denstar

I have started in a city health department (in communicable disease) after years of school nursing. I already have my masters degree, technically an MS, not MSN. I did a program for direct entry into nursing/masters (I had a non-nursing undergrad). I know I am going to spend the rest of my career in public health. I am debating what degree would be most beneficial - an MPH or a DNP (with focus on public health). There are MPH/DNP dual program, but none in my area. Any experience or thoughts? Thanks!

Hi - I am in an elementary school (through 5th grade) and we are looking to see what other schools do for injuries that might be in more delicate areas (any area that would involve removing or pulling down of pants-private area or upper thigh). Barring an emergency, do any schools have a policy on how to assess injuries that would involve removing clothing? My own instinct, again barring an emergency, is to relay the information I have to parents and have them come look at the area with the student. I am not comfortable with asking a child to pull down pants for an assessment. Administration is wondering if we have 2 staff present and phone consent from a parent, would it be appropriate for the nurse to remove clothing to assess the area? Any feedback on what other schools do or policies in place would be appreciated. Thank you!

Has she considered that if kids attend school while still contagious, they get more children sick, leading to.....MORE absences?!

Yes - I remember when a staff member found out how many kids I see in a day and how many ice packs I give out. She thought I had a rotating supply of 5 ice packs (like my TOTAL ice pack inventory was 5). Hahaha!

I agree overall, that this isn't a battle I generally choose to fight-so I feel many of my ice packs are just 'TLC ice packs'. I do find with playground/classroom injuries that seem super minor though, that if I have them go back to class (without ice) and 'see me in 10 minutes' or next class break or something if still having pain, at least 50% of the time the student does not return, as they've probably completely forgotten they were even injured in the first place! That avoids any children complaining they didn't get any ice or treatment for an injury, and avoids me giving unneeded ice.

I think I need to add you to my 'bubble wrap' list. We'll just wrap you up in it, and then you won't get hurt so often.

Oh goodness...I'm already creating a poster to put up. If that doesn't make someone wash their hands, nothing will!

Unfortunately, I think it's pretty common. I remember being (embarrassingly far) through part of my first year and realizing - wait, who checks that the AEDs are working?!? It just hadn't crossed my mind (I think I thought of it as part of the facilities management), and there was no documentation/protocol for it. Sure enough, one of our AEDs hadn't been checked since loooong before my arrival and wasn't working. I think there are so many little (and big) things that can be missed without a proper handoff from the previous nurse and without a policy/systems in place.

Last school year, my then 7 year old told me that he and classmates had a 'mini rally' against Trump and McDonalds. How random kids are. Wish I had seen it!

Yes! The salad bar is fantastic - the children are really encouraged to make healthy choices, and do!

That's a good idea - for certain students who might have any of their allergens in the food bar. I'll bring that up!

Thanks OldDude! We're figuring out a good plan going forward. Part of the issue is parents pay ahead of time for lunches. Students then go to the hot lunch or sandwich line to get the main part of their meals, and then go to the salad bar. From the salad bar they just go straight to their table to eat, so there really is no one checking salad bar food before students eat. That would be great to have food services have to check students out and have a 'back up' allergy check!

The student sometimes brings lunch and sometimes takes hot lunch. I agree it would be best for the student to avoid the salad bar altogether, but mom seems to want him to use it still. He does always have some sore of an allergy free hot lunch option. For now, we are taking out chickpeas completely, but we can't feasibly do that for every allergy in school - we wouldn't have much of a salad bar left!

The student has a chickpea allergy, and knew not to eat hummus, but had never actually seen a chickpea, and so, didn't know what it was. I have the parent in touch directly with our food services manager to discuss as well. Not sure if it makes a difference, but we are not only a private school, but also receive no state/federal funding whatsoever.

Good morning, Well, last Friday, I had the moment I've had dreams about since starting school nursing - a student with an anaphylactic reaction at school. Staff did everything perfectly, and student is well now. Student complained throat "didn't feel good" at the end of lunch and then staff member noted bottom lip swelling. Student was immediately brought to me and needed his epipen. Really proud of my staff for recognizing the severity of the reaction, especially as the student was not yet in any obvious distress. Going forward, however, we're hoping to prevent any further reactions. This student (who is young), has known food allergies, and one of the foods he is allergic to was served in our school salad bar. The salad bar is open to all students, and students self serve (even the younger ones). Although we avoid peanut/tree nut products, we have a number of students with random, atypical allergies, and so we cannot guarantee these foods are not sometimes served in the salad bar. In looking to prevent reactions though, we want to see what we can change/improve on. Do any schools have salad bars and young students? Do you have any policies or advice on preventing reactions? If so, please feel free to PM as I would love to discuss. This is our 4th year of having the salad bar and the first time we've had an issue. Hoping to make it the only time. Thanks!

I am in Chicago and attended a direct entry masters program. I don't think anyone in my cohort had trouble finding jobs at good hospitals. Maybe this varies greatly by location? I'm from Wisconsin, and knowing the great reputation Marquette has (did my undergrad there), I would be surprised if you have trouble finding a position. Maybe see if you can reach out to Marquette and ask to speak with some recent grads to get their take?

