MollyJ

Re: dogs in the building well, maybe I'm old but I've seen this. Problems: Drug sniffing dogs get nose fatigue just like you and I would if we went on a perfume sniffing mission. They are only good for so many minutes of work. Like maybe an hour. Not claiming expertise on the exact time. Disruptive to the school day and may not be worth it.

You are very young and when I see young people admitted to nursing school, I wonder at the wisdom. But you're there. Here's the news: You are going to have to take at least some of what she said "to heart". You are going to have to subsume being a typical 17 year old to some degree. The patients are not there for your edification, enjoyment or amusement. They are there for care. You are going to have to learn to censor yourself in a way that most 17 year olds don't have to. If you can, go _back_ to that instructor and tell her you want to talk to her again--not on the floor but in private and in her office. If you cannot do it with her, do it with a faculty member you are comfortable with. Get a very concrete list of what you need to work on. Consider finding a mentor, a nurse who will talk through situations with you. See, if you do that, you will be exhibiting a mature desire to work on doing what it takes to become a nurse. we have very minimal contact with student nurses in my school setting and I often meet students that I think could benefit from mentoring but I've never seen it done systematically. Still, try to create that for yourself. wouldn't think you are alone on this....

I think you are reacting to the parent-child dynamic here. The pain of a mom who could not "make it better" (even before this time) for her child. You might try writing out your thoughts. _Pretend_ you are going to submit it for the writing contest that allnurses sponsors. Here is a mantra that I sometimes invoke. My DH introduced me to this one and he says it is Buddhist in origin. Imperfection is part of the perfection of things. Many situations cannot be made "all right" and they can become the stuff of what makes us softer, more compassionate, more understanding of how love is always expressed imperfectly.

Perhaps we can form a support group. I'm using ours under duress. No one would ever think that ours was put together in consultation with nurses but many nurses obviously think the computer is the future and they embrace it uncritically. That last part is the part I don't understand.

In the state I live in we use a drug recognition protocol that is based on field sobriety tests. I think the results are iffy at best. I also believe that in our community parents can request from the sheriff's office a drug screening kit for urine that they read themselves. I will tell you that I am not necessarily for schools having the right to test kids. You know when we do tests in a clinical setting we do it to facilitate decision making, clinical decision making. I don't think schools are the best people to test kids. The "zero tolerance" policy means the kid may get expelled and that might not be the best thing for him. It also may simply generate too much resistance on the part of the students and the parent. I do not like our drug recognition protocol but it forces a discussion between child, parent and principal. That can create some movement in the situation especially if it can be connected to things the parent worries about with their child and things the child sees in his life that are signs that his/her usage is problematic. But it may not and you cannot make it so. I would say that I would _try_ to improve my relationship with the student. Let's face it, who among us would want to be a teen diabetic? And if someone here was one, then pipe up. The age of this student matters a great deal. I am guessing that we are talking about a High School age child. I would work to just get him to test more often and help him do problem solving but acknowledge he is in the driver's seat. It is not easier but it is more effective to confront a kiddo about drug concerns if you have a relationship with him. I think at least sometimes marijuana is a (mal-adaptive) stress coping mechanism. As you build relationship you can talk with your kid about diabetes and stress and stress management. Also another question is, "do you have an SRO in your building?" If you do, you, the principal and the psychologist should know what the protocol is for confronting a student that you think may be acutely intoxicated.

Jules, I would like your comment "twice" if I could.

I think possibly what matters is what your goals are for getting the BSN and what you want it to do for you. The place I got my BSN from was a State University and I feel I can "take my degree anywhere" and it definitely added to my nursing practice. It is these last two features that I feel are essential. You want a credible degree--and for me that meant a bricks and mortar institution--and it should add to my nursing practice. Now I am not arguing that everyone should look for a bricks and mortar institution but I think a nursing faculty who are working cohesively to provide a body of knowledge that they think a BSN prepared nurse should have is important to me. My two cents worth.

AbbyNurse, The test is done using a standardized kit and while you "could" cobble the kit together, I would say that surely in your community there is a kit you can borrow. The manual with the kit is invaluable. If you are a student, I would hope that the school might have one or could help you find one. It's a common enough tool in pediatric offices and maybe if you know a peds office they could help you. I administered them all of the time when I worked in public health and maybe the local public health agency could help. The test items are normed with being presented in a certain way and to be a credible presenter you will want to be able to do that.

You know, I think I would also consider calling my state rep or senator and telling them I cannot get the BRN to call me back. The more I think about it, the more outrageous I think it is that it is so hard for you to get them to talk to you.

I use "all bleeding eventually stops" but more often with teachers than kids. I'm in an elementary building. But how about those nose bleeds? You would think they needed T & C 2 units RBC's....

