LovingOBFutureFNP

I'm less than 2 hours from freedom! My students finished yesterday, and today is just a staff workday. It's been a fun year working with these kids, but I can't wait to be back in a hospital and working obstetrics again.

I just finished my second year as a nurse - a little over a year in the ER with OB/GYN patients, and this school year at an inner city high school as the school nurse. I'll be starting L&D in June, am planning to start FNP school this fall, and would like to work as a nurse practitioner with women's health patients after finishing up my MSN. ... Sounds like we're on similar paths! Best of luck to you. :)

Oh my, I just made one of my students so mad at me! It's a shame that sometimes they think we're just out to get them instead of looking out for everyone's best interest. He came to the clinic the other day with an ankle injury after landing incorrectly in basketball. There was a bruise all around the front of the ankle, moderate swelling, and there was an obvious bone deformity. Today is his first day back at school, and he brought a note from a doctor saying that he has a fractured fibula, and he will require a splint, crutches, and follow up in 2 weeks. He came into my office and asked for my wheelchair. I explained that he couldn't use the wheelchair because the doctor's prescribed treatment plan included crutches, and in the event of an emergency, I need my wheelchair to be available. (He should know! The other day, he had to make it down to the clinic with the assistance of some other students from the gym because I had another student who was so heavily under the influence that he was unable stand, ambulate, or get out of my wheelchair while his guardian was on the way to pick him up.) The student was walking with crutches correctly, and they fit perfectly. "I have a note from my doctor that says I can't use crutches at school." I asked to see the note and pointed out that he would be responsible for providing his own wheelchair if that was correct. The only instructions on the note were "no stairs, no physical education for remainder of the school year." Mind you, students only have three days of school left after today, and from here on out they are half days because of finals. His counselor already agreed to let him take all of his finals in the library so that he won't have to walk all over our large campus. Typically a sweet kid, but kicked my trash can several times on his way out, said "I'm not wanting to hear what you're saying right now" when I told him to put away his cell phone and pay attention to what I was explaining, and made some other comments about how I'm ridiculous. Oh well! You win some, you lose some. Not everybody's going to love you! ... And you know what? With 3 days left, that's ok with me. :)

If I ever move back to Dallas, I'd go back to Parkland in a heartbeat. Working in their ER would be an incredible experience for you. The ER is divided into medicine, surgery, trauma, psych, and OB/GYN units. The OB area is staffed with OB nurses and is run by the OB/GYN residents with the exception of the occasional family practice or ER intern. I believe that the psych area has its own staffing too. Both hospitals are teaching hospitals, so you'd be working with residents at either location. The patient load at Parkland is larger, and it's a much different patient population. Baylor has more private patients, whereas Parkland's patients tend to be uninsured or underinsured, from lower socioeconomic backgrounds, and there are many illegal patients. If you have issues working with any of the above, it's not the place to work. Other Parkland pluses: nationally known for its OB, trauma, and critical care, competitive pay and good benefits, and it's a close knit place to work. Parkland nurses look out for each other. You might have heard it said "you'll see more in 6 months at Parkland than other people will ever see in their career," and I agree.

Yeah, I've been blessed with a very supportive administration who has backed me in everything I've done this year. It definitely makes all of the difference in the world! If I can't document a reason that a student needs to go home, I tell him he needs to return to class to wait whether someone is already on the way or not. When a parent arrives, I explain that the student called before being evaluated by me, that I didn't find anything significant, that I sent the student back to class, and that I am not excusing the absence for medical reasons since the student is not being sent home through the clinic. Many times I've had parents who roll their eyes and say they're going back home... without the student in tow. I like those parents. :)

