PattyB RN

Hi 110 kids! Here's how I do it: I log in every single kid I interact with. I have about 10 daily medications, 2 blood sugar checkers, and 2 students who have straight cath orders. Yes, I log each one in because I interact with each one. I speak to them, ask questions, see how everything is going...it's a mini assessment in my book. I have about 850 kids in my school and I'm the sole RN. I have a health aide who helps with logging in and taking temps etc. I need to take credit for every student. Each day the meds need to be counted, calling parents when supply is low, assessing for efficacy with teachers. Actually, I have to log them in or I'll have no idea how many students I gave meds to at the end of the month for my monthly report. I'd have to go through the med book and I have about 100 prn's as well as my daily & special procedures. How do you do it?

Hi JZ...In my school district the nurse are not required to do the diapering/toileting of any child...whether early intervention at age 3, pre-school or special needs. Instead, the Board of Education requires paraprofessionals, who assist teachers, to perform any personal or hygenic need. The union contracts clearly define the roles of these paraprofessionals and they accept the job knowing what the duties entail. Since it seems that it's your responsibility, I would say to request a changing table; it will be better for your back and safer for the children. I don't think standing a person up to change them promotes self confidence, do you? How can it promote self confidence when someone else is cleaning your bottom? I don't buy that logic. Also, check to see if it's actually your responsibilty. If your school has "paras" it may very well be in their job description. I don't understand why it would be a nurses' job to change children. In our elementary schools there too many children to have the nurse do all the changing! The nurse would be constantly changing kids! There would be no time to administer meds, give first aid or tend to the sick children! Obviously if a child has an accident I will assist and help but it's very rare as I'm in the middle school. Good luck with your endeavor as a school nurse. It can be a lot of fun!

Caregive 1977..I'm not sure where you practice, but it's always a good idea to know your school's policy before something happens. I work in CT and we follow the state of CT guidelines for life threatening food allergies. It was stated very clearly that the elimination of any food item that is considered "life threatening" would be ill advised. The point being that if a district tells parents that the school is in fact peanut free, someone had better be responsible for enforcing the rule. It also impinges on the majority of the students' civil liberties as they might enjoy a pb&j (or whatever the allergen is) and they should not have to be deprived. I think the best approach is to informed and prepared. I have 10 students with peanut allergies, one with a latex allergy, and 2 with bee sting allergies. I require an epi-pen and benadryl for each student and plan co-signed by their PCP. I ask the parents how they feel about a peanut-free table in the cafeteria. At this point (I'm in mddle school now) all of the parents are against a "special " table. Instead, we focus on educating the child (and by middle school they know how to look @ ingredients), they are aware of the signs and symptoms of the onset of anaphylaxis,and we inform and educate the staff, teachers, paras and cafeteria staff.Our districts' nutritionist has also removed any peanut containing foods from menus and has provided all of our schools with a detailed analysis of every single item offered by the schools from main courses to side dishes to snacks and juices. I have taught many teachers how to administer the epi-pen if needed (for field trips and after school activities), but the pen is always kept in my office. We have a very good system and so far in my 11 years I haven't encountered a problem. I can't imagine the school district hiring a CNA or med. tech to shadow a student all day. What a horrible job that would be! Good luck in your school nurse career. It can be very rewarding.

I also work in a large urban school district. We have many students with life threatening peanut allergies. When the discussion turns to abolishing peanuts (shellfish is not an issue, we're too poor for that) we, the nurses, were the ones to point out :If you abolish peanuts/treenuts, who is going to police the large student body for peanuts? Not the nurses! It would have to be the teachers who see the students all day and at lunch. And I'll tell you right now, the teachers are NOT going to be on board with taking the responsibility! You cannot expect a large population to comply with a no peanut/treenut policy. Besides, there are peanuts/treenuts in many items that one would never even suspect. I can see the district ban peanuts/treenuts from their lunches (the ones the school makes) but not from lunches provided for by parents from home. It does infringe on non-allergic persons civil liberties to deny them of a food item that they enjoy. So if a school bans all pea/tree nuts and an exposure happens, who will be liable? I wouldn't want to be the school district in that case. They would have to prove who it was that was responsible for "monitoring" all of the students. Good luck with that! Being prepared, informed, educated and ready for situations is the way to be in my opinion.

