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Substitute School Nurse

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  1. AutumnDraidean

    Sitting down - New nurse looking for advice

    It sounds like you love the ED, just not the pace. I don't know how location locked you are, but you might love a small critical access rural hospital. You will see many of the things you'll see in a level 3, you will go on transports and get certifications galore (if you don't already have them) but you will do it at a slower pace. It won't advance as many skills but you would gain assessment skills working in an urgent care. School nursing is really dependent on crack assessment skills and differentiating big trouble from work avoidant otherwise healthy children...and everything in between.
  2. AutumnDraidean

    School RN in high school

    HS students are cool, but they may also be avoiding a class they don't like. They also may come just to play on their phones and you have to assess that as well as the other unwanted phone stunt, texting parents and saying they are ill when they are just DONE. As a sub I can shrug my shoulders and let the consequences fall where they may. As the regular school nurse you would have to be right in there solving the school avoidance issues as they crop up.
  3. AutumnDraidean

    C'Mon Now!

    LO in complaining that breakfast will give her a tummy ache, if I had alternate food I'd have given her some, but I don't. She wasn't telling me what part of breakfast would give her a belly ache, so I told her to eat whatever she thought would be best and if she got a belly ache we'd figure it out after. Interestingly I didn't see her again all day. I do wish this nurses office wasn't the repository of spare gym sneakers!!
  4. AutumnDraidean

    Lost job over HIPAA violation

    Where I work we are reminded regularly that we are not to look at who's in the ER (in the computer)for ANY reason, until they are admitted to our unit and assigned to our care. This is a kindness because they WILL fire people for it. I was once told that I could theoretically be fired for looking at my own lab results!
  5. AutumnDraidean

    Accessing work email at home

    I don't really want to post my state, I work for a cottage type hospital as a substitute school nurse and I have access to my e-mail on my phone. someone got into a lot of trouble because a spouse got access to their e-mail and a hullabaloo ensued. What blew my mind was that for a long time they were sending an e-mail every week with a unit census, I sent my manager an e-mail explaining why this gave me the willies, after a good month these little bombs ceased with absolutely no explanation. I need my e-mail off site, it's how I get offered work and how I turn in my time sheet and other administrative things. I have to go on site every 90 days to change passwords.
  6. AutumnDraidean

    Calling all Massachusetts camp nurses!

    I work as a substitute school nurse in numerous school districts in northern NYS. Someone once said that in New Hampshire there is a tax behind every rock and tree, I would extend that to say that in NYS there is a regulation behind every rock and tree. Here in the Adirondacks there are plenty of rocks and trees! My daughter will probably be attending a camp that has moved from NYS to MA; my older girls went to this camp and it's a really great experience for kids. They have a history of playing fast and loose with some things and OTC meds is one such area. Is Massachusetts like NYS in that any OTC med given a child and camp or school must have a doctor's order, and parents written permission and any Rx meds need a doctor's order, a pharmacy label that matches the order and parental permission? Until I called them out on it in NYS they were all set to go with only parental permission and even that was sketchy as they were having us fill out the information on a website with no way to sign off on anything. I explained the law to them and asked them if they had shown this to their camp nurse. They responded that they hadn't hired one yet. I strongly suggested they investigate this situation or they would risk the nurse they did hire quitting the first day. (I would have, in that situation) I would just as soon know, from MA RNs who work camps, what the process should be and how it happens in the wild. Also will I hit any other hitches, is a "Recent physical" any within the last year? lucky for me I never met a vaccine I didn't like so she's as up to date as she can be with that. Thanks
  7. AutumnDraidean

    One step Microtia reconstruction?

    So I'm looking for peds nurses and other opinions. My daughter has microtia and atresia on the right and I've been doing the watchful waiting game. A doctor in Boise Idaho sent information to my pediatrician on his one step reconstructive surgery for this condition and my daughter has a fair amount of pinna to work with plus, we know her middle and inner ear are fine, she simply lacks a tympanic membrane (bone instead) What I would love to hear from are peds nurses who take care of these children post-op, How do they do, how personable is the doctor, does he respond in a timely manner when called, does he listen to you as nurses. and any other independent observations. We live in Northern NY and know nobody in Boise. So this would be logistically challenging and I just want to know more from independent sources. My daughter is 12, she's more self conscious about the hearing deficit than she is about the ill formed pinna.
  8. AutumnDraidean

