basketball13

I really appreciate all your feeback! Like you all said, I think it was just too early when I saw her so she only had mild symptoms. I just wanted to make sure there was nothing else I could have done. I actually did have her hop up and down a few times, and she did that without any trouble. Anytime anything like this happens, I tend to overthink and doubt myself. Thank you all so much for the reassurance.

Hello everyone, I am looking for some feedback. I had a 3rd grader come into my office mid morning the other day. She said that she felt like she may throw up. She did not have a fever, had eaten breakfast earlier in the morning, and she said she had a normal BM that morning. She had no specific area of tenderness or guarding of her abdomen. A couple other kids have had the stomach virus, so I thought she probably had the stomach virus or maybe it was from eating too much candy (this was after Halloween). I told her if she vomited or felt worse to return to the office. I told her to try to eat lunch and see what happens (lunch was about an hour later). I left to go to another school at lunch time, and I actually left a couple hours early from the other school that day for my own medical appointment so I did not follow up with anyone that day about her. The next morning I found out she had returned to the office later in the afternoon (still no vomiting or fever). They let her rest in the office for a little bit, but did not send her home. Apparently, her parents took her to the ER later that night for appendicitis, and her appendix was remove the next afternoon. She is fine, but I hate that I didn't catch it. Is there anything you would have done differently? Anything else you think I should have done that would have helped me recognize appendicitis? Of course, anytime a child complains of a stomach ache/nausea I consider appendicitis, but in this case I just did not have much reason to believe it was appendicitis, at least not at that point of time. I just want to do better in the future and appreciate any feedback you may have!

No, they didn't do much other than put O2 on her. They listened to her lungs when they first got there and said that her lung sounds were clear- which they most definitely were not. They took her BP, and I already had my pulse ox on her finger. That was pretty much it. Her mom did take her to the doctor and she has an inhaler prescribed which is at school now thankfully.

Thank you all. I am glad I called 911. In the future if something like this happens again and I am far away, I will tell them to call 911. The way the secretary described her condition to me, I was not sure how serious it was. Plus, this school calls me all the time for minor things. One time they called me and said this little girl hurt her knee really bad and needed checked. I drove over to the school, and when I got there she wasn't in the office. They said she was sitting on the bleachers in the gym. I walked in the gym and she was doing jumping jacks and running. The secretary was like "she was crying a lot!" lol. Regardless, better safe than sorry!

Thank you all! I definitely wish we had portable O2 tanks lol. Do you all think I should have considered giving her epi (and call 911 of course)? I just want to know better for next time.

I did at least tell the secretary that if she seems to be getting worse before I got there, not to hesitate to call 911, but I wasn't sure if I should have went ahead and told her to call 911 or not. The bad thing is is that I have no cell service between the two schools. Of course, I did not think of this until I was on the road. I wish we could stock albuterol, but it's a state law we can only stock epi and narcan. Narcan was just added this year, but our schools don't stock that as of now. Just epi.

I am a relatively new school nurse. The other day I got a phone call from one of my elementary schools (while I was at one of the my other schools) that a student was short of breath and struggling to breathe. They stated that she had been running in gym class when it started. No PMH or allergies that we knew of. I asked a few questions and then drove over to that school as fast as I could (about 15 minutes). Her face was bright red, lung sounds were wheezing, very labored breathing, tachypneic, O2 in the low 80s. She'd been like this for about 20 minutes at this point. Principal said she hasdn't gotten any better. Attempted to call mom, but initially could not reach her, so I called 911. While I called 911, the secretary reached the mother and she was on her way as well. EMS got there and put 2L of O2 on her. Within a couple of minutes, the wheezing went away, her O2 went up to the mid 90s, and her breathing became less labored. Mom arrived after the student looked much better from the oxygen. Mom has asthma. We took the O2 off of her and she continued to do fine at this point. EMS talked to the mom and didn't feel that she needed to go to the ER, but encouraged her to follow up with her PCP and get tested for asthma (which I generally agreed with). Mom ended up taking the student home and said she was going to call her PCP. Of course, since this has happened I've been questioning whether calling 911 was the right thing to do or if I should have held off. The nearest hospital is 45 minutes away. I had absolutely nothing at school that I could give her (we can only stock epi and narcan). What would you have done?

