niferbu

It is my understanding, as an LPN, that I can fill in admin data (patient name, date of birth, demographic info) and directly observed vitals, height, weight only on FLMA forms.

School Nurse Pass Student's Name________________________________________________ Date: ___________________ Time: ___________________ Reason for visiting the school nurse: □ Bleeding – not resolved with pressure x5 minutes □ Asthma/Allergic Reaction/Rash □ Vomiting/Diarrhea □ Fever □ Head injury/Severe Headache □ Burns □ Injury – Injuries that occurred at home should be treated at home Student: "What would I do if this happened at home?” ____________________________________ "Would I stop activity with friends/go home if this happened outside of school?” Yes No If student's complaint would not require immediate attention outside of school, it does not require immediate attention during school!

I was also seeing ~100 students per day, and my "biggest" sent home day ever (16 years of school nursing) was 5! I just finished the data survey and of the more than 12,000 visits I have already logged this year, only 202 were sent home by me due to illness/injury! I decided in February that changes were coming! I had begged and pleaded and sent out countless "frequent flyer" list to no avail. So, I closed and locked my office door. It has been posted on the door and every syaff member received an email to let them know that no student will be allowed entrance to the nursing office without a call from their teacher and approval from the nurse! You and I would not accept other people walking in on our visits when we go to the clinic, so we need to treat students with the same respect and attention! It is too easy to miscalculate an insulin dose or to grab the wrong bottle if attention has to be split 10 different directions at once. And, we have the double onus of protecting HIPPA and FERPA! Generally, even the "every new day brings a new illness" students end up staying in class and seem to "forget" how sick they are once they are asked to sit and drink a bottle of water, wait 20 minutes before c/o headache to nurse, etc. I have cut my visits in half and I know that I am still seeing those that truly need help, scheduled meds, diabetics, enteral feedings, etc and ultimately helping the others to learn some self coping skills!

I finally ran a report, as of yesterday I have charted 9,320 visits. (High School 9-12th grade; 685 students). I had just reached my breaking point with 100 visits per day and so many of them were so silly and clearly avoidance! Besides requiring that the teacher call and receive permission, I have some other "set" rules: 1. Injuries that happen at home, need to be taken care of at home 2. I will not see students during 1st period-- you do not need to walk off of the bus and into the nursing office - if you were that ill then it should have been discussed at home 3. I will not take care of piercings, tattoos, body modifications -- if you were a "big" enough boy or girl to have received these, then you are "big" enough to care for them! Does anyone else hear, "My mom said I had to come to school and have the nurse send me home?" THAT might be my biggest trigger! If your mom is saying that, it means that you are already in trouble related to truancy. I will NOT then help you "cheat" the system by "sending you home." If you don't have any clinical symptoms of concern, you are going right to class. If you do have clinical symptoms of concern, you are going home, but I am not excusing it because it has already been made clear that your parent(s) was aware that you were sick and sent you, against school policy and risking the health of all the other students and staff -- I won't "reward" that!

I have 685 students (grade 9-12) and I was averaging 95-100 visits per day (including diabetics, scheduled meds, enteral feedings). In February I gave up on the idea of asking for help or asking for permission and locked my door! I have my door open and available 3 times each day for scheduled medication administration: 30 minutes start of school, 1 hour over lunch, 30 minutes ~2pm. I have sign on the door during those times to let everyone know that these times are reseved for scheduled visits. For all other visits, I require that the teacher calls and gets permission to send the student. I dropped to 50-55 visits per day!

I have been physcially threatened, had more hateful things than I can count posted online about me, I had my house set on fire - yes, really - and most recently I was pepper sprayed! All as a SCHOOL nurse!

You rock!! Thank you!!

