Csn2016

Update: Called mom who states student has been so busy with all the recent activities and is a super picky eater. I asked if she would like me to weigh her daughter and compare it to my BMI screening in December, she requested I do this. I weighed the student there was a 10lb weight loss. I called mom back who had already made an appt with her family doctor for later in the week. So there was a pretty good weight loss for this student who is already on the smaller side. Mom said she was going to talk to student tonight and follow up with the doctor.

What do you all do when there is suspicion of an eating disorder in a student? We had several students come to the guidance counselor over concerns of their friend no longer getting lunch. She has started dressing in very baggy clothing as well. Guidance counselor has asked me to weigh her and compare it to her weight from December and if there is a weight loss she wants to contact the students mom. Wanted input on how you all approach this before I go that route (weighing the student before calling)... Also any guidance on how to approach this type of phone call?

Not my scenario but sharing for a fellow school nurse. She currently has a student who is in her elementary school and diabetic (7 years old, diagnosed 2 years ago). Mom is very overbearing and difficult. Student has a pump and CGM that alerts moms cell phone. Basically this year mom demanded the school provide a private 2 way radio for the teacher and school nurse to be able to communicate on (in case something happens at recess etc). The little girl also carries a cell phone on her which mom continuously calls her on using face time. Problem #1: the 2 way radio has created such a problem for this nurse-remembering to carry this in addition to the regular school 2 way radio, and god forbid she stepped out of her office and down the hall for 5 minutes and she did not answer right away. (FYI school size is under 300 students so not a big building). Mom did not want them using the regular 2 way radio because of privacy concerns (but nothing medical is ever discussed over the radio-it comes down to a teacher radioing the nurse saying 'I need a nurse to the playground now" etc so I don't get this at all....all rooms have a phone so radio is not necessary then) Problem #2: as soon as this precious childs monitor alerts mom that her blood sugar is going high/low mom face times the student and refuses to hang up until everything is done (blood sugar is coming back up or insulin is administered etc). This leads to a privacy issue in the health office setting. The nurse is running into a lot of issues of this mom watching her every move and nitpicking everything....and it is leaving her extremely stressed out. Administration is not helpful either. Looking for some good advice to pass on here...I did not think having a private 2 way radio is even a responsibility this nurse should have to carry but I wanted to help arm her with info before going to admin. Any experience with something similar to this?

lucky! We dont get a Spring break...just Easter break but this will be the first year in a loooong time where we have not lost our entire Easter break due to snow make up days (they always keep Good Friday as a holiday but this year we get close to a week off!) Then last day for students is Friday 5/29....and we have to come in Monday 6/1 for inservice (insert eye roll...I'd rather stay an extra hour every day the week before to avoid coming back in that Monday)

This happened to me 2 years ago...what a nightmare. I had a 3rd grade kid with a pretty decent asthma history that peaks in fall and Spring (of course). He had been battling an upper respiratory infection for a bit which flared the asthma. Did not bring his inhaler to school that day (self carry), no back up in nurses office (long background with family history and poor care at home and C&Y involvement). Anyway I called 'mom' to bring in his inhaler...she was at the hair dresser an hour a way and had color in her hair and couldn't leave. Told me he was 'faking it' and to send him back to class. She had no one else to bring his inhaler from home. So I try some tricks that may help but he was just getting worse...then he looked at me and said "I'm scared". That did it...called mom back up...said I was calling the ambulance, she said "yeah thats fine...let me know what hospital they take him to so I can come get him" then hung up. ? poor kid Ambulance came for him, he needed 2 long neb treatments in the ER to finally get his lungs to the point they were clear enough to go home. Honestly the inhaler probably wouldn't have helped much to begin with but thats a WHOLE other story on the poor care this kiddo receives at home. Next day I had an extra inhaler to keep in my office pretty sure thanks to my billionth call to C&Y

My 2nd year I had a teacher send a student down with her bookbag and there was HUGE spider in it (okay not tarantula sized but any spider is huge to me)--our students have to use clear bookbags so we could see it crawling around. I told her I dont do spiders...she can set her bag outside and grab it when its time to go home if no one else wants to try and capture it.... that was the last bug related issue (other than bedbugs and lice of course) sent to me.

are you the only one involved in this? I would assume teachers are being subpoenaed as well too for information? I know this happens frequently with students involved with serious C& Y cases and basically we print out what ever records they request and wait to hear if we have to testify (typically in the past the nurse has never had too...only once because it was a serious neglect case with multiple health office visits.) If its against your nursing license thats a whole other issue but it sounds like they are just trying to get all the documentation the school may have on the students? I could be totally misunderstanding

I've gotten to the point that it angers me and as unfair as it is to the kids maybe if I leave Administration scrambling a few times they will wake up and realize the health care component in the school setting is more important than using funding to put in a 'gaming room' with playstations and xbox's (yes you read that right)

I used to stress about it, we didn't even have a sub lined up when I started but then I informed them I was pregnant and they had to find someone to cover for me so they 'hired' a sub. But she is our ONLY sub and if she cant do it they're out of luck...I used to feel bad but now I've hit the point where I am annoyed that we dont have some sort of float nurse hired full time (I know extra money but we are using money on ridiculous things we dont need) So *shrugs* I'm entitled to my sick days (which are far and few between but when my child is sick I'm calling out).

