anxiousnewgrad58

What do you all do for your elementary school kiddos complaining of chest pain? I am brand new to school nursing and subbing a few weeks at a school I am not familiar with. A kiddo came in complaining of chest pain "like someone punched him in the chest" as I was about to walk out of the door for the day. I asked when it started he said 10 minutes ago in math class. He had no n/v, SOB, headache, dizziness, difficulty breathing. He was talking up a storm with no difficulty let me know he had a bit of a sore throat and hurt his wrist at recess. Told me about every bump and bruise he's ever had. Looked completely fine no change in color, and no signs of distress. He wasn't crying or guarding his chest in the slightest. The front office staff let me know he is seen frequently and they thought he was just fine. Another nurse in the building also was ready to send him right back to class. I struggle with school nursing as I always feel like this may be the one child where something is gravely wrong. The schools in my district have essentially nothing in the building (no pulse ox etc). I had him rest in the office and drink water which made him feel "a little better." Before going back to class I said he could stay for a few more minutes but he wanted to go back (he was very bored in the office with us). Although everyone else was ready to send him back to class I called the parent especially because he has a hx. of asthma that he "mostly grew out of" he also takes ADHD medications. I told the parent he seemed to be in no immediate distress. I asked about his asthma. I gave the parent the option of what to do but said I could send him back to class for now after resting and hydrating with instructions to return to the office with any complaint. Parent was comfortable with that. I instructed the parent I always strongly recommend contacting ped for anything "chest and above." I checked in with parent once the kiddo was home from school. Kid explained to parent something a bit different from me and said it was "tightness" parent thought he may have gotten a little tight at recess and kiddo said "maybe that was it". He was already asking to go outside and play and acting his normal self per parent. I know that with peds chest pain is rarely cardiac. It could have been GERD from lunch (taco day), mild asthma symptoms from recess during allergy season, the very beginning of a mild viral infection, anxiety or distress over his wrist injury (from baseball at recess), MATH CLASS itself or a million other things. I just feel like I under reacted here partially because of the opinion of the health aid and other nurse there. If I would have been solo I would have done further investigation, taken a really good listen (although my ped assessment skills are not stellar I.e. I can often find some issue when nothing is there). I felt a lot of pressure to not over react (as I tend to do because I am new to nursing in a well population) and feel like I failed this kiddo by undereacting. I am having a hard time letting go of this one. What would you have all done and do you think I messed this one up? I will take any honest critique at all.

Hello all! I am new to school nursing. I run into situations everyday where I feel I am WAY overreacting or in some cases under-reacting. It is difficult to switch from an ill population to a well population for me. Is there any school nurses that would be willing to chat or PM at some point? I would greatly appreciate it. I have so many questions that I would have a hard time writing on a public forum. Thank you so much!

Thank you! I have been considering doing that. However, it would be nice to speak with a professional in that field who has some nursing background as well to go through some situations from work with. I am having trouble finding someone who matches that description in my area. However, in our virtual world I would love any suggestions of possible online nurse coaching/therapy/etc! ?

Thank you for your reply! You are right I can't remember all the details I just wish I would have had the knowledge I have now to have used luke warm water and have done proper foot care. It was definitely hotter then it should have been now that I know better. I always just wish I could go back and make sure everything turned out okay and correct my mistakes.

Thank you for your reply! I think that one of the hardest things for me is I can remember asking the question to the patient. I can remember the feeling of realizing my mistake later on but I can't remember the details of the day if I checked water temp with an ungloved hand had him check with his hand first etc...it's just been too long to remember the details. I just so want to do the best for my client's and I think all the time how I will view what I am doing now as a new grad thrown into nursing during COVID when I know even more later on. I know this type of reviewing mistakes is only helpful to a point but it seems like I do it very often.

Thank you for your reply! How do you cope with those mistakes you can not fix? I can take mistakes where I can walk back into the room and fix it as a learning experience. However, I have a really hard time forgiving myself for mistakes where I don't know if it had a negative outcome.

How do you cope with those mistakes you can not fix? I can take mistakes where I can walk back into the room and fix it as a learning experience. However, I have a really hard time forgiving myself for mistakes where I don't know if it had a negative outcome.

Thank you for your kind words. We all go into nursing because we want to help. I am anxious and not the fastest learner. So for me looking back at these mistakes is hard I always think "I should have known better by then!" I KNOW I want to do everything I can for the people I serve sometimes I just wonder if everything I can is enough especially when I think of mistakes like that where someone maybe was hurt.

I am searching for some guidance. I can not get over some mistakes I have made YEARS ago. Simply because they seem so damn stupid to me now. For example, I keep replaying this patient scenario... I was in my early 20's and my first year as a CNA. I was working home care. I was working at a home of an older gentleman and one of his tasks for the day was to wash his feet. I asked if the other CNA's usually washed this man's feet and he responded no but they are suppose to. I filled a basin with hot water from the man's apartment sink. I recall having my hands in the basin with my gloves on and it may have been a little steamy like a hot bath I can't recall for sure. I asked if the water was too hot each time he began to put his foot in (as I was there a few days and washed his feet a few times) I remember him saying something along the lines of "I can't tell" or "feels like nothing to me." I thought it was an odd response but took it as the water was not too hot. I would wash, lightly dry, lotion and put his socks back on. Months later, sitting in one of my first semesters of nursing school it clicked that this man had diabetic neuropathy he couldn't feel the water at all. That anxious "how did you not know that WOW! Were you thinking" feeling kicked in ... and for some of these mistakes hasn't left since. The water was likely WAY to hot the feet were soaked and not properly dried as they should be for diabetics. I will never know if this caused this poor man burns that could lead to more serious issues. I remember leaving those days thinking I did something good for this patient other CNA's refused to do. Now I just can't stop thinking of how many mistakes I made that harmed patient's that I didn't notice. Do I have no common sense? I feel like a failure for these mistakes and wonder how many I make as a nurse each day from knowledge I haven't acquired yet.