    Diabetic orders

    See the other sub did that...I can't take phone orders so calling the endo office isn't in the cards. I've got the willies about this but I've been lucky so far, she hasn't needed the correction factor. It'll be a year before she gets a pump, I've dealt with lots of pumps, but only one other student with injections (pen) and then the primary nurse had it ALL laid out on a chart, no changing ratios just if X carbs than Y insulin, if BG=A then add B more insulin to Y. Additionally what this Mom says we do, I'm not sticking anything into that hornet nest! I just worry...
  9. AutumnDraidean

    Diabetic orders

    So, bearing in mind that I'm a sub give me some insight into this: T1D orders are for her carb total to be divided by 20. that's her insulin dose for the meal, added to that is BG -120____ and then you divide that by 50 and add the result to the insulin dose as a correction factor. So one day I find that the other sub had divided the result of the BG -120 and she had divided it by 20 instead of 50, so I wrote her a note and she said she asked Mom and was told that the correction factor can change...but if you divide something by 20 instead of 50 you will get a much higher result. Further, the orders from endocrinology state that the correction factor should be 50... My "nurse sense" is most unhappy and I'd love to know what you guys think, I hope my explanation was clear.
  10. AutumnDraidean

    C'Mon Now!

    Well, in some ways it was better but I had a bump & bruise brigade and a questionable head bump thanks to the "Olympics" they were holding. And a win. They wanted a letter because a whole class had been exposed to strep/scarlet fever. I found one on my state's department of health website and had it e-mailed to the school secretary to be prettied up and approved in under 5 minutes! (The full time school nurse is out on long term medical leave, there was NO ducking this request as a sub)
  11. AutumnDraidean

    Parents keep medicating their febrile kids in the morning

    I so feel you... Thank FSM we are going into a break, I sure hope this school is scrubbed to within an inch of every finish...
  12. AutumnDraidean

    C'Mon Now!

    I want to know how many times and ways I have to tell this one school that as an RN in this state I can not give a child a med without a doctor's order. Again today, complete with a "humph!" as the principal left with the med. this happened at 8:15 this morning and already my anxiety is at 11 or 12. Next I get a kid who is afebrile and only c/o malaise and a stuffy nose. Teacher wants him sent home so he doesn't spread his funk. Ok whatevs, I'm a sub, I don't care. But none of his contacts will answer the phone...He asks to go back to the classroom, mom calls me, apparently a sibling was sent home by the teacher and mom's mad because I didn't call her earlier...I didn't know... kid was sent home from the classroom. They had to send him home on the bus. I have to go back there tomorrow...hold me!!
  13. AutumnDraidean

    Napping in health room and other things...

    As a sub I would be VERY unhappy with this set up. beyond all the infection control issues I wouldn't know the child and would be very unprepared to deal with behaviors.
  14. AutumnDraidean

    Stocking OTC meds at elementary school level

    In my state you have to have HCP orders and parental permission for tylenol and the like, Cough drops seem to vary by school, although I don't know why. One school is frighteningly loose with this policy and I had a parent mad because I wouldn't administer abx to her LO. She hadn't gotten a written order which she could have easily asked for when she got the Rx, She went to the principal who did it instead...I'm not thrilled with the compromise but at least it's not MY LICENCE. The part that drives me craziest is how in some schools I am not to apply so much as hand lotion and in others this is going on. I got otc orders for my kids and this year the school is providing. It's also hard in my area to track down 325mg tylenol, they're all 500mg.
  15. AutumnDraidean

    C'Mon Now!

    I originally thought this would follow on the posts about the hassle of calling some parents, I have two related struggles. One version, Parent wishes to be called with most visits, with good reasons. OK, so I call, and I get voicemail box is full. I call other numbers and then both parents call me in seperate phone calls to make sure Precious is ok. Fine, but if mom would just answer her cell phone THE FIRST TIME it would have been over in a 60 second phone call. They want these calls, why do they make it hard? Other version, different school, kid's got a 101 temp, none of the contact numbers work, I tell the school secretary and she messages them on Facebook, (!) THEN they call me back. I thought keeping a cell phone alive was adulting 101, never mind parenting school children 102.