photomom

I think sometimes, not all cases but some, the parents are scared. Either they don't know how to care for their child or they're afraid of stepping on the nurse's toes. I agree that it's important for parents to get away, etc, just as it is for parents of "normal" children to have time away from their children. I'm sure there are some parents who DO take advantage because they may not *want* to parent a child with special needs. I don't do private duty, but maybe there's another reason, besides being lazy, terrible, uncaring parents, that they act the way they do. I've also known nurses who are *very* controlling. Maybe a previous nurse set the expectations for the parent and told them to stay away while the nurse was there. Have you tried to talk with the parents? What is your relationship with the parents? If they don't care for the child because they're scared or don't know how, then maybe there's a great opportunity for you to do some education.

I like the idea of telling parents (backed by the principal) that they must have the authorization in place to come to school, but what if the parents just don't care that much about whether they're in school or not? It's an alternative HS - last chance at staying in school for students with behavioral issues. Many have attendance problems as it is - after all, only about 1/3 of the total enrolled actually showed up each day, and they weren't always the same students every day. In your experience, would this type of threat help encourage the paperwork to be returned? Or would it simply be another excuse that the student doesn't need to come to school?? And the principal nor the office had any other contact info and were also busy dealing with their own issues (constant behavior problems all day), so they didn't have much time to help me out, either. Thanks for all the advice - it's nice to see how things work at other schools as well!

Unfortunately, there was only one number for mom (a cell) and it was turned off because she was at work and the child didn't know where her mom worked (it was fast food, but she didn't know which location and there were plenty to choose from). I did call the clinic she sees and they faxed a new order, but unfortunately the fax machine in our school was still out of order (nothing apparently works there, it's insane) so I had it faxed to my supervisor's office, but she wasn't physically there because she was elsewhere in the district and then was coming to my school and her office wasn't close. But even having the order does nothing for us if we don't have needles to administer the right amount of insulin. No, I was not able to test ketones. The student stated she does test ketones at home (not sure if that's even true, she's very noncompliant) but didn't bring her supplies. I am amazed at this whole situation, especially since when I found out about her on the 3rd day of school (still missing records on most kids!) I was told that she controls it well herself and that last year, at her regular school, they didn't have a school nurse (district was trying to get rid of having nurses) so she kept it on her and just did everything herself! Well it's no wonder she's so poorly controlled! I sent her to the ER about 2:30pm and heard that parents could not be reached until 7pm! I am just amazed. And like I said, maybe it's a culture/whatever thing because it's inner city, but it seems like nobody cares at all about the health of the kids! The office doesn't even have backup contact persons in case parents cannot be reached, so it's no wonder they're so hard to reach. I had called mom the day before when I found out about this girl and let her know what I needed and that it needed to happen or she can't get insulin at school. She was very agreeable and said she would be sure to fill it out and send it back the next day. The student didn't show up to school at all on Friday (day after ER incident), so I guess we'll find out next week what's going on. But at least we now have the order they faxed to my supervisor! As far as sending kids home per policy, what do you do when you can't REACH the parent to send them home?! Just keep them in the office all day??

I understand requiring parental consent, but why a drs order or sunscreen?!

I had a situation yesterday that I'm personally frustrated about. I had a student who brought her insulin pen to school, and her brand new meter, and left them with me. I thought everything she needed was in the case she brought, but I didn't check it right away. Later, I realized there were no needles for her insulin pen and figured I would ask her about it when she came to check her sugar before lunch. The problem is that we're a new school and I *don't* have all the paperwork I need on this girl! I sent home paperwork to mom, and called her to make her aware I was sending home and how important it is to get back to me, but it didn't come back. My supervisor said that I can keep the pen in the office and she can check her sugar here, but that she has to self-administer since we have no authorization or order. So she comes back to check her sugar and it's over 200! She has her insulin pen and I ask what her regular dose is since her sugar is so high - 13 units! It's apparent to me that her diabetes is not well-controlled. Unfortunately, she also states that she forgot her needles at home. Now, what do I do?? She obviously needs insulin but is not likely in immediate danger. I try to contact mom to no avail - she's working and the kid doesn't know a work # or even where she works, but cell (only phone) is turned off. Other #s I have for anyone are no longer working (I work inner city, so no surprise). She is completely asymptomatic. I did receive an order sheet from her diabetes clinic for insulin in school, but it did not have a specific dose/time on it. It did, however, have a signature with parent's authorization for school nurse to contact the clinic, so I did. They stated that she's been without a meter until they just gave her one the other day and that based on her A1C, she probably runs 300's, which didn't surprise me. The girl, meanwhile, is upset because she doesn't understand what the big deal is - after all, she's gone without her shot before and been fine. Attempted to educate her, and she rolled her eyes and turned away. I ended up calling 911 for an ambulance to come get her so she could be treated since even if I had regular insulin needles, I had no order for how much to administer. I just feel so silly for doing so, and such a waste of resources, when she had no symptoms and seems to run high in general (although I had no official documentation of such and it was an educator I spoke with at the clinic). My supervisor and the principal agreed we had no other option in this case but it frustrates me!!! I guess I did the *right* thing, but surely there's an alternative, right?? Could I have asked to speak with her physician and taken an order over the phone to administer the insulin (if we had a needle)? Does EMS carry insulin syringes? At least then we could have avoided leaving school and avoided an unnecessary ER visit... Would love your thoughts on the matter. Thanks!