Two helpful hints: 1) When I was a new grad, I would find a great, bouncy vein and would aim right at it. I blew several veins before a fellow nurse saw what I was doing and gave me a tip. Don't START the IV in the best part of the vein. Remember that it's where you want your catheter tip to end up. Start below it by a bit. 2) If you have to choose between starting an IV in a vein you can feel or a vein you can easily see, definitely choose the one you can feel. After starting several IVs per shift, you'll be a pro before you know it! It didn't take long to learn to place IVs in the ER... I sure do pity my first few IV patients when I return to the hospital this summer from a year of school nursing though! Stay encouraged. :)

I just worked with OB/GYN patients in the ER, but we saw some pretty interesting stuff. -Box cutters in the lady parts - A prisoner knew she was going to be arrested, and this was her way of trying to land herself in solitary. She refused to be treated, and we had to tell the officers that nothing could be done until they came back with a court order since we weren't going to hold her down and commit battery. ..... Now I've never been to jail, but I'm pretty darn sure this isn't a risk I'd be willing to take!!!!!! -"I have gonorrhea." "What makes you think that?" "It's going around my family." -"I think I might have an STD, but it's not from having sex." "How do you think you got it, ma'am?" "Either my cough syrup or sharing a bed with my dog..." "Are you having sex with your dog?" "no" "Then he didn't give you a sexually transmitted disease." -A woman reportedly hid $160 of cash in a ziplock bag inside of her lady parts from her boyfriend so he couldn't spend it on drugs. A few days later, she came in for severe pain. She asked the doctor if she'd get the cash back, to which he replied "nope, finders keepers!" -- We didn't find the money. -"I think I got that tricky osmosis again." -HIV patient, can't recall the complaint "I only sleep with men who have HIV. Don't worry." Dr "How do you know who has HIV and who doesn't?" "I look into their eyes to see if they look sickly inside." -"I just had this baby on the bus on the way to the hospital, but the nurse in labor and delivery told me I can't be there." "Ma'am, that is a stuffed pink cat." "No, it's the baby I just had on the bus." "Why did you just wet your pants?" "That must have been that baby fluid... No, actually it's just because I needed to go. I don't have to stay here, you know." "No ma'am, you're right, you don't." ... and then she walked out (fear not, we had her picked up by the hospital police before exiting the hospital for a psych eval)

I'm two weeks away from wrapping up my school nurse gig to return to my true nursing love, obstetrics, but since I'm a school nurse for 2 more weeks... I like to drop words like "truancy officer" and "court" and "big fine" to parents whose students are absent on a regular basis, and all of a sudden students seem to be in school more! I think you did the right thing with requiring a doctor's note to return to school in order to excuse the absences. This reminds me of my student who had missed over a week of school and came back with a handwritten note from mom saying she'd been out with measles. She'd received both doses of MMR and had not gone to a doctor. Like you said, no doctor would hesitate to write an excuse for any student with N1H1 - or regular flu, strep throat, etc. for that matter! One of my pregnant students missed 14 days of school within 2 months because "my doctor says I'm very delicate right now since I'm pregnant and that he can't believe I'm attending a public school!" I made it very clear that because of the excessive absences, no more absences would be excused for the semester without a note from a physician. Have to draw the line somewhere!

I'm two weeks away from wrapping up my school nurse gig to return to my true nursing love, obstetrics, but since I'm a school nurse for 2 more weeks... Oh geez, I don't think I've made it through a week this school year without something like this! I usually just shrug it off and say "sorry! As a nurse, I'm not able to give out medications without a doctor's order." If they stay persistent, which seems to be the case frequently, I say "I can't even keep Neosporin up here for cuts since it's technically a medication. District policy is that I can't store any medications that aren't in their original prescription bottle with a physician's order." -- Then they look more annoyed with the district than with me. I don't think anybody does this to be malicious or because they want to risk your license. I think there's just a genuine misunderstanding about scope of practice, and this is a prime teaching opportunity.

