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I participated and loved it! The families and staff had to “pre order” via text so only families that wanted one received them. The response and feedback has been very positive.

Nope, I don’t stock it or offer it. They are grown adults and if they need a tums or a Tylenol they should bring their own. I don’t have a budget for it or have interest in being asked for any more advice then is already being asked. Especially when my advice is always the same... “what did your doctor say about your concerns?”

I would encourage a conversation with administrators to discuss a strategy to better educate parents on ways to avoid certain absences. Collect data on how many days are missed because of: physical exams, dental exams; chronic medical conditions (asthma, diabetes, etc.), vacations, “too tired”, missed bus & no transportation, lice policy, poor weather, etc. I feel there are a high number of avoidable absences and possibly if those can be dealt with then administrators will not go after the truly sick. Getting the sick back is the easy conversation, but the one that will have a lasting solution and is more difficulty are the avoidable ones.

I do not call for every visit. I obviously call for immediate exclusion reasons, and will be rather direct. “ Hello Mrs. X I have little Johnny down here with me he’s complaining of having a sore throat and when I took his temperature it was at 102 ...I know shocking right?” I’ll be a bit Conversational...”so has anyone else been sick in the family or was he ill this morning before coming to school? OK I’ll get him all packed up and ready to be picked up, will it be you or somebody else picking him up?“ for an injury to the face I always do not want to cause alarm so i would say “Hello this is Alex I have a little Johnny down here with me he took a little tumble on the playground and bumped his head now the only reason why I’m calling you is because he does have a slight scratch above his left eye and there’s a little bit of swelling in the area so I do believe when he comes home on the bus that he’s going to have a little remaining Mark there and there may be some residual swelling and maybe even a bruise but everything on the inside looks perfectly good his eyes look great his you know he’s not complaining of any kind of head injury and I’m not concerned at all that there something going on like a concussion the only reason why I’m calling you is because he’s going to come home looking a little differently than the way you sent him this morning.” For an injury requiring follow up... I’ll say most of the above and “ Hello Mrs. acts I have little Johnny down here with me in the health office he bumped heads with another student and actually bit down on his lip and he had a good amount of bleeding about 15 minutes ago but it’s all under control now we put some ice on it and I was able to inspect the area he does have a small little slit in the bottom lip and I do believe that it’s going to need some medical follow up so are you in the area and can you come by and kind of take a look at it and we can determine from there as to what we need to do.“ I also always start with everything is okay, even if it is not. I might recommend for illnesses follow up with a medical practitioner depending on the situation, but not for all situations. But again I do not call for every visit and certainly not if the student was sent by the teacher or if it’s there first visit with light symptoms.

I would say yes, just document the name of the nurse doing the assessment and use quotes. And yes to your 2nd question. I code this under communications or “parental role” in my system and again use quotes within my documentation. I keep it simple and direct.

Two thoughts, one create a system where you can do both, either by having a float nurse cover the health office and perform the screenings elsewhere in the building or have another adult in your office and manage non emergencies. two- I encourage you to use another word other an “emergencies”, the definition to a teacher / school staff and to you of what is a medical emergency is two very different things. I will say something like unless a student is unable to breathe well or they have active flowing blood or an obvious broken bone the office will be closed as I will be performing state mandated screenings until 12pm then the health office will be open for students.

-“stomachache” with no fever, vomiting, diarrhea. ?s- when did it start? What was your last meal? Point to where it hurts. Any nausea? Last BM? Send to bathroom, hydrate, rest up to 10 min then back to class - “headache” with no fever or other symptoms ?s- when did it start? How much water have you had today? Inside or outside pain? Injury? Seasonal allergies? Hydrate, wait 30 minute, deep breathing exercises, rest up to 10 min with heat or ice if they want. - smelly kids that teachers send First contact on this should come from the teacher, sometimes social workers and school psychologists could also assist. But I have called home and just plainly stated the facts as they are given to me.  - “ chest pain”- with zero other symptoms, vitals look perfect, they are not in distress. always have them point to where it hurts, many times it is not the chest. Ask how long, inside or outside pain, asthma, any medications at home. Inspect area, listen to heart and breathe sounds, pulse oximeter, hydrate, evaluate for emotional reasons, rest up to 10 min. - extremity “injuries” that kids are totally playing up lol. Aka walk to the nurses office and as soon as they get in here they are suddenly limping mine are told if no redness or swelling then no ice and since no pain is sticking out to walk normally. BA BYE - teachers that send students for literally anything and practice no common sense/judgement.  well that’s a million dollar answer, ask the teacher why they are so willing to let their students to miss class time for non issues? Be direct. I was once surprised to learn one did so because once she didn’t and a child’s finger was actually broken or the most common reason seems to be parents giving teachers such a hard time they are just always covering there butts. I remind them my job is not to cover their butts or kiss them but when in doubt to send them. Make sure all teachers have a zip lock bag of bandaids and a guide of what they can do in the classroom prior to sending children to the nurse for common complaints such as stomachaches and headaches or any concern that ‘just started now’. Also empower the children to understand when is and when is not an appropriate time to seek care from the nurse. Good Luck

I would close the office door, don’t worry about offending.