I agree with all the input from the other nurses... Wanted to point out from the parents side maybe they should thank you for avoiding the ambulance fee....I had to call an ambulance when my 1 year old had full blown grand mal seizure that lasted well over a minute. Scariest moment of my life even with years of ER experience long story short she spiked a sudden fever (no indication of illness prior to)...BUT we had an 1800$ ambulance bill! We have great insurance too....So yeah maybe you should bring that to everyone's attention because the parents could dispute that they did not want the ambulance and could have refused to pay the bill and pin it on the school. I think you handled it perfectly

The clothing room attached to my office is my living nightmare. I get it all organized then parents will come in and tear it apart. I attached a picture so you can see how I have it set up (dont mind how disheveled it looks-friday 2 moms came in and pulled everything out and I did not realize it until after they left so now I have to go in and refold it and put it back). But one set of shelves is for girls and the other set for boys. Then each size I have a spot marked for shorts and pants. I have a separate shelving system for shirts. We live in a very low socioeconomic area and a lot of families come in with several children and are unable to afford uniforms so my office is where they are sent. Until recently it was come in at free will but I put my foot down after Friday (caught parents going through drawers) and from now on they are only allowed to come in for clothing between 8-830AM. It still does not look 'neat' enough for my organizing OCD but it works and it makes the job of putting donations away and finding clothes quickly effortless.

I have had two babies since becoming a school nurse and one thing I was adament about was my pumping times! If I am taking the pay cut to be a school nurse then I am certainly not going to cut something out of my life that is going to save me money haha. I would typically pump while enroute to school (about 30 min commute and yes I'd pump the whole time-so around 715 I'd start, then Id pump again at 1030 for 15 min, then again at 130/2 for 15 min...and then my whole drive home at 330). That being said it drove me crazy when I'd open my office door and see a line of kids all standing there and impatiently asking me where I was. I did not notify any other staff (because they never pay attention to those emails) however the administrative office is right across from my office and my door is always open so if the secretary saw me shut my door and turn off the light she'd try to intervene and redirect students). It worked pretty well but is never perfect of course. The only time I had an issue is right when I hit a let down and the secretary came running in with a student having an asthma attack (I have a back room attached to my office that I lock myself in to pump) I was frantically trying to stop the let down and shove paper towels in my shirt while yelling instructions to the secretary through my closed door) I think you should hang a sign on the door that directs all students to the office where the secretary can give them an actual time to 'return' if its not emergent. Also come up with a back up plan should you have an emergency right in the middle of pumping

Wait...the teacher has to self inject medication? And it escalated to the principal because she could not do it herself and you werent there? Thats not your problem thats the teachers problem (and the districts for not have a qualified substitute) you are allowed to take sick days/personal days etc. Do not beat yourself up over this, if I am understanding this correctly you did nothing wrong!

We have a no live lice policy I have a student with chronic head lice for the past 2 years (despite LOTS of communication on how to treat lice AND the principal and I even bought the family lice treatments.) I got CPS involved 2 months ago when her sores on her head looked infected. They finally made the 'parent' take her kid to the doctor...problem is kid gets cleared and I'm pretty sure the parent has it but refuses to get herself treated or even let anyone check her so now kid has it again. I'm at my wits end and have started just combing the live lice out of this poor childs hair every day so she can stay in school, she's missed so much, truancy is involved but not getting anywhere, they do not remove kids for this problem (and even if they did I had a social worker from CPS tell me they do not have enough foster parents and can't even remove kids from addicts homes at this point....not sure how true that is but what the heck?!) so yeah lice is not a concern of theirs

https://www.amazon.com/Motorola-MBP36XL-Baby-Rechargeable-Temperature/dp/B01N7KEY4P/ref=sr_1_3?keywords=motorola+camera+baby+monitor&qid=1578410812&sr=8-3 Mom of 4 here and this has been my favorite baby monitor. I can pan around the entire room and I can talk to my kids through it

In our district and the surrounding districts the 'health aide' has to be either an LPN or RN, they must have a professional nursing license.