No, not necessarily, but it doesn't hurt to be friendly. On the flip side, I've heard from several agency nurses that they always just feel like they're there alone and that the FT nurses are too clicky and exclude them from everything. If you want to be alone and not share anything, that's fine, make it known, just don't expect to be included in a group that knows each other well. But also know that you're not the only type of agency nurse there is and that you're not always asked because they're nosey, maybe they're just friendly. Is this the general feeling of most agency nurses? That they don't want to share anything personal or talk about anything non-nursing related???

Yes, I am in touch with the supervisor several times a day but she is also new to the district and rather at a loss of what else to do. Ended up sending a student to the ER today - oh what a mess!! When is rains, it pours, right?

Working this week in an inner city alterniative middle/high school as a sub. They actually haven't hired a FT nurse yet (and I heard rumors they're looking, but the way I've seen this place run, who knows when that will really happen). After this week there is another nurse who will work the next few weeks (and has more experience than I do in school nursing - I've only ever worked one day as a sub in my life before this week!) My problem is that it's a new school and so there is NOTHING established, and I keep running into problems because I'm only a temp. Additionally, because it's an alternative school, only discilinary records are sent from their home schools. This means I have NO information about the kids. I have sent home health history forms with the students, but when we only have about 1/3 of the enrolled students show up, and not the same ones everyday, I'm not sure which kids now even got the forms and which haven't! Working with the office is a struggle because the nurse is the farthest thing from important on their list. I have barely enough supplies in my room (mainly a first aid kit and some really OLD 4x4s, and finally got a thermometer) in case of an emergency (I hope?!). I found out yesterday that there's a diabetic but she won't return the paperwork for the insulin she needs at school, and I hear rumor there's a kid with a serious heart condition who takes daily meds at lunch time and another kid who takes daily adhd meds at school. Nobody seems to know the names of these kids and I don't have their meds in the office. My next attempt for information was to request a list of the students and where they came from so maybe I can call and request their health info be faxed?! The secretary's response? "Oh, it should be in the system" - yeah, I don't have ACCESS to the system! So, she'll try to get me a list, when she has time. The counselor did just offer to let me use the system in her room to look up kids and then call, but I need to wait until after lunch. Meanwhile, the VP is jumping on me because I don't know anything about this kid with the heart condition or if anyone else has serious problems (yeah, that's what I've been hounding everyone about since Monday, but everyone's too busy with trying to get their areas in order and disciplining kids that it went in one ear and out the other!) I'm so frustrated and wondering what I could do later today or tomorrow (since thats my last day here, for now) and suggestions on what i should have done, or should do if in this situation again. Once I *DO* get their histories, I need to create care plans or something for all the kids with problems, right? What else needs to be done? What should I pass on to the next sub to get her going in the right direction? I feel like such a failure right now because it's thursday already and I still know nothing about most of these kids and don't feel like I've accomplished much, since I run into a brick wall at every turn! I would love any advice from anyone who's ever been in a crazy situation like this. Thanks so much!

Just a quick question as a new school nurse sub. If a student comes asking for a bandaid because the one they had on fell off, do you need to fill out all the paperwork as if that was a full clinic visit or can you just give them the bandaid?

Go with how you feel about the situation, but honestly it's not always about being nosey. Before I started working with an agency, talking with agency nurses was honestly the best way to do my research. What's a good agency? Do you get cancelled? Do you go to good facilities? If it's travel, how are the accomodations? I wasn't trying to be nosey, I was honestly interested. And as far as asking about insurance, I did that, too!! Not because I wanted to pry into their personal life, but because I have a family to care for, too, and it makes a difference. I was looking for a way out of my last FT position because I was burned out. I *wanted* agency nurses to give me the inside scoop on what it's like - would I regret it if it I did it? What do I need to watch out for? It's really like the new grads looking to get into their first job - we dont' say "those nosey students, they should mind their own business!" Also, my old unit was very close-knit and so it was almost instictive to ask about the new nurse coming to work with us. Do you have kids? if so, and they're little like mine, than I can relate to you! Where are you from? Where are you living? I would have been more than happy to answer these questions to an agency nurse if we're chatting while we work to get to know who I'm working with - especially if we're going to work together a lot! I need to know if I can trust you in my unit. On the other hand, there ARE some nurses who may ask for other reasons. And there may be agency nurses (and you may be one of them) who LIKES to be agency because you don't like to chat with coworkers and get to know them. That's okay, too, but just respond that you prefer not to discuss your personal life and maybe change the subject to something work related - like "could you show me how your XX works? I'm not familiar with it" or "what is your policy/procedure in XX scenario?" Or if you're not up to talking at all, maybe ask if they can help you turn a patient or give a bath or whatever. Or just tell them to buzz off and then go do your work, but that doesn't often build very good trust/rapport with the FT staff. Anyway, just a few thoughts from someone who's been on the other side of this situation...