To answer Flare...would I use another child's epi-pen to save the life of a student who doesn't have one? Yes. Without hesitation...as long as it was the proper dose (Epi-pen jr for a smaller person) and if was boxed & labeled from the pharmacy. How could anyone stand by and watch another human being die? Fortunately for me, I have my own epinephrine to draw up for use in an emergency if the child does not have an epi-pen of their own...which all my students have. It's the unknown that we have to be prepared for; the unknown allergy, the unknown severe asthma attack. I know if I did use someone else's epi-pen to save a life I open myself up to legal action but I would go to bed with a clear conscious knowing I saved a life. That's why I became a nurse. That may be why I was put on this earth..you never know.

It's heartbreaking when a preventable tragedy happens. I am a school nurse in Connecticut. In my district, we have a standing order to administer epinephrine to anyone exhibiting signs/symptoms of anaphylaxis. Also, upon registering for school, all parents must fill out a health form. If a life threatening allegery is noted, an Epi-pen must be on hand at school for an emergency. If the parents do not comply, an immediate referral is made to our State Department of Children & Families and action is swift. Needless to say, every child identified with any life threatening allergy (bee sting, nut, latex etc.) has both an Epi pen and diphenhydramine on hand as well as orders to call 911,transported to the hospital where the child will be observed for several more hours. If an allergy has not been identified, our standing order for epinephrine will allow us to administer the life saving shot if necessary; minutes matter when dealing with anaphylaxis. There is no reason to exclude a child from any school. Parents need to disclose information and be responsible for providing for them. Schools also need to be proactive; for not every life threatening allergy is known ahead of time. A life threatening allergy can develop at any time so it behooves school systems to have professional, registered nurses at each school to ensure the safety of the students as well as staff members as well as standing orders (and medication) such as epinephrine. My prayers go out to the family for their loss. Hopefully, this little girl's story will prompt action and her little life may save many, many others.

No, we don't screen for acanthosis. I think it's a good idea. Makes you wonder if the parent even notices the furry darkness of their child's neck! Thanks for the thought.

I agree, checklists can cause mistakes. I was in nursing school back when we all wrote a narrative at the end of our shifts. Blue ink for days, black for evenings, red for nite shift. Ahhhh...those were the days! We all had Bic four color pens! That's when nurses still did bedside care. A perfect time to assess almost everything was when you were bathing them. I know times have changed but we need to be so careful. Every checkmark can/will be challanged in a court of law if needed. I'm just surprised that a patient was allowed to view the chart. It's my understanding that it is not within a patients right to look at the chart. I am the keeper of student records in a school and no one is allowed to view them without written request and then they can only view them in my presense. They may not make copies. I guess I'm old school and I always go by the book. Sad to think nurses are unethical or dishonest; politicians sure, but not nurses!

Thanks so much for the details. Really helps put a few pieces if this puzzle together. I've had a ton of kids with just really red throats (sore of course) but no fever. Now I'm curious to see if those same kids come down with the fever/flu symptoms a few days after the throat. I don't know how many pediatricians are actually testing for the flu but it's definitely a good idea. Hope she's feeling better!

