CrazyTrainRN

I would also like to add this is not the first display of violence in our office from this student. I was not in the office the first time. It was back in the fall of this school year. The other nurse said he was screaming and banging his head on the concrete wall and cabinets and punching himself in the face. The resource officer and asst principle responded. She talked to the head principle about what occurred. Not one thing was done about the situation.

I need your thoughts and advice on this situation. This student has been a problem for years, but it has escalated to this. He is 17 and a senior, but failing. I do not feel we are getting support from the HS administration. There have been numerous meetings with this students parent.s They say what we want to hear but never follow through. I know he needs help, but it has gotten to the point where it is beyond our scope as school nurses. I have been physically sick since this happened and I am an emotionally a wreck, as is the other nurse. Neither one of us has ever experienced a student act like this. Words could never accurately describe what happened and how fearful we were. I will be as generic as possible to protect all those involved. Here is my account: On Thursday, January 21, 2010, at approximately 9:25 a.m. Student X came into the nurse’s office. I noticed he had something all over his face. I asked him what it was. He said chocolate from chocolate donuts. Nurse A told Student X that his father called the school and was looking for him. (The previous weekend he had been missing for 3 days and when the father found him, he had no insulin and a blood sugar of 800) He said he left school to get donuts with friends. When he returned to school, he did not go to his first hour class because he had work to do and went to the library instead. Nurse A asked him what his blood sugar was earlier and he said 123. She told him that since he ate donuts he needed to take his blood sugar. I watched him take his blood sugar (because he lies to us about his numbers) and it was 509. I told Nurse A that his blood sugar was 509 and Student X replied that he needed to go home. Nurse A called the assistant principle to come to the nurse’s office. Student X became agitated and started talking to himself, using the word “f***.” When the assistant principle assigned to this student. He arrived, we told him the situation, and he asked Student X to take a walk with him. Student X returned to the nurse’s office to get his book bag. I asked him what he was going to do. He said he was going to class and left the office. The assistant principle then came back to the nurse’s office. There was discussion about Student X and the concerns we are having with him, such as uncontrolled blood sugars, possible substance abuse issues, mental health issues and his disruptive behavior in the nurse’s office. We agreed that his father and his doctor should be contacted regarding these issues. Nurse A told Assistant principle that it was not safe for Student X to be back in class with a blood sugar over 500. Nurse A called the father and left a message on his phone to call her back regarding Student X. Student X returned to the nurse’s office. We requested he give us a urine specimen so I could check his keytones (neg). Student X's father called him on his cell phone and after talking to him a few minutes, Student X handed the phone to Nurse A. While Nurse A was on the phone with his father, Student X became belligerent and agitated. He yelled several times “Let me talk to my dad! I wanna talk to my dad!” I told him that she would let him and he needed to be quite. He continued to cuss, stomp around and yell. After Nurse A was done talking to the dad, she handed the phone to Student X. He began screaming and using foul language, such as “I f***ing want to go home!” “The nurse is a f***ing liar!” “The nurse is always in my f***ing business!” “I am not on f***ing drugs!” His dad hung up on him. He called his dad back and continued to yell and scream as loud as he could. His behavior was threatening and becoming more violent in nature. After 10 or more minutes of this behavior, I felt as if Nurse A and I were in danger. I did not want to agitate Student X further by calling for help on my radio, so as discretely and quietly as I could, I dialed Officer Q's (resource officer) extension. He answered the phone and I whispered in the phone “come down here,” then was quiet so he could hear Student X screaming. Officer Q came directly to the nurse’s office and witnessed Student X's behavior on the phone with his father. He told him to calm down. Student X handed the phone to Nurse A to talk to his father. Officer Q tried talking to Student X, but he continued to scream and yell. Officer Q told Student X to lower his voice. He was screaming and cursing so loud that Officer Q told him to lower his voice as he was taking that as a threat. The head principle came into the office. Officer Q said “This is a safety issue.” Student X continued with his rant. His face was red; he was crying and grabbing his face and hair. He was screaming and yelling things such as he was going to “gouge his eyes out.” He was continuously screaming, “I want to go home.” Officer Q again stated “This is a safety issue.” After this going on for many minutes, the head principle convinced Student X to walk to his office. They escorted Student X out the door. Nurse A stated as Student X walked out the door, he mouthed the word “die” to her. Later in the afternoon, we had a meeting with the head principle, 2 assistant principles and the nursing supervisor in the nurse’s office. We agreed that before Student X returned to school, several things would happen: 1) Student X's doctor would be contacted and written medical clearance would be obtained; 2) a 504 plan would be implemented, or medical homebound would be put into place; 3) we would have a meeting with Student X's’s parents, which would include nurses, all assistant principles and principle. The head principle said he would call the parents and let them know that Student X could not return to school until these things were accomplished. On Friday morning (January 22), I was informed that Student X was allowed (by the head principle) to return to school, but was asked to leave because he did not have his diabetic supplies. (Not because of his behavior the previous day!) Student X's behavior has created a hostile work environment for Nurse A and me. He should not be allowed to return to school due to the unstable, irrational and threatening behavior he has displayed in the past, and on January 21. It is a safety issue for Nurse A and me, as well as the students and faculty. If Student X will be staying with the school district, it is my recommendation that he be placed on medical home bound. my name and credentials position in the district