Hey danceluver, I actually got an ICU job right out of school and have been doing that for the past 5 years. I am only starting as a school nurse sub now through an agency and apparently it depends on your state and even disctricts in some cases as to what qualifies you as a school nurse. For me, it's being an RN and passing the tests, etc through my agency that qualify me for ANY agency job through them. In my opinion (and maybe those of you with school nurse experience will disagree and that's fine), unless you went to nursing school for the sole purpose of being a school nurse (and maybe other community nursing positions, I'm not sure), then you should probably start your career somewhere you can get the greatest amount of experience in the least amount of time. That will open you up to a world of possibilities later, including school nursing, but then you will have real world experience to draw on if there's a real emergency and not struggle to remember what you learned years ago in nursing school. But, if it is what you've always wanted to do, then by all means, do it! You just don't want to be pigeon-holed into it down the road if you decide it's not really for you. As an experienced ICU nurse, I can basically pick and choose where I want to work and what I want to make. Good luck with the rest of school!

Oh, and maybe a silly question, but how high of a fever = send home criteria?

Thanks Donnacee! That makes me feel a LOT better! I know, I know. It's just a basic nursing job, but my brain isn't usually in minor complaints mode when I'm in scrubs so it's sometimes hard to step back and remind myself I'm not at a hospital and they're just kids. How are docs orders usually organized? Should I look for charts on invidual kids? What else should I look around and find when I get there to make sure I have everything I need available when/if I should need it?

MassED, thanks! You make it sound so easy and fun and like maybe I'm worried for nothing. :) I just don't like to be unprepared and since I don't know what to expect, it's hard to prepare. I think I'm probably worrying myself to pieces for nothing! Is there usually something that tells you the routine? I'll be at an elementary school. Anything I should ask when I check in? Reading some of the posts by FT school nurses, it seems there's a lot of chain of command and you should have reported such and such to whomever. Do I need to worry about that? Who would I typically talk to if there's a problem or if I have questions? Would it just be the secretary that i check in with in the office?

Hey all, I come from a critical care background but have an opportunity to work as a school nurse sub. I thought it would be a great opportunity to broaden my nursing experience and to pick up a few hours without being unavailable to my kids for a full 12hr shift. I signed up as a sub for Thursday through an agency. When I reminded them I had never done this before their brief response was "oh, it's no big deal. A lot of nurses love doing it because it's easy. You just give meds to kids that have it ordered and you're available if they need you." Sounds simple enough... but now I'm getting nervous! She told me I just check in to the office 20 minutes early so I have time to review the sub notes and that's all I should need. Oh, and she said there are not tube feeds at this school. (I never realized school nurses DID tube feeding!) This is just so far OUT of my comfort zone it's making me nervous when it probably shouldn't. It's kids and I'm used to being a nurse for big people (often VERY big people), it's during school so they're not hospitalized, and I'll be all alone. I think that's what probably scares me the most. I am very comfortable floating just about anywhere in a hospital setting because I know there are other nurses there if I have questions. As a school nurse sub, I have NO orientation so I don't know the school, the people, or even the basic routine. I don't know the policies. What if something bad happened? In the ICU we're prepared because we expect these things - there's a crash cart, a code button, doctors on call, LOTS of great nurses all around, etc. I'm a mom, but my kiddos are still pre-elementary (4&2) so I don't even have experience with this age group or in dealing with schools really at all. I'm sure things will be fine and I know you have to step outside your comfort zone to grow and I'm willing to do that - but I DO prefer to be a little prepared! So, that's really what I'm asking for - some encouragement and some idea of what I can expect. Any tips for making things go smoothly? Anything I should ask? (I feel silly that I don't even know enough about school nursing to even know what questions I should be asking!) Aside from giving kids their meds (and is there a list I should find somewhere or how will I know who needs what? Do they come to me or do I find them?) what else should I expect? What else do school nurses do as subs? I remember from nursing school years ago that the school nurse implements a lot of education, I've read about how some of you have talked about immunization records, etc, but I don't see how I would do anything with that in one day as a sub. Would love any advice you have!!! Thanks in advance :)