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laflaca BSN, RN

Public High School Nurse

Content by laflaca

  1. laflaca

    Rules for next year

    Well, I'm finishing out my first year as a school nurse (high school). Thanks to you all, I've wised up and plan to set some clear expectations for the fall... 1) Ice pack? Sure! But you have to sit in my boring office to use it so that a) I can re-assess appropriately, b) there will be no public flaunting of ice packs, and c) I get my reusable cold packs returned. 2) Vaseline, chapstick and lotion: not a nurse thing. Never heard of 'em, never saw 'em, don't have 'em. See also sewing kit, glasses repair, hair ties, gym shoes, water bottles. 3) Snacks are for diabetics and kids who need to take meds with food, and the occasional kid with food insecurity at home who is getting help from our social worker . If you just came late, or didn't eat the free breakfast here, or are my coworker: the cafeteria opens at 11:30. [I have noticed that since I got rid of the sugary granola bars and started offering carrots, apples, a cheese string, and/or a pack of almonds...snack requests plummeted] 4) Health office is strictly one at a time for confidentiality. No friend visits, no twin complaints, no socializing. 5) Students before staff, unless someone needs an AED What else should I add, oh benevolent yet clear-eyed Keepers of the Ice Packs?
  2. laflaca

    Staff Needs

    I have to say, this was the most confusing part of the job when I started as a school nurse this year. Staff members would barge right in while I was with students, demanding Neosporin or eye drops or chapstick, or to have their blood pressure checked, or for rubbing alcohol, or to ask me to clean out their ears (!) or rule out fractures....seemingly with no awareness of the room around them, and seemingly under the impression that I'm a no-cost PCP with xray vision, running a bunch of side gigs in personal services. These are my favorite responses, with the most patient voice and sincere smile I can manage: 1) Hmmm, not sure what to tell you. That (fixing glasses, sewing torn clothing, chapstick procurement) is not really a nursing skill, you know? But I'm sure you'll figure it out. 2) That is something you should really discuss with your doctor. 3) Students have to come first unless there's a life-threatening emergency. But I'm glad to talk to you when I have down time (translation: never) After a few dozen broken-record repetitions of these answers, I think they grudgingly accept me as OK with the kids but "not as helpful as the last nurse" for their personal care needs. Hey, it works for me.
  3. laflaca

    When nurse is needed outside of the clinic

    Every day, all day. I don't want them to triage for me or decide to call STAT vs "when available" because they only see body fluids as an emergency (loud "vomiting," a tiny drizzle of nosebleed)... on the other hand, an unexplained loss of consciousness by an adult with chest pain didn't concern anyone but me ("it only took a minute before he woke up"). So I've tried to explain that I'd like a 1-3 word description. Busted lip, twisted ankle, fainted, feels dizzy, pinched her finger, seems confused, broke a tooth, etc But then they just use unhelpful short phrases like "on the ground" (pulseless? Chatting with a friend?) or "allergies" (seasonal? Or allergic to bees and just stung?). Or the classic "I don't know but they said you should come." Sooooo yeah. They don't distinguish between me running with an AED vs handing Kleenex to someone. It's all COME NOW. If someone else knows the magic answer, please share!!
  4. laflaca

    AM meds at school

    With proper orders and paperwork per our policy, I happily give them. Many of our kids spend more than an hour on the bus, getting picked up around 6AM, and they don't eat at home beforehand. Given the GI upset that can happen on an empty stomach, administration with breakfast at school seems like the best solution. I actively encourage parents who report med compliance problems at home to set up administration with me at school. At school I can offer education, elicit information about any side effects so I can advocate with doctors if needed, I can offer incentives for showing up for meds without a reminder, and I can call parents with "good news" reports when kids are taking meds consistently... increasing parents' confidence that YES, the kid actually can and eventually will learn to self-manage. I make kids learn the name, the dose, and why they take it. I make it a positive experience to see me and encourage their questions. I really try to engage them in their own care. Med pass is a chore, and I do kinda roll my eyes about doing all these cartwheels to get 17 year olds doing such a simple task, but if it gives them better odds of success, I'll do it!
  5. laflaca