I agree! I have said - more times that I can count - that we need to have classes on personal finance and classes on self coping! I worry that we have an entore generation that is not set up to be let out in the world! I am constantly telling my high school students that if they are "mature" enough to drive a car, have a job, have relationships (that are far too grown up) then they should also be mature enough to place a bandaid on a cut that they were aware that they had before leaving the house! Or, that because they live in a "smallish" town, they WILL run into their ex or a former friend, so they can not just skip the classes that they have together or come crying/anxiety attack 3-4 times a week to avoid the situation. They either do not believe me or can not understand that in life they will have co-workers that they may not like or neighbors that they find annoying but they can not run away from everything! Side note...I do understand that a lot of nursing involves mental health, but I do encourage nurses that have guidance counselors available to refer students! They are trained for these situations. I have 2 guidance counselors and 1 me for 700 students, so we need to back each other up and work in our wheelhouses!

This is brilliant! I might have to steal this idea!!

I supply every classroom with a PPE bag (gloves, disposible clothes) and then a goody bag of bandaids, cough drops, and foil packets of lip balm and will still get multiple students walking in asking for these things daily! I call parents to let them know if their kiddo is coming to the nurse more frequently than needed - I.e. asking for medication for headaches multiple times each week, daily requests for cough drops, etc. and am almost always met with astonishment because "(s)he never complained of this at home." I will get a reprieve for a week or two and then it starts up again! I have to shift a lot of the blame over to the teachers after this happens and info of parent response is shared! I don't know why the word "no" is so difficult?!

I did have a student once that I created a plan for that allowed the student to see me one time per day for 5 minutes. He had to be very wise in chosing the moment because once it was gone, it was gone! I knew that he didn't have anyone "on his side" at home, so I was happy to greet him and let him know that we were so happy that he was in school, and then send him on his way! It worked really well for him because I KNEW that there were no medical issues, but a little encouragement each day from the nurse, seemed to go a long way! He graduated in 2013 and still pops in to see me when he visits over the holidays!

And don't you just love how no one is sick on days with "fun" activities like pep rallys or guest speakers? I did have an issue early on of having my office swarming with students on Fridays (can't wait to kick off the weekend, I guess)... I started calling the parents and beginning the conversation with, "Johnny is sick and needs to be picked up, but I think if he stays home and in bed all weekend, he should be good to go by Monday." Once I ruined enough weekends, that problem stopped!

We have had countless meetings with student, student's family, family and admin, family and all current teachers... Plans are made for when student may see the nurse, but come the next day, she is (was) back 5 times! Since starting this new "rule" I have only seen her twice and for a total of less than 5 minutes! It is almost like she didn't NEED to see the nurse all those other times! LOL

I am 16 years in and feel like I have pled and bargained and wished away any chance of help curtailing the frequent flyers! This year they went from asking to see the nurse multiple times per week, to asking to see the nurse multiple times per day (up to 7!) -- btw, these are High School students! I have one student that has been to my office over 400 times already this school year! Anyway, I finally decided that it was going to be better to ask for forgiveness than for permission and I sent out a staff wide email with the "rules" for seeing the nurse. I have my door open for 30 minutes in the morning for scheduled visits and then open again from 11:30 -1:00 for all scheduled meds, diabetic cares, enteral feedings. Otherwise, my door is shut & locked! If a student is "needing" the nurse, they must have asked their teacher, then the teacher must call my office and confirm if I am avalable/when I will be available to see this student. If I have seen and treated this student already, I have the option of declining request. I started this process at the beginning of February and went from averaging 100 visits a day to averaging 55 visits per day! It allows me to actually do all the other duties that our jobs require without having to be here until 5pm every day! The "fight" I am fighting at the moment - and I will send out another email to all staff today - is that the students come down to my office with a handwritten pass because "when their teacher called, I did not answer"! I thought it would stand to reason that, if I don't answer, I am not available/in my office and to try again later, if needed. If it is an emergency, contact the main office and they will make contact. It is a forever battle, but I will not give in and eventually (I hope) this will be the "norm." Good luck fellow school nurses!