After I graduated a few years back I worked and floated between a cardiac floor, medsurg, and 2 psych units for a about a year and then worked the psych unit for a couple years before starting school nursing a year ago. I think a psych nurse can absolutely be a school nurse, especially if it's your dream. Psych comes in handy in school nursing. If it's always been your dream, I think you'll be happy with the switch.

I am 24 years old. I worked in the hospital setting for a little over 2 years before starting school nursing. Initially I was in a float pool working between a cardiac stepdown, med surg, geriatric psych, and adult psych floors. Initially I was exactly how you described. Incredibly anxious before each shift and super stressed during my shift. It was pretty bad in the beginning. After 1 year I had definitely calmed down and became far more comfortable, albeit an anxious mess during my shift. Towards the end I fell in love with the psych floor. I found it to not be nearly has high stress as the medical floor (though perhaps some would disagree), but busy enough so that I was certainly not bored. Plenty of direct patient care. Also, I just generally find psych fascinating making it even more enjoyable. I had to move however, and became a school nurse during that time. To be completely honest, I feel the school setting is far less stressful than the hospital setting. I'm not bored though. There is certainly always something that needs to be done and crisis do happen. While I may be rather busy doing various things like paperwork and such, it is not a stress/adrenaline type busy like it is in the hospital. In the hospital high stress/emergency situations typically happened the entire shift with no break, where as in the school those life and death type situations aren't happening constantly.. Therefore, I feel school nursing in less stressful because of that. I do personally though miss having those adrenaline type rushes while working, and I do miss getting to do direct patient care constantly so at times consider school nursing to be boring for that reason (not because I'm not doing anything productive). Does that make sense? It is hard for me to explain. One thing that does stress me out about school nursing in particular is that the public knows you're the school nurse and you become almost like a public figure. That means people are watching you more (at least in my small rural area). Also, you're likely to have angry parents talk about you on facebook for whatever reason and your friends and even family may see it. While I dealt with angry family member from time to time in the hospital, at the end of the day I likely didn't see them again or hear from them again making it easier for me to move on. I hate when people don't like me or get mad at me so this is one of the hardest parts of school nursing for me. Also, I miss having other nurses around to help me and even to talk to during work. Teachers understand teacher problems and aren't interested in how the school nurse feels lol.

At my busiest and biggest elementary school (around 230), I see around 20-35 (for a full day that is, on my half days I see around 15). Some days are easier than others. Some days it is mainly very minor reasons (bandaid for a cut, ice pack for an imaginary bump, itch cream, simple temp check). I personally do not mind seeing kids for all of these minor things.. I see it as job security lol. I quickly take care of each child and send them on their way. However, there are some days when it is a little more complicated. Hygeine issues, lice issues, truly ill or injured but cannot reach anyone by phone, etc. Even if I see significantly less kids on those days, it is much tougher for me and frustrating on those days. I've never had to take work home though.

I myself have battled depression and generalized anxiety since I was a teenager. I wrote it off during my teenage years as hormones. I went to college and started nursing school. I was a nervous wreck for clinicals. I was so terrified of hurting someone or messing up and killing someone... and I was just in the beginning stages of clinicals doing bed baths and talking to patients and I was terrified of messing up! I did great on the school work side of things, but clinicals were harder on me. I never slept the night before clinical. I did okay, but still had doubts about going into this profession numerous times. I almost quit in my last semester convinced I was too anxious of a person to do this. ICU clinicals terrified me and I did not even witness anything horrific as you are describing. I stuck it out and graduated. (I even worked as a nursing aide to try to help me overcome it and I do think it helped but I was a nervous wreck in that capacity as well though I was told I did well). I immediately got a job in a hospital in a float pool rotating between 2 psych floors, cardiac stepdown, and a medsurg unit. I never slept well before work and had horrible anxiety which led to even worse depression. I was so scared of messing up and not doing a good job. I cried before I had to go to work nearly every day and on my way to work I'd wish I would wreck so that I did not have to go.... things got easier though! After about 6 months I realized I hated med surg which was where I was scheduled to work the most. I then only worked between the cardiac stepdown and the psych floors. After 8-12 months I finally didn't dread coming to work. I also finally saw a dr. and was prescribed lexapro which helped my depression and my generalized anxiety. I was finally comfortable in my job and while there were still some stressful situations, I did not hate my job. I eventually went to psych full time and loved it. In my opinion psych is generally less stressful than medical units, but some would disagree. I did though just recently start working as a school nurse and overall the stress is significantly less on the average day. There are tons of different options out there, and once you become comfortable you are significantly less stressed. Don't let it scare you away. You are not alone. Critical care was not for me and may not be for you. You'll figure it out.