    New School Nurse

    I just switched to school nursing from ED last year. Will you sub just with particular age groups, or is a unified district with all ages/levels? On the surface it's much simpler than hospital - healthy young people, lots of ice packs and Tylenol. But, then you dig into other layers of things you never thought about.... *Training laypeople with VASTLY different levels of medical literacy and common sense about everything from VNS magnets to EpiPens (as an ED nurse I had never seen an epipen even though I had given Epi IM and IV many times!)... *The sexually active 15 year old who replies, when you ask about protection, "don't worry miss, we only do anal" (!) *Someone has to decide if this pale, shaky kid with a headache is just anxious and tired, or if he has something more serious and needs a higher level of care - and it's YOU, by yourself, without a lab or imaging *Um wait, what? Wrap an ankle? But the techs do tha - aw, man!! So I think above advice about study topics is good, but the most important thing is a spirit of adventure, appreciation of the kids, and confidence in your skills. Your hospital experience will serve you well- you know sick vs not-sick. The learning curve is all about policies and personalities, which you really just figure out when you arrive. I hope you love it (I do!)
  6. laflaca

    Drug/Alcohol screenigns by school nurses?

    There's a recent thread on the school nurse forum....
  7. laflaca

    buying supplies with your own money

    Hi friends - I work in a public school that is nearly 100% low-income kids. Public school funding here is 48th out of the 50 states. There's no money for anything, anywhere...which basically means that in wealthier neighborhoods, parents get a list and purchase $200+ dollars of classroom and office supplies at the beginning of the year, apart from what their individual child needs. In schools like mine, not so much. Our teachers typically spend at least a couple hundred bucks of their own money, or sometimes considerably more, on basic supplies for their classroom (adding insult to injury, since their salaries are low). The budget for the school health office is zero. Our resourceful administrative assistant pirated $200 from her office supply budget so I could get basic supplies from the district warehouse in September. I brought my own manual BP cuff, pulse ox, and thermometer to the office since it's out of the question to pay $300 to replace the battery and re-calibrate our Welch Allyn rolling unit. I regularly find myself picking up cough drops, disinfectant wipes, snacks, etc for school when I'm out doing my own shopping. Do others face this issue? In a seemingly bottomless pit of needs, where do you draw the line? No one's going to die for lack of a cough drop, for sure. But there are some basic things that make my work life easier (like the organizer bags I purchased for storing medications) - sometimes I'd just rather have them than not, and I'm not going to get them any other way.
  8. laflaca

    Nurses that “only do it for the money”

    ha! I was a social worker before I was a nurse, and it was the same thing. Not that we were "only in it for the (terrible) pay,"...more like: "If you truly were compassionate and cared about our clients/mission/social justice vision, and if you were the special person truly called to this profession, you would.....(stay late, agree to be on call, work for free, not complain about unsafe working conditions, etc)." For the record, I worked for a few years as an interpreter/translator, and no one ONCE asked me if it was my calling. I think that some people are very uneasy about women working at all, and tolerate the idea more easily if we are motivated by our 'natural caring abilities' and not by filthy lucre. Other people use the 'true calling' argument to justify why traditionally female jobs are paid so much less than traditionally male ones. We get paid less, but we're just up to our ears in warm fuzzies. Personally - I'd rather be up to my ears in filthy lucre
  9. laflaca

    Arizona state/government hospitals

    The pension plan is 11%-and-change from your check, but the employer ALSO puts 11% which is unheard of in the private sector....so once you get used to the bite from your paycheck, it's a great benefit. If you stick around you get an actual pension....like people used to in the olden days The State is definitely a mess pay-wise. I think that broad categories of State workers, not just nurses, go without pay increases for many years. They also implement hiring freezes regularly; here in the great wild west of AZ, my fellow citizens are not enthusiastic about funding government services. Except law enforcement. County nurses, I'm sorry to say, do not always get raises. I worked for Maricopa County (2014-2017 plus PRN work) and did get a small (2%) raise while there - however, my coworkers told me the last increase was something like 7 years before that. No cost-of-living, no step increases, no nothing, exact same number on your paycheck. Can't speak for counties other than Maricopa. MIHS (Maricopa county hospital) gave raises while I was there. I don't know if that's reliably true. The best scenario in most of these government nursing jobs, I think, is to come in with 10 or more years of experience (common scenario at County is a nurse who is sick of busting their butt at the bedside, who takes a lower-key job in government). You're pretty much topped out on pay range in the private sector anyway; switching to government you get hired in around the middle of their (modest) pay range, and if you're there for a long time you will eventually creep up the scale. You take a pay cut, but the benefits are better and generally the work is not as intense. If you've still got 10 or 20 years to work, you'll have a nice little pension to add to whatever you saved before. If you get hired at State or Maricopa County with less than 5 years experience, they're going to hire you at the dead bottom of the range. Since the pay scale is already low and you might not get raises for years, and since your earnings in the private sector would increase quite a bit in the first few years of practice....the gap between your pay and non-government pay gets bigger and bigger each year. You'll creep up the pay scale eventually but with such a long way to go, it's not guaranteed you'll even reach the middle. There are tradeoffs, no matter what you do. Hope this helps.
  10. laflaca

    Blackballed for leaving after only a year?

