nursekoll

High school age, wheelchair-bound student with incontinence, unable to physically reposition self in chair during school day. Prior to this year, the student was being changed once or twice a day by two trained school staff with use of a manual Hoyer lift to a padded trainer table in a private bathroom area. This year student has started refusing being changed. Student states discomfort with lift sling and also denies need, as sometimes student is not wet or not very wet at scheduled time of changing. Physical therapist has brought concerns to me about skin integrity and sitting in power chair all day with no pressure relief of skin and possibly wet skin for good part of the school day. PT has asked me to do weekly skin assessments for skin integrity and breakdown prevention. Student does have a gel pad on the power chair seat. How do I validate the student's right to refuse and also fulfill my requirement to assess skin integrity and provide interventions to prevent breakdown at school? Parent seems OK with student's refusal and parent changes the student's incontinence brief at home before and after school. Is this enough? Can I document this and ask that parent will bring any skin concerns to my attention? What do I tell the PT? I believe part of the refusal is also related to the student's age and general teenage rebellion/embarrassment about being changed. Also the student likely is not drinking enough water/liquids in order to not be wet or very wet though the day. The student rarely has a BM at school. (I am the only nurse in the district and am not in the high school building daily, so I have trained paras to assist with this student's ADL's) Thoughts.....

Hope it's just the bulb- that was my otoscope's problem last year! Maybe the rechargeable battery won't hold a charge anymore? If those are not the issue, could you reach out to any local clinics or hospitals to see if they might be updating any of their equipment and could donate a gently used otoscope to the school? If you do need to replace it, there are some pretty cheap otoscopes available, but the quality is also not great.

Yes, trust your gut! At my high school level, vomit needs to be witnessed/seen in order to be sent home for it. They also will figure it out really quick if coming back in multiple times gets them a ticket home, so I'm still very much a rule-follower on that as well. No fever, no vomit= back to class. If the return visits are excessive or if they truly don't feel well I'll offer to call the parent and say the student doesn't meet the criteria for being sent home due to illness, but if the parent wants to choose to pick them up as a personal absence, it is up to them. Always wait 5-10 min to take temps, kids have been known to put something hot on their forehead or drink something hot right before walking in to my office to fake a fever. Water challenge- give them a good 10-15 oz water and have them sit for 10-20 min. If they can keep it down, they are probably good! It's a constant fine line between -trust me to take the student concerns seriously and keeping parents and teachers happy as well in keeping students in class as much as possible. Set your limits, be compassionate yet reasonable.

Any advice for school dealing with the death of a teacher? K-12 teacher and coach, the medical emergency happened at school in front of several classes of elementary students. I was the one responding and calling the ambulance. I have some peace that everything on my end went as well as it could possibly have gone. I can't think of any way we could have been better prepared or changed the outcome in this case. Crisis team is here for support. We're all just devastated.

And this is what makes the school nurse job so difficult! I'm guessing you aren't a school nurse or haven't/won't be one very long. This case it's an administration/school policy issue, please don't put it on the school nurse. We are NOT babysitters!! Sending a sick kid to school is awful parenting, selfish, and borderline neglectful! Shame on you!!

Oral ivermectin is not FDA approved for treatment of head lice according to the CDC. Even if prescribed, the child would likely need 2-3 tablets per dose for an appropriate dose depending on weight. This would be considered off-label use, and I will not administer off-label medications at school as per my school policy. (The topical is over $150 per tube.) If you provide parents with this information and they want to go this route, they'd need to do it at home. If it's a problem of re-infestation from different family members or households, this would likely not be helpful. They need to be checking all contacts and households the student stays with and treating all of them on the same schedule. This has been my experience at least with those recurrent cases.

"Treating appropriately" may mean different things to different people. I've heard all sorts of crazy "treatments" that parents use that are truly not appropriate (mayonaise, salt water, olive oil, perms, hair dye, vinegar, hair straightener, etc) . I would offer to have them come in and go through the treatment process step- by- step. I show them tips and tricks for using the nit comb such as using a headlamp and reading glasses to help to see the tiny nits and nymphs. Explain the reason for treating every 8 days to break the life cycle of the lice. I recommend treating everyone in the home at the same time schedule for recurrent infestations. I also ask for the empty container of whatever brand product they use to be turned in to me after each treatment. That way I know they've used the whole bottle as recommended each time. I've found the vamousse brand and other "all natural" products just do not work, so I try to steer them away from these products. Our school has some funding for purchasing lice shampoo if finances are an issue for appropriate treatment.