I think it depends entirely how the school administration handles the 'position' for the school nurse. In my district the certified school nurse falls under the 'teachers contract' so I am part of the union, I am salary, I get all the same holidays/inservice days, open houses, and meetings as the teachers (the meetings are annoying because they NEVER apply to me and more often I am allowed to just do busy work in my office during those times). I receive full health benefits for myself and my family and I receive the same amount of PTO and sick time as the teachers. I am paid year round (with extra on the days that I come in for that I am not contracted such as the middle of august for a week I come in for last minute kindergarten screenings-I get paid hourly for that since that is not in the other teachers contracts). The other nurses in the district not hired as certified school nurses are hourly employees and are titled 'health aides', no sick time, no vacation time, paid for when they are here, and no health benefits.

No hooded sweatshirts in the hallways, they can put a sweat shirt on during class, no hood up, it must come off when they switch class in the hallway (uniform policy)

Same here! I went from averaging about 15 visits a day last week to 30-45 visits a day this whole week...the bad thing is a bunch of them are legitimately ill too (vomiting, fevers, poss strep). The first 30 min of school today I saw 15 kids AND a teacher and sent 5 home (including the teacher). Get me out of here!!

Yes this is what I was looking for! I know its just an inhaler and chances are it would be fine but what if? What if it doesn't make it there? Who is responsible for it? And now I see its not allowed per USPS with out a license to physically mail it...so no thanks. I just find it funny how the child has never stepped foot in my office for the inhaler, they move away and suddenly its emergent that they get it and its their ONLY inhaler... Thank you for this link!

Thanks for the replies! I did email the school health coordinator RN for our area in the state for guidance. I just dont want anything coming back on me if something happens with it. They moved an hour and a half away and I'm not about driving 40 min the opposite direction of my house to meet a parent when I live 30 min from work as it is lol

Quick question! We had a student transfer out of our district and move an hour and a half way (as usual the nurses are never informed until they are physically gone). The parent just called and requested that the students inhaler be mailed to their new address. I told her I'd have to check school policy first (not that we have one on this) so I could look further into it and talk to our principal--of course mom is mad, (yet it would be way faster to contact the old pediatrician and have a new script sent to a local pharmacy) and I dont think we can mail medication right? I mean if it were Adderall or any other med I'd of course say absolutely not but its an inhaler so before I say 100% no wanted to see other nursing input on this. This is probably a really dumb question but one of those things that makes me second guess myself.

4 here as well!! Although they are tracking a possible snow 'event' that may get us a late start tomorrow ? And we get out early on Friday to get a jump start on the holiday break!

Like others said clarify with physician. For the diabetics I currently have, both use a pump--one does very well with eating all of his lunch (and he packs every day so carb counts are 'exact'). We do correction and coverage prior to lunch. My second diabetic who has a pump is terrible with lunch--one day she'll eat all of it, the next day she'll eat 2 bites. Because of this she comes in, checks her sugar, we do a correction if needed and I send her to lunch with a notebook that a cafeteria aide completes for me (student used to report she would eat 75-100% of something and in reality it would be 2 bites), also our lunch menus offer multiple options for sides/desserts which throw off anticipated carb calculations prior to lunch (student may claim shes picking one thing then goes to lunch and picks something entirely different), then she comes back after lunch we calc carbs and do the coverage. Prior to her having a pump I would do an injection for coverage prior to eating if she was 250 or over just to get the insulin in and circulating and not delay it.

I swear I made a post very similar to this one when I started school nursing 4 years ago. I was drowning in documentation for the first year because the nurse before had papers for EVERYTHING. It took me a year to create documents I could keep on my computer and a flash drive and then I just print as needed. I cleared out SIX filing cabinets of useless papers, she had records from the 1970s yet, still had a pile of old glass syringes and needles (the type that used to be sterilized), and a ton of information pamphlets from the 1980s. I did discover a Dunkin Donut gift card for 10$ too...didn't know how to get in touch with the previous nurse so figured it was my payment for cleaning up her mess haha. But I digress...I posted something similar here and took the words of encouragement with me and just worked at it one day at a time until I could find my system. It was impossible to even find a system in the state that the office was in and took me close to 6 months to straighten out (throwing in a maternity leave as well). I averaged about 50-60 kids a day. Then the next year I had my system figured out, I was ready to hit the ground running, I learned who my frequent fliers were and could address them right from the beginning, I had to start giving tough love. My second year average daily visit was cut in half to about 25-30 kids a day. Each year gets easier, you figure out how your system works and what you need to change. As for the frequent flier ice packs, I make them sit in my office with the ice pack. That really cut down the usage (most of them like to take them back to class and 'play' with them or gain sympathy from peers-- if you remove that equation that eliminates a lot of the unnecessary ice pack visits.) I also remind them ice packs are used for injuries involving swelling, if I see no swelling then no ice pack is necessary. If I have a student with repeat band aid visits for something so minor I'll give them an extra band aid to keep in their pocket (or better yet I sent a ziplock bag full of band aids to EVERY teacher at the beginning of the year which pretty much eliminated all paper cut/minor scratch injuries that do not require a nurse assessment.