I completely understand and "feel your pain". Whenever a parent writes a note like that you can take it to the bank that that kid will be in your office :angryfire. My question is why do we care? If we evaluate the student, find nothing to support their claim, we should let the parent dismiss them in the office. Keep the nurse out of it. It is the most frustrating aspect of this job. Well, second only to not having any working phone numbers! I had a friend once tell me to call each parent each time a child came looking to be dismissed and insist that the parent pick up the child. After all, the complaint is subjective, we can't say they aren't feeling whatever they say they are (even though we know). The theory is, if the parent got annoyed enough times, the behavior would stop. I did this in beginning of the school year and I haven't seen those kids since October! But there's always more to replace those. Sometimes I feel like a cheerleader "C'mon, hang in there, there's only _____hours left, you can do it!" Only to have them return 2,3 times with angry/frustrated notes from the teachers. Why do we care? Send them home immediately. Oh no! Now I'm venting..sorry:icon_roll.

I just saw on the TV yesterday (an infection control specialist for a large well-known hospital) that here in Connecticut the flu has just been upgraded to "Regional" from sporadic (From the CDC). It seems the flu is off to a slow start but it was also pointed out that the vaccine for this year is not proving effective for the type of flu they are seeing. We had a small, private school close for several days because 1/3 of the student body had the flu. Right now I'm not seeing too much at my school for acute febrile illnesses but that could all change!

First off, I want to say that I LOVE your name! My next cat will either be Don Chich or Mrs. Fanuch. I may have the spelling wrong but you know who I mean, right? I'd have to say that after 20 yrs. in nursing I've settled into my niche. I've done geriatric nursing, med.surg nursing, home health care nursing and pediatric office nursing. Now for 8 years I have been a school nurse and I like it, not love it. Can't beat the hours & vacation time but I spend most of my time trying to convince children that they're not that sick and to go back to class. When I do help a truly sick child, I wish I could do that sort of thing more often which cause me to entertain thoughts of going per diem in an acute care facility. But I'm lucky enough to have a daughter who is an ED nurse so I kind of live vicariously through her experiences. That way I don't have weekends, holidays, and 12 hour shifts. Who knows, if my 401K loses any more money I may have to do more than entertain the idea of going per-diem!

I know you posted this a while ago but I just read it and have to say I'm chuckling to myself. I'm an elementary school nurse and it just crossed my mind...I wonder how many of your "frequent flyers" were the same in school. I'd love to take a poll! It is apparent that in every aspect of health care there are the "regulars". My daughter works in an ED; she sees them. I worked in a pediatrics office; they were there too. I think there's just a certain number of people who think they are sick all of the time. I just do my assessment of each person and if I find nothing objective they go back to class. I'm consistent and no-nonsense and the kids know it. I'm hoping it teaches them a life lesson. If/when I get a student who abuses the health room, I refer them to our school psychologist or social worker because there's usually always an undercurrent of some sort of stressor. I would imagine it's got to be the same in prison only worse...Thanks for doing a job that is not ever covered in nursing school!

I am an elementary school nurse in CT. It is state mandated that we weigh, measure and calculate BMI on our 3rd grade students. The problem is, once we have the result, we aren't allowed to anything with it but chart it in the health record. In my school, for the past several years, the results have been that 50% of the students are considered overweight. 50% of those are actually off the chart obese:o. My results are typical for all the schools in my district. With today's trend of increased obesity at a younger age, wouldn't it be helpful to send a letter home simply stating that the facts? We do for vision & hearing. We've discussed this at our staff meetings to no conclusion so we leave it as it is. How do other schools handle this? Does anyone else do this and if so what do you do with the information?

I agree with my school nurse colleagues. This job may not have the highest pay or the highest technological skill level but I love it. I am the sole medical person in my building responsible for about 600 people; that's an awesome responsibility! We are in a unique position but sometimes our role can be blurred. Be careful not to be the dumping ground for non-medical issues. Also, with so much free time from week-ends to endless school vacations, you can go per-diem and make a little extra income as well as stay in the loop of technology. Good luck!

see I told you i 'm glad i don't have to take tose tests any more...my bad!

It's true that sometimes in nursing school we had to choose the best answer out of the four not necessarily what we would actually do. I'm just happy I don't have to take those tests anymore! Too much second guessing!