NanaPoo, I had a kindergartener whose mom is a teacher in the building. And the kindergarten teacher was telling her that at the beginning of the school year, some kindergartener was crying after being dropped off at school. The teacher's daughter looked up from her work and said, "You do realize you're going to see your mom after school, don't you?"

Subbing is a good way to get to know the building(s) and to try on the job. It also is a way for staff to decide if they like you. However, nothing beats the long term relationship with kids, staff and families. It may be what I like about school nursing the most. Shining in an interview is difficult. It can be "just chemistry". However, know that while the first aid stuff is often the most connected image of school nursing, it is not, IMHO the most important. Be willing to talk about your experiences in the care of children and families, your aptitudes and abilities in working with special needs kids including psych mental health issues, your comfort with doing or learning about technologies that might come to school, and your experiences with family nursing. Finally the weirdest thing about school nursing is that health care is not the "main event" there. Education is. Nurses and nursing are not very...important. Perhaps others can speak to this, too. You are an adjunct to the main business of education. So that's different. But I like it.

Jules, the APRN's and PA's I refer to mostly work (but not exclusively) for community mental health center's. Their supervising MD is retired and lives 3 hours away by car. They do not for the most part have access to the bushel of child psychiatrists that exist in the state that are in private practice. My community, a decent sized community of about 40,000 people has long struggled to recruit child psychiatrists because for the most part the hospital is not willing to admit child psychiatry patients. And I am not trying to paint the hospital as a meanie--their are some real formidable reasons for their decision. The features that feed in to the undersupport of the APRN's and PA's are systemic and not single cause. Reimbursement is a big part of it.

BostonFNP, I am not talking about kids who are well managed and doing well on the prescribed regimen. I am talking about outliers, tough cases. But these are individuals whose less than optimal _situation_ exacts a price on the child, the family, the school and the community. If they were your kid, I assure you, you would be seeking expert resources. But see, when we perpetuate the idea that all care can be equivalently provided by APRN's and PA's, then we lose access to that deeper level of expertise that is sometimes needed. I am not trying to argue that APRN's and PA's created this situation, please do not misunderstand me. But they have been exploited I would say. And if you are, as your name indicates, living in Boston that deeper level of expertise exists within a 30 minutes drive radius. That is not true my area. And many of the children in question are covered by Medicaid, CHIP. It would be hard to understate how poor the quality of child psych services are in my state and I am not trying to diss any practitioners that might be from my state. The system perpetuates a fantasy that these children can be solved with brief hospitalization and then tossed back to their local MHC's with no coordination or support to the MHC. I know that over-referral has been a topic here. I am talking about a different problem. The problem of APRN's and PA's not having sufficient support or resources for them or their patients. This model suits insurers but arguably in my state it is reimbursement issues that have limited access to experts. This is a systems problem but one that affects children and families in my community.

BostonFNP, I am not trying to get into a fight here. Surely, everyone has a patient they say about, "They needed someone; I decided it was someone smarter than me." This just looks more like APRN's and PA's left holding the bag than anything else to me. And surely you understand that 4 years of medical school plus a residency in psych and specialization in child psych might count for something, even though I know that you DO help a lot of people and I am glad for that as are they.

Jules, I like the APRN's and PA's I work with just fine. They are nice people. They do help people. But my school building has some really complex kids with ODD tendencies along with ASD and these kids need coordinated team approaches that include a skilled psychiatrist and in my area, that is just hard to come by. And I think that depending on who mentors whom, people can arise to great levels but these patients are in a psychiatric care dessert and the mid-levels while doing their best I think would love to know that they had somewhere to turn--to talk to, to have the patient seen with them--though I certainly cannot speak for them.

I am interested in knowing how you picked L & D for your senior practicum, which to me should be a capstone experience. Are you wanting to become an L & D nurse? If the answer is yes, then your topic writes itself: What are the learning needs of experienced nurses in the L & D setting. If you are wanting (say) management to be the focus of your L & D experience, you can shape it around that but how much credibility would a nurse manager have if they didn't have L & D experience? I cannot answer that. I would take advantage of what L & D uniquely offers and maybe connect it to what you have done before. For example, if I worked in a public health setting with teen mothers and came to do a L & D practicum, I would link my real life to that setting and I might focus on meeting the needs of teen mothers in labor and delivery. Just some ideas to roll around in your head.