    Good advice above....I'm sure you're a fantastic nurse but they are not going to be "devastated." As you're talking to your manager, she's already going to be adding "Tell HR to post TurquoiseTortoise's job" to her task list. It might be disheartening, but also a relief, to realize that you're a small part of a large machine. They'll be OK. Double check your employer's policy as soon as you can, ideally before you get an offer, so you know when you'll be available to start. When I quit a job because I was moving out of state, I was very surprised to find that my hospital had a 30-day notice requirement for RNs. I'd never had a job that required more than 2 weeks.
  11. laflaca

    Job hopping

    I've never understood the preoccupation with job hopping among nurses. Teachers, PTs, social workers, pharmacists, ....they all seem to change jobs without worrying about being branded as flakes. In my previous two careers I never once heard the phrase "job hopper" used. It's a common theme from nursing school that doesn't seem to play out in real life (also "risking your license".....look at BON discipline records in your state! No one is losing their license for running late on a 30-patient med pass. People lose their licenses for DUIs, for posting meth photos on social media, for stealing stuff at work....but I digress). Your ability to change jobs depends on a) what's open, and b) the applicants you're competing with. If it's a market with a lot of competition for a few open positions, sure, a manager might only choose someone who sticks around for 10 years, or someone with an inside connection. But generally it's a question of how in-demand your skill set is....for instance in my area if you're an experienced OR nurse right now, you could probably show up to interviews with visible horns and a tail, breathing fire, and still have no problem . If you can get a better job, and if you act professionally in giving notice....why not be happy? You're employed at will, not on a contract with a specific time commitment, right? If your employer thought you weren't a good fit, or they had to factor in some changed circumstance of budget or staffing, it'd surely be "thank you and goodbye." You get to do the same thing.
  12. Yes. Because "for-profit" means the shareholders by definition come first. And what's good for shareholders is cutting labor costs, because it's much harder to cut equipment/pharma/building costs, which means understaffing, which means there is no way to provide good patient care.
  13. laflaca

    Speciality change, again??

    THIS! I still think getting some support for your anxiety is a good idea, but TAKOO01 has given you even better advice. Many of us in nursing sort of have this mindset (that suffering is somehow noble or required at work)....even though it's not helpful, or true.
  14. laflaca

    Speciality change, again??

    I'd suggest another possibility - consider getting some support and work on your anxiety. Anxiety can be really responsive to therapy and behavioral strategies, improving even within a few weeks... whatever job you end up in, you can take those strategies with you. And you'll feel better! Not saying this is a purely personal problem. Hospitals could be, and used to be, less brutal places to work. It shouldn't be the way it is. There's a reason why so many nurses have anxiety problems! But it's more practical in the short term to change what's in your control, so you can enjoy your life more. Also, you will make better career decisions coming from a place of security and calmness. If you're operating in escape mode, it's easy to jump from bad work to worse. Good luck! You'll figure something out.
  15. laflaca

    First visit after spring break

    Ummmm a 16 year old with blisters on bilateral heels, from wearing new shoes.... two days ago. Already covered in bandaids. Urgently needs new bandaids! Also a staff member who interrupted me on the phone to show me an invisible splinter in her foot. Uggggh I need more coffee.
  16. laflaca

    What is considered a positive reportable TB test?

    Then it's not a positive result, right? No positive result, no reporting. (Even if it had been positive, you could report it tomorrow- believe me, public health departments are not going to punish you for reporting an asymptomatic positive PPD a couple hours late. If it was suspected botulism or MERS or Ebola or measles... Or if the guy were hacking up blood and had a history of known contact with multidrug resistant TB...then yes, they need a report this minute on the after hours line. But awesome that you are being so conscientious!!) if you work in a hospital, remember you always have the resource of your infection preventionist (who is often a nurse) - she probably can answer your questions and may actually be the facility's designated reporter to public health. Or your infectious disease docs are handy, too.
  17. laflaca

    What is considered a positive reportable TB test?

    Call the health department, describe the situation and ask if it's reportable (is the patient in one of the listed high risk groups, for whom that measurement is considered positive?). ... They'll let you know the criteria and procedure in your jurisdiction. They get questions like this all the time.
  18. laflaca

    Any new nurses escape the floor successfully ???