Ah, yes, for chest pain (which I don't get often), I would do full vitals, no matter what. I used to do the same for dizziness (when I was wee newbie), but I see that complaint so often I try water/snack/rest first (if students seems well otherwise), and it often resolves (or I notice the student is quite talkative, and I say, "Oh, you must be feeling better?".

I think that sometimes (and I'm not being sarcastic, I literally mean just sometimes), teachers send the kids at the end of the day if they are still complaining so that the kids don't go home and say they felt unwell and the teacher didn't do anything. This way the teacher can say, well I sent them to the nurse. Do most of your kids ride the bus? The kids at my school all get picked up (we're private-no bus service), and by 3pm, whoever is picking the student up is on the way and will probably get to school at about dismissal time anyway, so sending to my office after 3pm isn't really going to get the kid home any faster. Also, do you have to take vitals on every student that comes in? I take temperatures very frequently, but only bp/pulse on occasion (and typically not for a mild stomach ache/headache without other symptoms).

Our school used to do the same as OldDude, however, we had many parents who either didn't realize, or purposely ignored the rule and either brought in home made items, or store bought items without the label. The number of treats getting sent home was getting a little out of control too, between every single birthday and every single holiday. It actually worked out well that a group of parents formed a group to reduce the amount of sugar in school and we now do not allow food related treats to be shared at school. Parents can bring in other small gifts to share with classmates, and/or donate a book to their class. I was worried how the policy change was going to go over, but the positive feedback far outweighed any negative, and parents overall are very ahppy with the change, and for new parents coming in, they accept it as the just the way it is. My children's school (they attend a different school) do the same. The kids love it, as when they bring their book in the principal takes their picture with it and gets put on the wall in the school lobby.

Thanks all for the reassurance! Maybe I'll see if we can add a line to our parent handbook next year regarding after school activities/illness.

When I first started, our school policy was to check the entire grade if even just 1 case of lice was reported (so that meant checking 80-100 kids!!). Absolutely ridiculous! I've gotten our admin down to checking just the class, and then if multiple cases are found in different classes, then I check the whole grade. We also used to send kids home immediately if any nits/lice were found (seriously, it was treated like an emergency and I was called to classrooms STAT!). I've never understood this, it's not like anyone expects nurses to go into classes looking at throats and checking temps if someone has reported having strep-an actual health condition! I've also gotten it changed so that we do not immediately exclude for nits only and whether a child with live lice needs to go home immediately is at my discretion. Most parents end up picking up early to get treatment started anyway. I would love to get our policy changed so that we do not do class checks at all (and possibly not even send letters home about it), but alas, I think our parents would push back waaaay to much, so I'll just be happy I'm not regularly checking entire grades of students.

Hi all - Do you ever have to make the call whether a child who was out sick during the day can attend a school concert that afternoon/evening? Our students had a winter concert last night and we had a kiddo who had thrown up in the middle of the night the before and was out school during the day. Mom asked me if she could attend the after school concert that day - I basically said if the vomiting seemed to be due to a contagious illness she cannot attend (especially as we've had a stomach virus pop up in school this past week that I'm trying to keep down until our winter break starts!). I did add that if it seemed due to congestion/coughing and she seemed fine the rest of the day she might be okay to come. We do not have a school policy specifically relating to school events, but regular school attendance and vomiting, students are required to be out of school 24 hours vomit free (with some exceptions made for vomiting related to mucus, etc...). In reality I know I made the right call, but am just feeling guilty as I know the student really wanted to attend the concert and was a little heartbroken that she didn't get to go. I guess I was just looking for a little reassurance that other school nurses handle it the same! Thanks!

We have had orders from the doctor for dexcom 5 stating that as long as blood sugar was in a certain range, we could go off of the CGM numbers and not do a fingerstick for meal/snacktime dosing. Seemed to work well for the student and her blood sugars were generally well managed. If blood sugars were running low/high, a fingerstick was done before treatment.

Our school stopped food treats (for birthdays, holiday, etc...) last school year. It was a parent led process, so maybe see if any parents are on board? It was getting ridiculous here, between birthdays and holidays far too many sugary treats were going home, on top of our 40 kids with food allergies I was worried about!! I told teachers when we rolled it out that if they felt uncomfortable talking to a parent who brought treats in still, that they could send the parent to me and I would be happy to have that discussion. We had a few parents that were upset with the change, but I think far more were happy we changed it. We also gave parents some suggestions for alternative ways to celebrate birthdays (donating a book to the classroom has been a favorite).

Just to add - the medications I keep in my office are in clear plastic bins from the container store. For now, I put each student medication in it's own Ziploc bag, clearly labeled and have a grade or two in each bin (depending on how many there are). I then have a label on the outside of the bin indicating which grades and students have medications contained inside. In an emergency, would just have to grab the appropriate bin and should be easy/quick to get it out. All staff are aware of their location and I leave the cupboard unlocked for easy access.