I am assuming we mean continuing ed here. I do sometimes leave it to the end of my relicensure period but frankly managing it is easier than ever with on-line offerings. In the olden days, you had to scurry around to find something you could attend that would give you 6 hours there, 3 hours there. there you would be, as an ED nurse, sitting in a breast feeding update class. I think a couple of things plague continuing ed. The stuff you must take repetitively that you may or may not get hours for that eats into your continuing ed time and energy budget--like BCLS, ACLS, re-cert stuff. Most of us want to hear high quality speakers talking about content we care about. That can be available but is usually expensive both in real cost and the time it takes to go to it. I am thinking national conventions here. And then there is on-line offerings. I tend to want the same from on-line--high quality information about something I care about. That is getting easier but it is a little didactic. As a school nurse, I see how public school teachers are flogged to make their educational offerings to students high interest and engaging and stimulating of critical thinking but the on-line format and most lecture format stuff is pretty much fact laden and then the test part (on-line) is feed back facts. My solution to that is do what you can. everyone should go hear highly engaging speakers in their field when they can. But when all else fails, go find that on-line content and make it as relevant as possible.

I was a messy young nurse. I had some older nurses tell me that I needed to leave my patient rooms in better shape and I'd like to think I got better at it. But I really think that you are just showing stress from working in an inhumane setting. Inhumane for patients and nurses alike. Until we can capture what nurses do AND eliminate the idea that unless it's reimbursable, it's not important, nursing will continue to have difficult, soul-destroying work places. Fix what you can; take care of yourself.

I will generally record pupils, extremity strength and can do BP and pulse for "bigger" hits. I look for signs of trauma (scalp abrasions). I like to just observe kids. Just walk away and "let them rest". Some kids will complain of headache but then they will socialize with other kids, want to read a book (I have Guiness books in my office) or just stay perky and interested in what is happening around them. I generally think the best thing you can do (for bigger hits) is re-evaluate over time and tell teachers to send kids back to you for c/o headache, head down on the desk, not focusing on what's going on. I always call parents for bigger hits and tell them what I am seeing and planning but tell them I am willing to do whatever they want to do. I always like to get the teacher to tell me what they saw or observed. Kids who get clocked playing basketball, goes down and stays down, comes in looking dazed, is happy to lie on my couch--those kids write their own story. They go home. Likewise, the approach of assess and reassess will help you make a decision. There are very few situations where you must decide to send them home this minute and you never lose the option, upon reassessment, to send them home. In the wake of discussions of post concussion care for students involved in school sports, I had the opportunity to have a couple of random guys tell me about their concussive head injuries. One kid didn't remember the game and slept the whole next day. Look at the whole kid.

My state no longer issues cards but you can go on line and print out a proof of licensure. My BON has a site that you can log on to as a nurse and so you are getting info you are entitled to only. I would peruse the web site.

I live in a psychiatrically underserved area and the bulk of psych care given to _children_ in our area is given by mid-levels. God bless them. This is what I will say. My mid-level colleagues do help a lot of people but we have a significant number of children in our area who are high complexity and require expert psychiatric care. I worry about a situation where the most vulnerable children are being cared for by the least educated practitioner. I would also say my mid-level colleagues are under supported by their advising docs who physically remote from where they practice and may infrequently see or never see their high complexity patients. It's not an optimal situation.

Arlorenz, can't help but notice that this is your first post and Flare's question is pertinent and by no means an indictment of you, your parenting or your child. I would be inclined to work with a parent like you and have the child go forward in the day and perhaps monitor him more frequently (neuro checks every hour or two) and ask the teacher to report to me if he's having any problems focusing etc. If you have proposed this to your school nurse and she is not comfortable with it--I'm somewhat of an old dog--then see if you can get your doctor to sign off on it. He could write a note like, "IF Johnny bumps his head and does not have any obvious trauma or loss of consciousness, let us have him go forward in the day with monitoring." At the end of the day and more frequently if needed, the nurse can report her findings to you. Our state, like many others has responded to the spectre of concussions in children participating in sports and that has influenced my practice. But I would say that as a parent and a school nurse if I thought I was seeing a pattern here, I would want to intervene on it.

Love the comments! I have a few teachers who send kids to me for "TLC". If they do it rarely or occasionally, I am fine with that but if it's routinely I can get a little stern. I do not believe in reinforcing the idea that if...your mom's a dead-ender, if you're feeling sad and out of sorts, if your friends dissed you today...that we adults should reinforce the idea that you should medicalize your feelings. "I feel sad--angry--upset and there fore I am sick." Anyone ever met those kind of adults in other settings? However, I DO think that every adult in the building should make an effort to have positive contacts with kids that are independently reinforcing. So, I try to be aware (and I am working on this--it's in progress) that when I see those kids in the hall that make me grind my teeth when I see them in my office, I try to acknowledge them and tell them I am glad they are with us today.

I use this a lot with my FF's but also with a lot of kids, "Keep going but listen to your body. If your body hurts during activity reduce the intensity of your activity but keep going. If the problem keeps happening, let mom or dad know." This is useful for the twisted ankles, sore knees, sprained wrists because truly if the problem persists or worsens, it should be evaluated but most of those aches and pains will improve on their own. I'd like to think that I'm giving them a life long tool for figuring out when a problem is a problem.