I'm two weeks away from wrapping up my school nurse gig to return to my true nursing love, obstetrics, but since I'm a school nurse for 2 more weeks... I work at a high school and haven't had to address this issue with younger students, but one thing I would suggest would be evaluating their knowledge. "What can you tell me about periods?" I think it might help open up the communication gate, and it would give you an opportunity to clear up any misconceptions!

I'm two weeks away from wrapping up my school nurse gig to return to my true nursing love, obstetrics, but since I'm a school nurse for 2 more weeks... I don't mean to step on any toes, but I feel like this might be a bit of a "teachers don't recognize our nursing expertise" power issue. I also feel annoyed when staff members don't take responsibility for their own care, but it's nice to go above and beyond for people. In fact, serving staff members can be a great opportunity for school nurses because it's a good chance to show them that you do know what you're talking about, which in turn leads to them trusting your clinical judgment with students better. An adult is capable of making decisions about her own care. If she decides that she needs ice for an injury, has an understanding of her injury and has already sought medical care, requests it, plans to apply the ice herself, and the ice packs happen to be kept in the clinic, where is the harm in lending her an ice pack? I don't see how you could be held liable for any such thing, and technically it's no different than being given a cup of ice by a cafeteria worker since you're not actively participating in her care. I believe school nurses are there to provide care and education for students, their families, AND staff members. I'm at a school of nearly 1,000 students and can definitely understand how busy our schedules get, but I'm happy to check blood pressures, give Band-aids, make referrals, and counsel staff members regarding medical questions. In fact, I think caring for staff members is even written into the school nurse job description for my district.

I'm two weeks away from wrapping up my school nurse gig to return to my true nursing love, obstetrics, but since I'm a school nurse for 2 more weeks... I can relate! My students always look at me in shock like I'm failing to do my job if I tell them I don't have any safety pins, but I just smile and say "I'm a nurse, not a seamstress!" Usually they smile and go on their way without much fuss.

I'm about to wrap up my school nurse gig to return to my true nursing love, obstetrics, but since I'm a still school nurse for 2 more weeks... I look to see if one eye or both eyes are red, ask if the eye was matted shut or crusty in the morning, ask if the eye has been draining, ask about allergies, and evaluate the conjunctiva. If the eye was matted/crusty in the morning, I automatically send them home without further ado. If not, I look for any foreign body in the eye (eyelash, mascara) and ask if they're wearing contacts since those things might have irritated the eye somehow. I'll try to rinse out the eye with saline and have them rest with their eyes shut for a little while, and several times I've lucked out and everything looks fine after a little while. Even if the eye wasn't matted, if my other tricks don't work, I send them home. Better safe than sorry when you have a population of students who can't seem to keep their hands away from their eyes!

I'm two weeks away from wrapping up my school nurse gig to return to my true nursing love, obstetrics, but since I'm a school nurse for 2 more weeks... If a student complains of a stomachache, I assess vital signs, N/V/D/C, bowel sounds, any abdominal distention or tenderness to palpation, the type of pain, and diet for the day, which frequently ends up being "I didn't eat breakfast/lunch" or "pizza covered in nacho cheese and hot wings." As long as students' vitals and assessment are normal and they don't appear to be in any acute distress, I always send them back to class. I always ask if they'd like to try to use the restroom before going back, and I've found that small offerings like giving them a few crackers if they haven't had a meal yet that day make them feel like I've addressed their complaint. I feel like a nursing student who is about to complete her degree could adequately assess for these things as well. This is my first year as a school nurse, so I used to fall for the "my mom said call home if I felt bad and she'd come pick me up" trick 30 minutes into the school day. After I realized it was a recurring pattern, I mailed home a letter to parents that said students will only be sent home sick if they are acutely ill. If you believe that your child feels poorly enough that he might not be able to make it through the school day, keep him home to begin with because I won't be sending him home unless my assessment indicates a medical need. Ever since then, I've had no problem. Students still pull the line on me, but I just explain that I'm sorry they're feeling bad, but their parents were made aware of the clinic policy and that they need to go on back to class.