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laflaca BSN, RN

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laflaca has 5 years experience as a BSN, RN.

*Two previous careers, followed by... *The horror of nursing school in middle age, followed by...*Emergency nursing *Good times in epidemiology/public health nursing *relapse into ED nursing and finally *2018 foray into high school nursing

laflaca's Latest Activity

  1. laflaca

    School Nurse: Managing a scene/coworkers

    Also: This corner of AN is the best! Peace, love, and practical solutions
  2. Looking for advice. I had a HS student who was assaulted by another another kid - punched hard several times in the face. Face is a mess, blood all over, kid is crying and freaked out. Airway OK, no broken teeth and wasn't choked or anything. Breathing fast but good color, crying and talking in complete sentences, sats good. A&o, recalls events before & after, no loss of consciousness, didn't fall or hit head against anything, steady drip of blood and a big visible clot hanging out but not gushing, nares patent after the bleeding stopped, nose already very swollen, eyes reddened and already starting to bruise but PEARRL and vision OK. No palpable or visible injury to the rest of head, mouth, jaw, ears; no pain in back or cspine, no changes in sensation; no obvious asymmetry or fractures in face, wasn't struck anywhere else. Not nauseated, vomiting, dizzy or confused. Not on anticoagulants, no worrisome medical history. So, a terrible situation requiring monitoring until he went to a provider (it took his group home over an hour to arrive, despite saying they were coming immediately. Vitals OK and he remained a&o managing OK with Tylenol and ice. But I gave them a stern talk about going straight to the hospital, and wished I would've just called 911 to get him going). But not appearing to be immediately life threatening. I never worked pre-hospital or in community settings like this before; I'm used to being around other nurses. So running through my ABCDE checklist seems logical and obvious, but I'm thrown off by my coworkers who say and do completely unexpected things (three of them hassling me about the blood while I'm trying to assess the kid - insisting floor should be cleaned up and his clothes changed immediately - while I of course am not concerned with the floor. I want to make sure there's not some c-spine problem or other injury before anyone moves anything). One of them actually yelled out from behind me mid-assessment that the kid should tip his head way back so the blood would stop dripping (um, no). I'm not used to managing onlookers on a scene. Also not used to a setting where freaked out teenagers can crawl underneath a shelf, making assessment a challenge. I probably should have just kicked all the staff out. How do you handle your coworkers in these situations? And what else could I have done for this kid? We don't do debriefings at work (we should) so I'm going over and over in my mind about it.
  3. I'm in my second year at a HS. It's a tough school, which I knew when I took the job. Nonetheless I like the role and the kids. My struggle is that at the end of last year, a certified staff member and I both witnessed an incident involving security staff and a student, and we each filed a written report. (Without going into detail - staff's behavior was awful, it was harmful, and I saw the whole thing myself). There was an investigation and for reasons I don't understand, there were no consequences to the involved staff person. The involved person found out who had reported, and then they filed some kind of counter-accusation against the other reporter, who was subsequently reprimanded and transferred out of our school after 10+ years of service. As for me, this person has made work difficult. For instance, security stopped coming when I call them. Even if I can actually see them and hear my own voice on their radios; they look right at me, and walk away. People associated with the involved person will not make eye contact or speak to me, even when I request information for an injury report or something. It would be ridiculous if it weren't also a little creepy. The principal who let this person off the hook is not going to help. He likes me but the involved person has been here much longer, is a supervisor, has strong relationships with probably 1/3 of our staff, and is quite intimidating. The principal frequently talks this person up in meetings. Filing complaints does not seem promising. There's a position open in another district. Would you consider leaving mid-year if the other job seemed better? (The school is definitely higher-performing with a wider mix of students. I don't know the principal or the work culture or why the vacancy, but am discreetly asking around). I know I did the right thing even though it didn't help. Sadly, our school is a mess overall. I have positive relationships with the teachers, the social workers, and the office so maybe I can gut it out....not sure. My contract says they could charge me a $2,000 fee, and I assume I'd be ineligible for rehire, but it might be worth it.
  4. laflaca

