at the time, jammed his finger playing dodgeball at recess. (Was trying to catch the ball and it hit straight on his finger instead). He asked the teacher if he could go to the nurse and she said no. When he got off the bus that afternoon, his finger was purple, swollen twice its normal size, and he couldn't bend it. I took him to the urgent care and it was x-rayed--not broken but dislocated. Doc reset it and he had to wear a splint on it for a week. I told my son that next time, he asks, asks a second time, and then walks out the door to the nurse and I'll deal with the teacher/principal/school board if necessary. The teacher just happened to call that evening to let us know he was doing great in school and I asked about the incident. She said if he'd asked her again then she'd let him go. I told her about our urgent care trip, the dislocation, and splint. She said the school nurse had asked the teachers to not send so many kids because they were going too frequently.