OH OK! I didn't realize it was a joke. Actually, some of the school districts in my area pay their nurses pretty good. One district I looked at pays higher salaries if the nurse has her BSN or MSN. (I am not sure if this is common.) That particular district only hires RNs, where the district I work for hires LPNs and RNs and the pay is the same for everyone. I talked to my boss about this and she said we are a "poor school district." The other district's starting nurse salary (step 1) is almost twice as much as I am paid now. (My district started me out at step 10 for experience). It is just discouraging sometimes. OH! A student just walked in -- gotta run!

Before the break, my mind set was "Working for Christmas Break." Now it is "Working for Summer!!" The high school was actually quiet yesterday but the elementary school is busy today. I am trying to get get some projects finished up and transfer students "squared away."

1) I have never been in this situation before, so I was interested in all the responses just in case I am ever in this situation. Thanks for the posts! 2) I am an RN BSN and I am paid $15.00 an hour (about $10.00 an hour after taxes). Not what I would call "the big bucks" for what I am faced with daily. I took the job because I was a stay at home mom for 11 years and getting back into nursing after being out that long was a challenge. I also wanted a schedule that would fit with my daughters school schedule. I am starting to look for a school nurse job that pays more. If anyone knows of any openings 40 miles west of st louis, let me know.

correction on above post i made: i meant random dot e!! not double blind e (duh!) it was late when i was posting - sorry!

I have almost all my 350+ 10th graders h/v completed (just 3 or 4 more to catch up with) and all my referrals out. It was only by the grace of God that this year an another nurse helped me out and we did a mass screening on 2 days. (Side note: We did the screenings AND saw students! It was a nightmare and I ended up having chest pain and high BP most of that week. My doctor ordered a stress test the following week. The test came back normal and my doctor said my symptoms were stress related.) I have my elementary kids done except for the pre-k, and all my referrals out. Our school district went to a new computer system this year (Lumen - hate it so far) and our immunizations are still messed up in the system. I am scared to enter the h/v results into the computer for fear that they will "get lost" like some of our immunizations have. (That is another subject for another post). So, as soon as I get the go ahead from our supervisor, I will begin entering h/v data into the computer - about 475 students. UGH! This year we are also required to do Double Blind E on a few of the grades (cant remember which ones right now) and I havent done that. Our district has to share 2 kits so i am in line for my turn.

mustlovepoodles: Love your post! It made me LOL because I identifiy with you. I agree with you on every point made regarding students, parents, etc. To be honest, middle school is my least favorite age group and the hardest age group to deal with, in my opinion. What type of nursing are you looking into now? Just curious.

This is my 2nd year at my job full time (I was a sub the first year) I have never been a school nurse, although I was med/surg/ostomy/wound care/trauma/ortho in the past, this is a whole new game!! I am at a small elementary school 2 days a week and a larger high school (1400 students) 3 days a week. There is also a full time nurse at the high school who has worked there for 12+ years, so she has taught me a ton about school nursing. I also get pulled frequently to cover for other nurses who are out sick or on vacation. We don't have enough subs. It is the high school kids that push the limits daily, even with the other nurse who has been there for years. Many of the frequent flyers don't even care that we know they are faking - they just want to leave school. Some of them scream and cuss if we don't give them a dismissal and sometimes they leave the school anyway. I am still learning to be tough with these kids and it is hard for me sometimes. I never thought there would be so much psych involved with school nursing. Any advice or suggestions are welcome! How about you? How long have you been in school nursing?