I too am younger, 24. I get it all of the time from staff. Occasionally from parents. I don't mind it though. In fact, I can of like it. For some reason it puts me at ease lol. Growing up, when I would go to the dr. or dentist and I was greeted like that, it made me feel more comfortable. My family talks like that a lot too. When I initially started working as nurse in the hospital at age 22, I got pet names all of the time from patients, other nurses, doctors, etc. Again, it never bothered me. Other nurses would ask me my age a lot and be surprised at how young I was. A nasty surgeon though who hadn't met me, went to the nurses' station and said the nurse of the patient in room # needs to come with me to that room for rounds. I walked in and he says "What are you in high school? You can't be the nurse." In front of the patient... He was always mean to the nurses. My first year, I struggled some with the older nursing aids. It was hard for me to delegate and they often looked down at me age. Eventually, I overcame it. I also struggled with patient visitors at times due to my age.

I am the one who started the original thread regarding my first emergency scare and it was similar to this! I had a girl come in for a super small paper cut with just a scant amount of blood. I put a band aid on it and she said she didn't feel good. She said she had a headache. She fell backwards hit her head and started seizing for 5-10 seconds and then came back to. 911 was called. The EMS too looked at me like I was crazy when I said she had seizure like activity (no history of seizures). They didn't believe me either. Turns out he doesn't do well with blood and has at least passed out before (parents never mentioned that to us of course lol). Apparently this is vasovagal syncope and when they pass out they look like they are having a seizure, but it is not actually an epileptic seizure. Pretty interesting. I couldn't believe a tiny paper cut cause that to happen! It was definitely scary in the moment though.

So I had my first real emergency scare in the school nurse setting. A fifth grade student walked into my office with a very small paper cut (and minimal blood) requesting a band aid. I finished putting a band aid on her and she then said she did not feel good. I asked her what was wrong and she said she had a headache. I asked herif anything else was bothering her and she said no. Unfortunately, I did not realize what was happening, and I checked her temperature which was normal. As I was putting the thermometer away, she fainted and fell backwards hitting her head and started to have seizure like activity for about 10 seconds. No history of seizures and no past medical history that we knew of. Her pupils were very dilated. She stopped and came to and started crying because her head hurt of course. We had her lay there. She was dazed, but knew her name, who the principle was, and where she was. I yelled for someone to call 911 as soon as the seizure like activity happened. The paramedics came and took her vitals which were normal. Of course, they doubted there was a seizure. Mom came and said she has fainted before from seeing blood. And she did say afterwards that the blood made her feel queasy. She did take her to the ER though. I did some research and apparently this is called vasovagal syncope and can cause what looks like a seizure, but really is not a seizure? Just wondering if anyone else has seen this, especially in the school setting? What did you do? I have seen NUMEROUS seizures in the hospital setting on a psych unit. Both epileptic and pseudoseizures.

THankyou!!

Thank You to everyone who was encouraging and kindly gave advice to my original question. And a special thanks to the ones who even stuck up for me!