Really? "A"? I can't begin to imagine challenging the patient to alter distorted thought patterns...what the heck? In late stage? I had an uncle and a mother in law with that horrific disease and "A" wouldn't have been an option...they were non-verbal. Maybe the quetsion didn't give enough info to answer it. I still say "D"

It seems "D" is the only possible answer. You can't actually get the patient to do any of the suggestions in A,B, or C and to use humor with a patient who is "last stage" alzheimers is pointless, perhaps even demeaning to the patient. I used to hate when questions weren't explained... how are we supposed to learn? I do feel humor is an important part of the human condition but if the person really won't be able to process it, it's lost. And you know what? Possible answer "A"is too complex! I wouldn't be able to do it and I don't have alzheimers. Yikes!

i wish i could sit down & talk with you but listen....just hold on. take care of yourself. talk to a friend, or even your nursing director if you have just finished nursing school you should be very proud of yourself. you have a new life within you, you should be so proud of yourself and happy. take a minute to reflect on your accomplishemnts...you are awesome!! remember what motivated you to go into nursing. no one can get through nursing school without wanting it. now hear this. you are also hormonal. i really don't like to use that as an excuse but you are really hormonal at this time. take that into consideration and don't make any major decisions right now. cry a little:cry:. breath. and then take one day at a time. you'll get there. talk to some other new grads or new employees. i was pregnant during nursing school. not once, but twice! i think i cried more then the rest of my life combined. i actually quit school once...at least once but then went right back after i finished feeling sorry for myself which was always the next day. and you know what? maybe where you are right now isn't the right place for you; it sounds like the staff isn't a s supportive as it could/should be. get what you need from this place then move on. keep looking. there are endless opportunites for us. just hold on a little longer. good luck with your pregnancy, don't give up:heartbeat! let us know how you do, okay? i've been there and i'm pulling for you! :wink2:

No nurse I know would advise a patient with both a fever and a sore throat not to have it cultured. We know strep does not have to result in "the inability to function" to be present and an untreated GAS can be very harmful. I do not think CMA's are qualified or educated enough to triage patients over the phone. If that clinic knowingly allows CMA's to dispense medical advice, I hope their malpractice insurance is paid because it's their license. I worked in a pediatrician's office with a CMA. She was not allowed to triage, return phone calls or give meds, shots etc. Basically all she did was weigh, measure and put patients in rooms. I'd also let someone know that she identifies herself as a nurse. She's not. We've all worked very hard to earn that title. Hey, I hope you feel better...please get it checked out. Even it's not strep, better safe than sorry.

God bless you hanging in for 16 yrs! I've been a school nurse for 8 years. I work in a small city of diverse culture. From a socioeconomic point, the population is working poor, lower income, and blue collar types with a few well to do thrown in the mix. Not a wealthy community by any means. I work in an elementary school of about 550 which is located in the outskirts of town, not in the inner city. The schools in the inner city tend to deal with headlice on a daily basis. I was previously assigned to one of those schools. Here's how we handle it in our school district. We are nurses employed by the city. We work for the Health Dept. not for the Board of Ed. We have standards and policies which are governed ny our state dept. of health, and a medical advisor who is a licensed physician (he's an old time pediatrician and super smart!). Our policy regarding head lice is not negotiable. We have a "No Nit" policy which we stringently enforce. I inspect the entire class. I also send home a letter stating a case of headlice has been identified and informing parents what to look for etc. Our school principals back us up if we encounter a parent who is uncooperative. Head lice is not really a medical issue per se, it's a social issue (or public health) so if there is a repeat offender (and there always is) we involve the social worker so the student doesn't feel stigmatized and so the student doesn't miss too much school because of lice. We also have a strict attendence policy so if someone has headlice a lot, administration gets involved and meets with the parents and it's not so much all on the nurse to "fix it"! I agree with you that the headlice, once discovered, have already been there for who knows how long, but our policy is to send them home. I wish you luck. Get your school to work with you, not against you.