Yes, but I feel a lot of things we assess for may end up with a need to see a doctor after our assessment. I assess students with ear pain and refer to the doctor if the eardrum is red, so they can get antibiotics if the doctor thinks it is needed. If I can more accurately know when to send them to the doctor for a sore throat, I think that would be a huge help to parents. I am the only health care person that so many of my kids ever see. I think it would greatly benefit them if I could do strep tests.

At home, Delsym is my go-to cough suppressant. It works so much better than any robitussin or dimetapp or mucinex. I suggest it to parents. It knocks out the cough reflex. At school unless the parent brings that, I can only use cough drops, peppermint candies, and encourage drinking water frequently.

I'm wondering if any School Nurses are doing Strep testing in schools? I see there are now both home- strep tests available OTC and CLIA-Waived Strep tests available from school nurse supply stores. I'm curious if this is within our scope of practice if offered to students with sore throats and parents agree to it. Obviously, if we got a positive, they would likely still need the Dr visit for the treatment, but if negative, it could save them a lot of unnecessary visits and costs. I would absolutely use it on my own kids as I've taken them in 3 times this school year, and once it was strep and twice it wasn't. Could have saved myself about $400 for the visits on those negative tests ? Is anyone using these (or other kind) rapid strep tests in their school? https://www.schoolnursesupplyinc.com/Clarity-Strep-A-Test_p_9537.html

@JenTheSchoolRN Yes, found under the swings. I assume the student either had a seizure and then fell off, or fell off and then started having a seizure. Either way, the call was appropriate and I did applaud the staff for calling even though the parent was angry. I think the parents were mostly mad that the ER "did nothing", just sent the kid home (according to the parent's report). We live in a rural area where volunteer EMT's take awhile to arrive, but still arrived before the parents.

I'm also a 10- year school nurse. I HAVE had a parent angry about a 911 call on their child with epilepsy. They were very angry that their child went to the hospital by ambulance after a seizure. I was not in that building at the time, but I stand by my staff calling 911 due to the fact that the beginning of the seizure was unwitnessed and it was on the playground, likely after a fall or blow to the head as the student was found under the swings. It is written in the seizure plan to call if possible injury before or during the seizure and if the timing is unknown, as the beginning of the seizure was unwitnessed.

MULTIPLE times this week: "Your toothbrush should not be in a ziploc bag with other students' toothbrushes. THROW THEM AWAY!" yikes?‍♀️

Are you sharing an office space daily with the other RN? If so, I'd be bouncing every question off of her until you get your bearings. Honestly, I spent a good part of my first year just figuring it out, asking anyone and everyone in the building for help/reassurance. I'm the only nurse though and did not have the previous nurse present for any training, so I asked the secretary or administration a lot of questions. I looked up a lot of the state regulations and standards of practice for school-related illnesses/injuries/communicable diseases in order to be confident I was making the right decisions based on my assessments. Use your knowledge base from already working in peds and have confidence in your assessment skills. One difference in school nursing vs clinic/hosp is the fact that you are dealing with pretty much the same families and school staff for years at a time, so creating a level of mutual respect and authority with parents and school staff is crucial. You could also reach out to your state school nurse consultant to see if there is a new school nurse mentor program in your state. After 10 years as a school, I am now a mentor for new school nurses for the past 3 years and I wish I had this when I was starting out!

Thanks for your input! I have involved school counselor and school psych in this as well. Hopefully we can all work together to find the root of this issue!

How serious would you take a threat reported by an elementary student that is a frequent flyer? This kid has now told me twice on two different occasions that the parent has threatened to "beat him up and beat up the nurse too" if the student comes in to see the nurse at school. This kid comes in frequently and I only call home if I have concerns that are urgent or unresolved from last visit or if the kid meets criteria to be sent home. I have never noticed bruises or other signs of abuse at home and parent has not ever been unpleasant or threatening on the phone or when picking up student in the past. I have informed the principal both times that I have heard student report the threats. I'm not sure if this kid just likes the attention or what? What would you do??