    Panic Attacks

    +1 for this grounding exercise; I use it almost every week. Another version is, "You get to go on a trip. Where do you want to go? OK, name 5 things you will pack....4 things you will hear when you get there....3 things you will see on your trip.....two things you will eat on your trip....1 thing you'll bring back home with you" I also use "star breathing" or "square breathing" (for example see: http://www.appleschools.ca/files/Star_Breathing_Instructions.pdf) once they're able to listen to instructions. BUT, also agree with above advice to start turfing this stuff to the SW or counselor. If you are known as being TOO good at managing panic attacks, you're going to get them all, and these kids need an amount of time that you probably don't have.
  5. laflaca

    "huge puddle of blood!"....oh boy

    Just a moment to vent. I not only got a radio call but two teachers sprinting over and banging on my door about a "huge puddle of blood" emergency today. I walked, did not run, to the room and found a high school student with a nosebleed - a steady drip, nothing dramatic, and maybe about 20 drops of blood on the floor in front of him. Student already leaning forward pinching his nose and asking for some Kleenex, no injury/trauma, says he gets nosebleeds from time to time. I had him gently blow out a big clot (thanks for that tip!), and with a few more minutes of pressure he was back to eating his lunch. On the other hand, the kid who may have been suicidal and cut himself yesterday... For that I just got a one-sentence email, at the end of the school day so I didn't see it until school was out (Luckily he was OK, I saw him today and talked to mom. Psych follow-up is in place, and a reminder of our policy re: self harm -which explicitly prohibits staff from making reports by email - was sent out) I like my teacher colleagues, but I seriously do not understand the way they think.
  6. laflaca

    Any MSW/RN's out there? Want to pick your brain

    Eventually it's possible, the same way it's possible to have any two part-time jobs at the same time. However, I think it might be best to pick the path that you most want to follow for at least several years, because it's a tough combination. If you wanted to be an LCSW, one thing to keep in mind is that AFTER two years post-college for the master's degree and passing the LMSW test, you need about two years of supervised clinical practice that meets specific requirements - if you're lucky, you'll get a clinical supervisor at work, or otherwise you might actually have to pay for those hours - before you sit for the LCSW exam and are able to work independently as a therapist. Slogging through those supervised practice hours as a novice therapist can be a long, expensive process, and it would be even longer if you're only working part-time. After you're licensed, there's another slog of trying to market yourself, find a niche and build up business, if you want to work as a private practitioner with clients who pay out of pocket. If you bill insurance, you'll need to get credentialed for that, and then you may be in a different version of what PMHNPs face...insurance coverage decides what you can do, for instance often limiting you to a few sessions. Some exceptions exist, but generally those are the rules. The first year as an RN is very difficult for most people. It's hard to convey how overwhelming your first RN job can be, even if you've read about it. Part-time work is not typically an option for new grad RNs. For most people it takes a year and a half in a hospital job before you have a reasonably good idea of what you're doing, and it might take quite a bit longer than that to find a specialty or area that's a great fit. The point is, both LCSW and RN jobs require a lot of dedication and focus in the first years, right after emerging from school and the exhaustion/debt/strain that goes along with it. You also have to consider the significant costs in maintaining both licenses - CEUs, licensing fees, certifications, etc. I don't see a real advantage to setting out to do both, myself, but good luck in your explorations. PS I agree with you on the PsyD issue - yikes, I don't know how they do it.
  7. laflaca

    C'Mon Now!

    Oh, this made me so happy. Thanks for sharing!!
  8. laflaca

    C'Mon Now!

    Wait, wait, another one. Three different teachers come to me on Monday, telling me that a student has a Very Serious Issue That Must Be Addressed By Nurse, Immediately. I bring in the student, who tells me with MAXIMUM drama that she is pregnant. She has taken no test and had a period three weeks ago, but insists that she feels a baby kicking (causing suprapubic pain). Incidentally she also has dysuria and frequency. Also of note, though completely irrelevant in her point of view, is the fact that she hasn't had any proximity to a penis or semen in 2+ years. I sigh and send her to a clinic. The next day she comes in with a script for Macrobid, and acknowledges that the provider told her there will be no baby. Yet each day, more teachers ask in hushed tones whether I've arranged an ultrasound yet. Yes, this kid has some ongoing issues but she is already legally an adult and.....c'mon now!
  9. laflaca

    C'Mon Now!