I know the exact situation! Or the student who is in the hall cutting up and laughing with friends and 15 minutes later they are in the nurse's office acting like they are "dying" and need to go home. Yeah, right! "Get back to class!"

Yes, we have one HS principle that thinks the nurses are "mean" because we don't send kids home for every complaint. I have discussed this with my supervisor and she always says, "Our job is to keep the students healthy and in school." When trying to decide whether or not to send a student home, I try to remember this. If they can stay at school, they should. The minute the students (esp. HS) figure out they can go home for every little complaint, the nurse's office will become a chaotic mess. My general rule is if the student is afebrile and not vomiting (in the bucket or trash can in my office), they stay at school. Of course, there are exceptions, such as a sore throat that looks like strep throat, etc. If in doubt about whether to call a parent or not, I err on the side of caution and call. Like luvschoolnursing stated, calling parents when the student is not around is also a good option for those who you think are "faking it" or you think they seem ok to stay. As far as the HS students going to the bathroom and calling parents, that happens to us, too. Here is how I handle that: If I have decided that a student is okay to stay and they end up calling the parent on their cell phone to pick them up, I refuse to write them a pass to leave school. If the principle wants to excuse them to go home, that is their call, but as far as I am concerned, they are okay to stay and I am not going to give them an excused pass to leave. The principles at our HS are pretty good at backing us up.

I agree with the others. Get a sub job for experience, to see if that is what you want to do full time and to see if you like the school district. Also, different districts pay differently. Subbing is a great way to get started. I was a sub for a year then went full time.

If you think they are faking it and are acting fine but feel the need to call the parents, I would leave it up to the parents as to whether they want to pick them up or not. I call the parents, tell them what the child said happened, tell them my observations (no swelling, bruising etc. and also how the child is acting ie, smiling, laughing, etc) what I did about the situation (usually ice pack). Then I tell the parent that only an xray would be able to tell if it is broken or not. Do they want to wait to see how the day goes or pick up the child right away. You could also add that you think the child is fine, but it is up to the parents. There are always those children who are constantly "hurt". Usually with these children I do my assessment and if I feel they are ok, I won't even call the parents and send them back to class. (If they need an ice pack, I might give them one, depending on the situation) After the child goes back to class and I feel it necessary, I may call the parent just to let them know what happened and that they should watch the child at home. For the children who say they threw up but no one saw them, I picked up a trick from the other nurses in our district. We collect the large plastic buckets that ice cream comes in (we buy ours at walmart). We use these for barf buckets. (I think they are 5 quarts) When a "frequent flyer" comes in, I always take their temperature and document that. If no fever, I give them a bucket and tell them if they need to throw up, use the bucket. Then I send them back to class with the bucket. I tell them they are not going home unless there is vomit in the bucket. The older kids hate carrying around a bucket and usually make a miraculous recovery!! Send out an email to staff that you need plastic ice cream buckets and you should be able to collect enough buckets for the year. I write on the buckets "return to nurse's office." We do this at the high school, too, and the kids called us sadistic. If they are fever free and have missed too much school or are frequent flyers, we give them a bucket and send them back to class. They hate us when we do that. If you are going to do this, make sure it is okay with the principle that you do this. So far, I have only heard of one principle in our district who does not like the bucket. Those kids are just sent back and they throw up on the floor, which does not make sense to me, but whatever.

Is your supervisor a nurse? Are there other nurses in your district? If so, utilize them for your questions and concerns. This is my second year as a brand new, full time school nurse. (I was a sub the year before I went full time) I still call my supervisor if a situation comes up that I am not sure what to do. And there are a few nurses in our district that have been there 15+ years, so I call or email them for advice. What state are you in? I am in the state of Missouri. The Missouri Association of School Nurses (MASN) holds a new school nurse orientation conference once a year. I attended it this past fall and it was well worth it. Do a google search to find your state and local school nurse association. Their websites are helpful, also. I also went to the yearly MASN conference last spring. I also found that helpful. I also subscribe to a school nurse magazine to keep up to date on issues, read the health department websites and joined any email lists that would help keep me informed. You may be overwhelmed at first, but hang in there. It will get better. I still feel overwhelmed at times but I can already tell this year has been a little better than last year. Like anything, it takes time to learn the job.

My thoughts exactly! :yeahthat: