lilbiskit78

Let me apologize in advance for the long post, but I feel the whole story is necessary. I am new to school nursing started in February for a 3-4 grade school. I am dealing with an angry parent situation and I am not sure what, if anything, that I did wrong. One of my students with asthma came to me in March with a note from mom saying she had bronchitis. At this time, she did not use any daily inhalers or asthma meds at school but she has two PRN inhalers on campus. There was an attached pediatrician's note ordering she use her Xopenex inhaler before PE for the following 3 weeks or until the bronchitis has resolved. Ok, check the students medical file, she has a parent permission slip for Xopenex prn and Azmacort once daily only if home dose has been missed. Fine, so we will do the Xopenex for 3 weeks. At the end of this period I call the parent letting her know that I would like a doctor's note saying that the bronchitis is sufficiently resolved before I feel comfortable discontinuing the Xopenex. Mom says she hasn't had a chance to take her to the doctor, so just continue the Xopenex before PE and she will take her as soon as possible. This was March, and despite calling again and asking for a note, the student was never returned to her pediatrican for follow up. So we are still doing the Xopenex before PE. During these past few months, seeing the student on a daily basis, I have observed her using her inhaler properly (she is 10) and she has never had any c/o SOB or acute attacks at school. This student comes to me Thursday morning 8:30 am complaining of "I don't feel good". She was more quiet than usual, but couldn't tell me anything specific that was bothering her. Vital signs look good, no fever, no red throat, no respiratory complaints. I let her rest for a period of about 30 minutes and then attempt to return to class. She tells me that she didn't feel well last night and her mom says she had a fever. Ok, so I am calling mom. Mom confirms, but says also no specific complaints last night and fever was low grade less than 100. She says to me "I don't even know if I brought one, but does she have a peak flow meter there? She sometimes gets this way when her asthma acts up". I respond, "I can't reach that cabinet right now but I will look in one minute. Why don't I check her oxygen level while I have you on the phone." Check the O2 sat 100%, pulse in the 80's, lungs clear, no c/o SOB. Student sitting in chair doodling on some paper. I tell mom the results and she says, "Ok, she is fine then. But I am going to send her dad to get her anyway since she isn't feeling well.". Whatever, you are the parent, your kid, your call. An hour and a half later dad shows up to get her.....she is in the clinic with me this whole waiting period, reading, talking with other students who come in, ect. Obviously not distressed. Mom leaves message for Asst. Prinicpal Friday morning saying that student had asthma attack Thursday night and they were at ER all night. She also expresses concern that her daughter's asthma is not being properly taken care of at school.....that she asked me several times to do a peak flow (no, just one time) and that we are not using the child's spacer for her inhaler. The part about the spacer is correct. I have seen the student use her inhaler properly, and assumed, maybe wrongly that the spacer was only for the Azmacort, as I know it can help lesson thrush, ect. that can be caused by the steroid inhalers. The student never expressed to me that she needed to use the spacer and I was under the assumption if the student can use the MDI properly they do not need to use the spacer. The parent did not return her asthma care plan given at registration, which details any daily orders for asthma and emergency plan. All that I found in her file was the above mentioned orders for the inhalers. Even if it were returned, I wouldn't have followed it Thursday as she was obviously not having an asthma attack. My opinion is if you were concerned about your child's asthma Wednesday night, why did you send her to school Thursday and then take an hour and a half to pick her up? And what does an asthma attack 12 hours later have to do with an obviously undistressed child with a O2 sat of 100% in the nurse's clinic that morning? Should I have done something different? Opinions are requested. Anyone that actually read all of this, thank you!

Purple Scrubs thank you so much for all the advice. I am trying to set standards for what needs to come to the nurse and what doesn't but there are so many gray areas.....like headaches. Alot of kiddos c/o headache or stomach ache they know these are the two things we can't prove or disprove...but I've had quite a few "just headaches" with the 102 temp and the flu. The teachers in my school do send everything down I mean everything.....they even send me the loose teeth kids cause they are tired of the kid wiggling it in class. SORRY!!! I get a lot of what I call "repeat offenders" during the day...ie...the kid came in with stomachache clinically fine sent with a note to the teacher back to class. Then they go off to their music class, tell that teacher they don't feel good, like you said lather rinse repeat. I think they believe if they come down enough I will eventually send them home. Had one yesterday came in 3 times within one hour...once before school had even started, once from her homeroom, once from music. She was clinically fine c/o stomach hurting and I looked her over several times afraid I may be missing something. Finally sent her back to music and the teacher was mad saying she was crying in class and upsetting the other children and that she must be hurting....I should at least call mom. I was so annoyed I did call and talk to mom and mom told me she was faking....she not only had made a comment to mom the night before that she was going to stay home from school but told me several lies about not eating, ect. I sent her back to class and went straight to my prinicpal I was so irritated.....I saw the child playing dodgeball in PE about an hour later. What has been hard for me with the "I puked in the bathroom" thing is that I may or may not believe the kid puked but if I try to send them back the teacher gets PO'ed saying they don't want a sick kid infecting the class, or them, or puking in class. I have also had a teacher decide a student needed to go home that had no temp, no vomiting, ect, call the parent themselves without my ever knowing the child c/o being sick, and then send her down to the clinic to wait for mom to pick her up. Ummm excuse me? I wanted to send the student back up to class and tell the teacher if she wanted to play nurse she could keep her in "her clinic" until mom got there. It is hard for me because I am new, I hardly know anyone, and I don't want to make enemies, but gosh....how would you like if I just came in your class and took over, ya know? Overall I like the job and it is great for my family, I just need to figure out how to run my clinic without getting run over by teachers or students.

Hi everyone! I am new to school nursing (only a month now) and my clinic visits are super high and I need some advice as to how to lower them. I am running ragged and can't get anything done except see kiddos. We have 650 students in my school (3rd and 4th grade only), I have been seeing an average of 70 a day (sick visits) plus about 20 that take daily meds and any parents that stop in to refill meds, ect. I don't know if the teachers are just sending down anyone that asks or what...most of these kids are not even sick, altho we have had a big flu influx the last week or so. I instituted a new rule that they must have passes....that has actually decreased the numbers since I used to have a lot of "wandering in" as well. Any advice is much appreciated. Lil

At my hospital, they usually write "continue home meds" and then if they are starting any new home meds the doc will leave a script for the new med on the chart. Sometimes they don't write anything.......LOL.......they write, "D/C home" and nothing about the home meds. If I know the pt is going home I try to look at what the Dr wrote before he/she leaves the floor so I can ask questions if need be. Also, sometimes I look at the physician's progress notes and see if they want them to continue home meds, but I still end up paging them overhead to get the actual order. I am a new RN and still get confused sometimes on the d/c orders, but overall that's how it's done where I work. Lil

Grin, Isn't it weird that Aggie and I work at the same place? I thought it was crazy, however, they are a big hospital in our area, so I guess it's not too strange. I never did figure out who Aggienurse was.........I didn't want to stand up and yell, "WHO IS AGGIENURSE??" b/c I wasn't sure how much privacy she wants to have. Aggie, if you want me to know who you are, you can tell me........if not, that's okay, too. Only a measly 2 days off this weekend; doesn't feel long after just being off for a month. I have to get adjusted to being a "working person" again!

Hey, aggienurse! I kind of figured this out last week when I saw where you live; we work at the same place! You must not be doing a critical care area.....I am, so that is why my orientation is a few weeks longer than the regular orientation. The "service excellence" was a dead ringer that we work at the same hospital. I will have to see if I can figure out who you are tomorrow.......guess I will just yell out "aggienurse" and who ever looks my way is you!!! Congrats to both of us on our new jobs, hope we both will enjoy them! Lil

CONGRATS HOLLI!!! :balloons: Way to go on your new job.....hope you love it! Lil

My first day was all classroom and still is! (M-F, 8-5)! I think starting next week we will have some time on the floor and some in the classroom.....but I have to do classroom stuff until the 1st or 2nd week in August (YIKES!! Thought I was done with class!). Lots of policies and proceedures.......blah blah blah blah blah.....I'm ready to get out there and learn something!!!!! Lil

Grin, Jefferson is in Marion County.....it's about 15 minutes from here and a fun place to go for looking at older stuff. They have really beautiful B&Bs everywhere, that would be a nice thing to do for your mom. They have a lot of historic homes that you can tour......and yes, they do have an old railcar that was someone's home that they do tours of. Marshall has a big thing at Christmas with all the lights & the town makes a big deal out of it. It is really nice downtown, but not so much in the neighborhoods anymore. I think everyone got tired of being expected to put up a bunch of lights and spend gobs of their own money doing so. Still pretty nice in some neighborhoods though. Thanks for the tip about not coming to first Monday during the summer....maybe I will wait until fall to head up that way. Hope you have a great first day, also! Lil

Hey, Grin! You don't live too far, do you? I've never been to First Monday, but I've heard it's awesome, although somewhat of a madhouse!! Jefferson is a really neat town too, my husband and I spent our wedding night in one of the haunted hotels there.......okay, that was a little scary! I am nervous about tomorrow, too, but it will be nice to actually have a job again and make a living!! I will kind of miss lying around being a bum (as I've been doing for a month), but you can only watch so many Dr.Phil re-runs before you get bored with it!! Good luck to you, hope to see you on allnurses often.....we can keep each other updated on how our new jobs are going!! Lil

CONGRATS TO YOU BOTH!!

Also start Monday the 13th for orientation, critical care, day shift. Went and bought scrubs today.....getting really nervous! Aggienurse, are you working at GSMC? I live in Marshall.......you will know where that is!!! Lil

congrats!!!!! :balloons:

I live in TX and they participate in the quick results; my results were not posted until exactly 48 hours after my test time. I did schedule my test on a Monday so I wouldn't run into weekends, so I do not know if they post results over a weekend or not.

Congrats to everyone! Sunshine, I hope you find out something soon!