    Student comes in and says, "I need some pain pills!" He is visibly annoyed at my questions about, for instance, what is hurting. Helpful instructional assistant says to me as though I'm a little bit dense, "He just needs some pain pills and then he can go back to class." My actual answer: "Well, I'm not a vending machine, I'm a nurse. I don't just dispense things on demand. I have to understand the problem. So I can only help if you're willing to talk to me." My mental answer: C'MON NOW!!
  10. laflaca

    PHN registration in Minnesota

    It totally depends on jurisdiction. In MN you need the certification to be a PHN; in other states there's a certification but with totally different requirements; in still other places there's no such thing as a PHN certification. So, base your decisions on where you think you'll end up working.
  11. laflaca

    Rough transition to PH from ED

    Hi there - I've gone back and forth between public health (I was also an Epi nurse, investigating communicable disease reports) and the ED. I would recommend reaching out to your State epi folks (in coordination with your boss the population health director of course), and/or start basing your policies/procedures/forms on what the consortium was using...don't recreate the wheel. All your case definitions and control measures come from state regulations....and surely your state has a database for entering and extracting communicable disease report info?? As for the nursing side of things - how to counsel patients/families on treatment and transmission prevention in individual cases - your best friends are: 1) the Red Book, 2) the Control of Communicable Diseases Manual, and 3) nurses, midlevels and MDs in your neighboring jurisdictions. I live in Arizona. Here's a link to "Forms for investigation of reported cases or outbreaks" - we don't fill out these paper forms by hand, but we conduct the interview and enter data based on these questions after a doctor or lab reports a case. Is this the kind of stuff you're trying to get a handle on? https://azdhs.gov/preparedness/epidemiology-disease-control/index.php#investigations-forms Good luck, sounds like an interesting and exciting new job!!
  12. laflaca

    How long was your training for school nursing?

    No training. Zero. Basically I got there and they handed me keys. Figured it out using my wits, the kindhearted secretaries, this forum, and random binders gathering dust in my office.
  13. laflaca

    Where to go after ER nursing

    Rightly or wrongly, employers tend to have a high opinion of ER experience even in completely unrelated settings. So with your current resume, you're probably in a good spot! Maybe try thinking about what you want and like (instead of what you don't want)....what kinds of hours, what working conditions, what patient populations you like, variety or predictability, a big or small place, hospital vs community vs an office, more on a team or more independent...and then the practical stuff, like how much money you need to make. Check posts on this site and read discussions about different specialties, and start asking people you know about other work they've done, or other jobs they've heard of. Start applying and go on some interviews, treating it as a research project for yourself as well as a job search. You might be surprised at where you end up. From the ER I went first to public health/epidemiology and then to school nursing It was like landing on another planet, in a good way. Good luck!
  14. laflaca

    School Nurse Salary?

    Thanks for bumping this....my school is FAR from ideal in most ways, but I see that our pay is better (or less terrible?) than most. I make about $59k for 187 duty days, 7:30-3:30 with a 40 minute lunch that I actually get to take probably 2/3 of the time. I have a master's degree though, which counts for more $ because we're on the teacher salary scale. This is my second year. We have a union and for that reason our district pays more than the average for my state (AZ).
  15. laflaca

    Outpatient Clinic vs. Bedside Nursing

    It totally depends on your personal goals and your individual situation - it's hard to give advice without knowing you. If your biggest dream is to become an ICU nurse in the future, it doesn't make sense to take a clinic position. On the other hand, if you love the clinic specialty and want normal-people hours, it doesn't make sense to work in a hospital. If it's absolutely critical that you make as much money as possible right now, you need the job with the highest salary. Maybe one of these jobs has tuition reimbursement for your BSN and the other doesn't. In this forum most people will tell you to get that one year of hospital experience, but that doesn't apply to every single situation. One thing I will point out: a 2-year new grad contract is a bad sign, especially if there is some financial punishment for bailing out early. It is a guarantee that they can't get experienced nurses there - something is wrong with the patient ratios, the hours, the pay, the work environment or all of the above. If for some reason you feel you have to go that route (is this an HCA hospital? Read the many posts about StaRN and HCA as a warning), read your contract very carefully and be prepared to pay the price if it's worse than you imagined.
  16. laflaca

    Unwilling link in the enabling chain...

    I do the same! The parents who answer usually tell the kid themselves to get to class, or they tell me "he said this morning he didn't feel like going to school, and he said nothing at all about being sick. No way he's coming home to play video games today." And the parents who don't answer, don't answer. Either way there's usually a miraculous recovery.