    +1 for public health! As soon as I got that one year of hospital experience, I worked first for the county health department and now as a school nurse. Great hours, great people, minimal stress. No regrets :)
  19. laflaca

    Measles!! No MMR #2 advice

    Yep, this. We all know that "quarantined in the hospital" happens in all kinds of situations where ultimately a non-infectious cause is found (you've got a headache and a stiff neck in the ER, everyone's masking up in case it's Neisseria meningiditis, until the results of the LP come back ). And "baffled infectious disease doctors" could mean "they were consulted along with neuro and derm and half of the other specialists, and they didn't find anything."
  20. laflaca

    My very first squad call

    Great job! No need to be moving anyone around, especially if they're not in immediate danger and you can't rule out head or spine injuries. You move him onto a wheelchair or bed, you might hurt something and they're just going to have to move him again, right? No need to be using our Girl Scout skills to forage for splint materials in the ditch, either (EMS has really nice splints, backboards and c-collars, plus pain meds!) Airway's good, breathing's good, circulation's good, nothing's immediately life threatening....you assessed, you kept things from getting worse, you got him to a higher level of care, and you'll follow up afterward to make sure he gets what he needs at school. Sounds perfect to me. And why are they always wearing those skinny, skinny jeans when they hurt their legs?
  21. laflaca

    Measles!! No MMR #2 advice

    Former Epidemiology nurse and current (brand new) school nurse here....it really does totally depend on your state law. Here in Arizona, where our state law makes poor choices related to vaccines, her parents can just sign a "personal belief" exemption for any old reason, and voila! Exempt! Why even bother with doctors and reasons? If someone's asking for a medical exemption, you can see Texas' dept of state health services guidance here: https://dshs.texas.gov/immunize/school/exemptions.aspx Seems pretty typical of laws about true medical exemptions: you've gotta have a letter from an MD or DO stating it's medically contraindicated, not just an anecdote about a hospital stay. It's true that the MMR has a decent level of protection with just the one dose BUT in the county where I work, she would not be considered vaccinated with one MMR. In an outbreak situation, our county public health department would require us to exclude her from school. I tell this to every parent who requests an exemption. Your mileage may vary... I've never worked in a private school and Texas sometimes has its own ideas
  22. laflaca

    buying supplies with your own money

    haha I get it....my attitude about that stuff is NOT improved by knowing that I bought the bandaids myself!!
  23. laflaca

    buying supplies with your own money

    Thanks for the ideas - I know some of our teachers have used DonorsChoose but I've never tried. I'll check it out. I've been pretty good at scrounging, and the district does supply emergency stuff (an epi-pen, albuterol, oxygen and tubing/masks, a "stop the bleed" kit and Narcan). There's a local agency that donates pads/tampons, lots of teachers or their family members donate clothes, plus I can sometimes "borrow" supplies from other nurses in our district (much bigger schools). Our admin assistant somehow liberated funds from her budget to buy my OTC meds - so that stuff didn't come out of my pocket. I also have been using y'all's idea of re-purposing unused food from the cafeteria - GREAT idea - we have a "share basket" where students can leave unopened food to donate. I do have a small Costco PO that I can use for snacks, though I'd rather have that money for other stuff. It'd be helpful to have a budget though! Our district OVERALL is actually very progressive in terms of school health - we have a doctor, standing orders, an awesome lead nurse, very clear and evidence-based policies, reasonable expectations and computer system for charting. The problem is that I work in a tiny specialty school, only 130 students compared to the regular home campuses of 2000+ students. For nursing & everything else, we kind of get lost in the shuffle. It's my first year here, so I guess one step at a time Thanks for all the ideas.
  24. laflaca

    Lead School Nurse vs Health Services Director

    Well said! Run!
  25. I had a difficult couple days at work. Kids in dangerous home situations, sick kids, not-sick-but-very-loud kids, kids in fights with each other, administrative disagreements.... just some trying moments. On top of this we were short staffed. Normally we have three social workers, and today we only had one. Any social work shortage inevitably spills over to the nurse - I dread their vacation days. Anyway, as the lone social worker and I battened down the hatches and got ready to embrace the suck, she told me something funny. She was dreading work this morning and decided to calibrate her dread more precisely. This is what she came up with: if she were required to urinate on herself in public to get a free pass to avoid this workday, she would do it. However, she did not dread work so much that she'd be willing to defecate in public. All day long when we saw each other, we laughed and said, "are you willing to soil yourself yet?" And everybody left the building vertical, ambulatory and conscious....SO, I guess it wasn't such a bad day after all. Still beats any shift I worked in the hospital. Happy weekend everyone!