Some Clarifications: 1. There is a doctors order for the insulin. There is a sliding scale ordered. However, there is a clause in the order that says the parents and school nurse may adjust it if needed. For example, I may adjust it based upon what she had to eat, if she is going outside for recess, whether or not she has gym, etc. I document everything related to this. I also look at how her blood sugar's been running the past few days and her reaction to the insulin. Some have suggested that if I see patterns then the doctor should be notified and he should adjust accordingly. That would be fine, but these trends do not last for long periods of times. That is what kind of makes it difficult. A trend may last a few days, but then it changes again. I've looked back at her blood sugars and insulin and there is no real pattern. There have been times when I've given 5 units for a blood sugar of 80 at lunch and in the afternoon her sugar was in the mid 100s. At other times I've given just 2 units for the same blood sugar and her afternoon blood sugar was still in the mid 100s. There is never a pattern or trend that lasts more than a few days at a time. I think a pump would be beneficial, but the parents aren't really on board with that at this time anyway. THe child plays contact sports and I think that may be why they're hesitant. 2. As for my comment regarding describing the other nurse as "older in her 40s," and me "younger in my 20s," I just meant that I wondered if part of my issue in taking care of this child has to do with the fact that the student see the other nurse as more of a mother type figure (therefore, listens better to her) and sees me more as a teenager (therefore, doesn't listen to me as well... also she has a sister who is around my age who the student bosses at home too). I was just attempting to describe the situation.. and why I may be having difficulty with the student..... It's kind of like when you work in a hospital and are in report and describe a patient as an "80 year old female with heart failure..." It was just a description of what is going on. Why is being told your "older" offensive anyway? It's a state of being. But I digress, and won't do it again. 3. Thank you to everyone who has given me advice about how to handle the child. And thank you to those who KINDLY gave advice and shared their experience in managing her blood sugar and insulin. I never expected to get backlash for this post. I just feel like my original post was picked apart, and to be honest I feel a little torn down. So extra thanks to those who stuck up for me.

Sigh, see above.... There IS a doctor's order... I've clarified this a couple of times. If I knew how to edit the original post, I would. I'm a new user on here. I have called the mother, but this doesn't seem to scare her... probably because she's got this same bossy attitude at home and doesn't face much consequence at home regardless. The discipline system at this particular school is to go to the principle's office pretty much. I've never actually done this, but perhaps I should go this route? I don't know.. I just feel weird sending a kid to the principle's office...

lol too funny! I understand that. I worked on a psych geriatric unit before I started this job, and some of those sweet, geriatric patients sure were a handful sometimes! I loved it though.

First, like I clarified earlier.... There is a dr.'s order on file for the insulin. There is a sliding scale ordered. HOWEVER, there is a clause in the order stating that the insulin may be adjusted based upon the parents' and school nurses' discretion. (For example, if she had pepperoni rolls and is not going outside for recess, etc., then she would get maybe a unit or 2 more than she would if she had say salmon and was going outside for recess even though her blood sugar was the same before lunch both times.) I really was just trying to shorten the original post so I didn't explain this in the original post. Clearly, this was a mistake due to the backlash I am getting instead of advice on how to handle this willful child from so many of those who replied. I am far too paranoid and anxious of a person to violate my license. 2nd what in the world does "trolling" mean? I mean really?

I myself have wondered if a pump for her would be more beneficial for her. She can be fairly unpredictable at times. She actually did go into DKA over the summer. She had gotten a bad case of mono which caused her spleen to enlarge etc. and she went into DKA. I agree with the more doctor involvement. The whole family has type 1 so I think perhaps they don't always see it as a real big deal. At the end of the day (245 pm) if she is above 250, she gets 1 unit (per doctor order). That actually is usually okay because she gets home around 4 and eats dinner at this time so she gets checked and covered at that time. The one unit usually helps keep her number reasonable when she gets home. However, if she is up in the 300 range, I go ahead and give 2 sometimes 3 units. She's been known to drop in the afternoon though which is why the order (1 unit) is so low. I rarely have to cover her in the afternoon though. She's usually in the 150 range. Lol, when I first got into school nursing and learned about how to manage her diabetes at school I was in shock. I mean I came from the hospital setting where there is a set sliding scale. A blood sugar below 150 at meal times would not get any coverage (not counting any scheduled insulin). The first day I had her, her blood sugar was 85 at lunch. I was thinking she didn't need any, but the other nurse told me to give her at least 2 units. We were having pepperoni rolls that day and she rose to around 350 by 2:30!

Let me rephrase. There is a sliding scale, but there is a clause that also says up to parental and nurse discretion as well (I can't remember the exact wording). If we followed the sliding scale to a T, she would not be controlled at ALL. That is why there is that clause in the order. As far as the more experienced 40 year old nurse statement goes, I just meant that I wondered if the student looks at the other nurse as more of a mother type figure (and therefore, listens to her better), and looks at me more like a teenager (and therefore, does not listen to me as well). It was not meant to be offensive at all. And I am not sure why offense was taken to be honest. So please ask me to clarify something if you don't understand what I meant. It is difficult to explain everything via a keyboard.