Do any of you awesome school nurses know of ways to get help paying for replacement AED pads and batteries?? Our school was gifted 2 AED's several years before I started here and we have since purchased 2 more to be able to send with sports teams. I have tried to budget for them in the past but that usually means I'm skipping or skimping on other necessary items. All 4 are going to have expired pads in the near future. Are there any programs or grants that help with these costs??

What do you guys say or do when you suspect a high school student is lying about throwing up or being sick? I need help with a good response that sounds professional and caring. Our school policy is to send home for any vomiting, but if it is not witnessed, I can not prove it happened and it gets to be a he-said-she-said thing. Parents will buck if I send these (typically chronically absent) kids home. So what's a nice way to say "Sorry, kid you're going back to class, and if you vomit again make sure a staff member sees it." I have the same issue with diarrhea, these older kids report having diarrhea more than 2 times because they know that's our sick policy. I think they just don't want to be here and need a nice way to say they're staying. They put on the pitiful face, but I'm not fooled.

Just wondering what other school nurses do with student medications at the end of the year? Some will be prescription meds, inhalers, some OTC meds that have been kept in the nurse's office. In the past I send a reminder that medications must be picked up by a parent, but so many just don't. I end up disposing of then when they expire. There has to be a better way!

Hello fellow school nurses! I have a T1D student who was diagnosed 2 years ago. Lately I've been dealing with poor control of blood sugars. I suspect this student has been sneaking food/snacks and not dosing for them. We monitor blood sugar closely at school and correct as needed. With the dexcom I can see what blood sugars are over the weekend and all evening/night at home. This kid is maxed out at >400 for 8-12 hrs outside of school hours and then we try like hell to get back in the normal range during the school day. Parents are very nonchalant about it. "Just a kid, *shrug*" It's super frustrating to see them not correcting or controlling (caring) at all at home/evenings and weekends. How do you motivate families or kids to take better control of their health?! I feel that many kids and parents have the mentality that it's "safer" to run high than low and they don't consider the long-term effects. At what point would you contact the student's doctor or even CPS for suspicion of medical neglect. Kid is supposed to be getting a pump soon, so I'm hoping that will help. Thoughts?

Here's a few things I've found helpful to have on hand: Slings and splints, reusable ice packs, both disposable and reusable velcro ice pack holders. Large wood tongue depressors mostly used for checking/removing nits and lice. Lip balm, burn cream, lotion, vaseline, cotton-tipped applicators, nosebudd ice packs, tooth chests, save-a-tooth. On my "wish list" this year are some big items, a welch allyn suretemp thermometer, a welch allyn spot vision screener, a toothbrush rack that sanitizes the toothbrushes, another digital scale so I don't have to bring it from one school to the next. I'm also looking for someone to donate deodorants and teen pads for puberty goody bags, since always is no longer doing their free sample program. Possibly our PTO group. I'm liking the previously mentioned ideas as well. What else are favorite items for school nurses in this group??

No masks required for students here this year. We did encourage them last year and many elementary students wore them due to teachers really pushing it. High school students did not mask near as much, since they knew we couldn't "require" it due to no state mask mandate and their right to an education. Staff were required to wear a mask last year, but not this year. This year almost no one is wearing masks unless they are returning early from COVID or exposure. Our vaccination numbers are very low for the 5-18 age group (about 35%). Staff are probably around 50% vaccinated. COVID numbers have been similar both years. Illness/absence numbers are similar both years and similar to pre-covid as well. I didn't see a positive impact with masks. They were always gross, dirty, little kids were touching them, etc. I'm glad to not have them this year. I'm glad to not be required to do contact tracing or testing in schools either. Kids are not getting serious illness with this. They are low risk and should be treated as such.

Scrubs are the easiest and most comfortable for me. Also, I like that it makes me easily identifiable as the nurse.

I don't do this job for the money. It works so much better for me than hospital shifts and the perks to me are worth it! No weekends, holidays, summers or call. Knowing the staff and families in my own kids' school is worth it's weight in gold! Also, having the autonomy to run the school health clinic as you see fit without all the B.S. meetings, surveys, and in-services etc. that hospitals require is a plus. You're entering into long-term relationships with your school staff and students/families, so there is great reward in making a difference in their health over time! If money is an issue, you can always do travel or temp positions over the Summer or on weekends.

Right around 300 total. It goes up or down about 10 students within each year. We have preschool through 12th grade in 2 buildings 10 miles apart.