Why do you feel you would panic? There should be a medical directors orders for these and other medical emergencies as well as individual health plans for medically fragile students. There are also multiple web site that review these medical conditions and how to stay safe in schools. Watch some training videos and review the policies and procedures of the district. Meet with individual families of the students to better understand their specific needs if they present with uncommon conditions.

Are you in a union? They have created a hostile work environment and for that they and the district can be held legally and financially responsible.

Your ability to fit in with the existing team will win over an individual with a higher education. No drama, no sticky wheels, no high demands, someone who will be able to handle demanding parents, and prove sound clinical judgement. Best of luck!

They can either sit on the outside bench and be observed by lunch staff or stay in the cafeteria and be watched by another class monitor. Last opinion is to sit in main office with secretaries.

1 school, 500 students 70 staff, no aide, one nurse

First year is always the hardest. Maybe the principal has had previous experiences with this student and was “helping”. Having really thick skin is a must. Remember you cannot expect teachers and staff to assume the role of a medical professional relationship like in the hospital, you have to adapt to being in their world. Start off just by being a voice of reason and advocating for your students on why or why not their symptoms are just for exclusion. Grow from there...this takes time.

This is a pet peeve of mine... “ I’m sending so and so to you to document an incident”. Not an injury...my last one was one where a student open mouth touched another students shirt...not skin, kinda bite at his shirt only. I told them they should as being first hand witnesses, I would only document with quotes what they asked me to do. And simply state no findings of medical significance, does not mean injury did not occur, just no clinical observable findings at current time.

How about personal letters of thank you with contact info and permission for you to used as a reference for potential new employers. Or a simple letter of recommendation they can use in a similar fashion.

Yes, and the DATE! C’mon now

It will come in time, the first year is always the worst, by year three it starts to fall into place. You know the teachers, kids, parents, and make best practices. As far as the charting don’t think of it as hospital charting. Real brief, less is more. It’s a serious injury that’s a different story. You don’t know what you don’t know and that’s okay, continue to ask questions. Yes write up the IHPs, the above advice of the other plans are correct. Is this a private school? Hopefully you have a medical directors orders to help with building your confidence on decision making. Continue doing what as a nurse you have been trained to do and the admins will eventually come around. We are not use to an environment where our medical judgement is questioned however the school environment is different and everyone feels they are an expert and feel they have a right to question yours. Just be you, this comes in time. We practice by evidenced based proof, the rest of your staff give opinions based on feelings. as far as the rude guidance counselor , I would try an engage them and open up about your lack of training and first time experience as a school nurse. They can become your biggest supporter and a great relationship with this group is vital for the care of your students. They are in the business of also helping others so hopefully that can be turned around. Keep in touch.

My first thought is to request a transfer within your district, but the grass is not always greener. But really my thoughts are to advice you to focus on the kids, that is why after all why we do what we do. It’s great if you have supportive administrators and friendly staff, but the real wins come from being there and making a difference in these students lives for 7 hours a day. Yes the parents can be a challenge but not all of them. Control what you can and try not to over analyze what you cannot. For some students your care might be the only smile they see all day and the only time they feel safe. Not easy, not at all.

I like the idea of moving the existing supply to a cabinet in the staff lounge. Maybe ask the sunshine fund to make donations to the “med closet”. I don’t stock, and refer them to the main office staff to see if anyone has anything they are willing to share. I do take BPs if requested but always refer to their primary care. We do not have access to everything for a complete health profile to give an opinion.

Not that I can think of but know how grateful I am that this population of students have a caring nurse supporting them. Don’t hesitate to reach out we are on the same team just in different buildings.

So I’m in NY on the flip side of your scenario. I have the charts on the students who are “out of district”. When I speak to nurses from other facilities sometimes they will call me and confirm records or ask for a copy to be sent to them. Since the medical information I have is part of their educational record there is no issue with HIPPA or FERPA. Nothing needs to be done on day one.

Follow your heart. Listen to what they have to say. Certainly nice to be wanted and someone that appreciates your experience. The first year is always the hardest, but it does not mean the grass is greener just because you got through the first year. I personally would meet with them and get a real feel of the chemistry and then follow my gut. Best of luck, not an easy one.

Yes this is exactly what the teacher does. Again I am not assisting them, except to give a plastic bag for soiled clothing. I will also call home to let parent know to remove clothing from backpack and send another set of clothing in tomorrow.

So how do you all feel if I enforce that bathroom accidents be handled in the classroom bathroom for kindergartener students verse the health office bathroom? Each student has the change of clothing in the classroom and they each have a bathroom within the classroom. It baffles me why the current process if for the student to leave with a buddy and come to the health office with their clothes and change by me. I don’t assist other than to give a bag for the soiled clothing and call home. Thoughts?