Let me give you a quick background. My county only ever employed 1 school nurse at a time. They finally added a second school nurse (me!) a few months ago. There is a diabetic student in 4th grade. She gets insulin around lunch time. THere is no set sliding scale as to how much coverage she gets. It's up to the parents and at school it's up to the school nurse to decide how much she gets. She also gets rechecked at the end of the day and if her number is over a certain number, she gets 1 to 2 more units. Her blood sugar can be very unpredictable at times but I have gotten her fairly figured out. Here are my issues. When I am checking her blood sugar and deciding on how many units to give her at lunch I have a hard time getting her to do what I ask her to do. Whether it be to actually check her blood sugar, to actually take her insulin, how much insulin to take, to tell me what she had for lunch, etc. Sometimes she will argue with me about how many units she needs (and I do listen to her and her rationale and there have been a couple times that I wanted to give say 3 units, but she wanted 4 so I did go with 4, but then she was a little bit low at the end of the day so I rarely do what she wants unless it's in agreement with me anyways,) I spend a good 5-10 minutes at lunch time arguing with her about how much insulin to take. The thing is, she is almost always a good number in the afternoon so I don't understand why she always argues with me at lunch time anyway. This was the big kicker last week though. On wednesdays I am at another school at the end of day and only come back over if she is above that certain number and needs covered. The teachers text me her number. Last week though she lied to her teacher and said she was 127 (no coverage or intervention) which was texted to me. However, the next day at lunch I came in and looked back at her blood sugars and saw it was ACTUALLY 280 (requiring 1 unit of insulin). I questioned her about it and called her out on it (explaining how dangerous doing stuff like this is for her) and talked to her teachers. She had lied (though she claims the meter is just wrong blah blah blah). Anyway, I told her from now on she had to show her number to her teachers which made her mad and she tried arguing with me AGAIN. I spoke to the principle as well and we called the parent to explain what had happen and also explained the trouble I've had with her. I don't think anything was said or done to her though at home. However, she is incredibly angry at me still today and argued with me again over everything and again argued about how much insulin to take today at lunch. I was incredibly firm with her, even raised my voice (something I don't really do. I am an easy going person), etc. I'm at a loss. She likes to say "the other nurse doesn't do this or that." The other nurse is in her 40s and I'm young and in my 20s so I don't know if that's part of the issue? Or if she just got so used to the other nurse and doesn't know how to take me? The other nurse and I switch schools every month so I only have to handle her a month at a time, but I just don't know what to do with her. Any advice??? Sorry for rambling and I hope that made sense? lol I'm just so frusterated, and don't want something bad to happen related to all this.

I've been looking for a PRN or casual psych nurse job. Especially so that I could work some in the summer. I actually tried to stayed on at my previous hospital PRN or casual (I not only enjoyed working psych, but I also had a very good working relationship with my manager and had wonderful co workers who became like family to me... which is surprising if you know me because I'm more of a closed off person, very shy at first), but at that hospital there is a nurses' union and EVERYTHING is by seniority. Therefore, they couldn't just let me drop from full time to PRN or casual because they had to post the job first, and then someone more senior than me applied. It's frustrating. Plus upper management there tends to hold a grudge when someone leaves for another job... even when you are a really good employee and upper management above my manager controls how many casual and prn jobs a unit can have. For some reason when the new upper management came in they decided they didn't really like PRN and Casual jobs (I have no idea why, they have NO BENEFITS like healthcare, vacation, etc.) There is only one other psych facility somewhat close by (both are over an hour away), and I've been checking their job postings a lot too, but they have not been hiring any RNs since I started my school nurse job in October. Please understand I do like my new job and if I had to do it over, I would still take this job (though I would have taken a casual spot that came open last May, long before I knew I would end up leaving lol)... Mental Health is just something I care deeply about. I was just wondering if I had any options, if that makes sense.

Thanks so much for the resource! It was reassuring to me to know that it will be very unlikely for the this child to spread lice to others in the school and to know that the lice don't really "bother" her. It still upsets me that she will have to live with head lice, but over all I feel better about the situation than I did before. I just pray that none of the other students notice that she has it.... but she does have some rather large, crawling lice so whoever is sitting behind her or near her in class will probably end up noticing at some point. I hope not though.