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"Frequent Flier" classification

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scrubsrn24 specializes in Pedi.

2,127 Profile Views; 74 Posts

Hello everyone,

In my district we are required to write goals for the year, and mine is going to have to do with decreasing frequent flier visits. Does anyone have any input about how many visits an average child has to the school nurse every year? Or how many visits a student would make before being classified as a "frequent flier?"

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Wave Watcher has 7 years experience and specializes in Community Health/School Nursing.

751 Posts; 8,239 Profile Views

I have one teacher who has already sent 60 students from her class in 2 months. I think starting with educating the teachers on good judgement is a start. A kid only makes it down to my clinic if the teacher lets them. I also send home visit logs to any parent of a child who I have seen more than 4-5 times in close succession. Normally, the parents will handle the child and cut that out real quick. I also send out couple times a year a "when to send student and when not to send student" to the clinic email to all staff. Just some ideas on how to work towards your yearly goal. :-) Good luck!

Edited by Wave Watcher
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Wave Watcher has 7 years experience and specializes in Community Health/School Nursing.

751 Posts; 8,239 Profile Views

If none of the above work I go to my principal. If you have a student who has been in your clinic 6 times for 10 min each then that is 60 minutes of educational instruction time lost. Usually, my principal "gets it" when I approach her with numbers like that.

Edited by Wave Watcher

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1 Article; 1,939 Posts; 41,092 Profile Views

If I'm seeing a child more than 1-2x a week then that counts as a frequent flier in my book. I would have one student that would literally come every day 2-3 times a day for non-sense.

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psu_213 has 6 years experience as a BSN, RN and specializes in Emergency, Telemetry, Transplant.

3,869 Posts; 28,294 Profile Views

I don't have anything productive to add, so I'm sorry. As an ED nurse, just sad that "frequent flier" applies to schools too. :cry:

Edited by psu_213

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cayenne06 has 10 years experience as a MSN, CNM and specializes in Reproductive & Public Health.

1,394 Posts; 18,689 Profile Views

I'm an OBGYN nurse, but I did work as a school nurse at a boarding school for teens with mental health issues, so I think I have some experience in this area. From my work with these kids, it was quite apparent that lots of kids who are "frequent fliers" might have some difficult stuff going on in their lives. Kids who have tumultuous home lives, are food insecure, are struggling with peer relations or have mental health issues might seek out your care, subconsciously or consciously, to try and fill a perceived need that is not being met somewhere else. So basically they could be seeking you out to help with a non-healthcare need.

I guess my point is to be very cautious about "labeling" these kids in a way that causes us to think of them as just a pain in the butt, you know?

Can you add something to your action plan about assessing for and identifying non-healthcare issues that could be contributing to the frequent visits? Like, "all students who seek care X number of times in X time period will be assessed for A, B and C, and these specific resources (school counselor, outreach worker, etc) will be offered/involved in student's care if the RN identifies such-and-such issue."

I'd make sure you have a working relationship with professionals who can provide potentially necessary services, if they aren't available at your school. For example, identifying a local ped who takes medicaid and will accept referrals from you for students who don't have a pediatrician. I think it would be very beneficial to have a social worker of some sort who you can refer parents to, if they need help accessing social services like food stamps, childcare assistance, etc.

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1 Follower; 542 Posts; 9,264 Profile Views

I'm an OBGYN nurse, but I did work as a school nurse at a boarding school for teens with mental health issues, so I think I have some experience in this area. From my work with these kids, it was quite apparent that lots of kids who are "frequent fliers" might have some difficult stuff going on in their lives. Kids who have tumultuous home lives, are food insecure, are struggling with peer relations or have mental health issues might seek out your care, subconsciously or consciously, to try and fill a perceived need that is not being met somewhere else. So basically they could be seeking you out to help with a non-healthcare need.

I guess my point is to be very cautious about "labeling" these kids in a way that causes us to think of them as just a pain in the butt, you know?

Can you add something to your action plan about assessing for and identifying non-healthcare issues that could be contributing to the frequent visits? Like, "all students who seek care X number of times in X time period will be assessed for A, B and C, and these specific resources (school counselor, outreach worker, etc) will be offered/involved in student's care if the RN identifies such-and-such issue."

I'd make sure you have a working relationship with professionals who can provide potentially necessary services, if they aren't available at your school. For example, identifying a local ped who takes medicaid and will accept referrals from you for students who don't have a pediatrician. I think it would be very beneficial to have a social worker of some sort who you can refer parents to, if they need help accessing social services like food stamps, childcare assistance, etc.

I wonder if you were the nurse at my boarding school ;)

I

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JenTheSchoolRN is a BSN, RN and specializes in School nursing.

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For me, if I see a kid 2-3 times a week for non-chronic physical issue, they become a frequent flier. I will reach out to the parent and also work closely with the counselor and student support team to rule out any other issues: stress at school/home/etc. Some of this kids have very real non-physical issues and stopping into my office a few times a week for a few minutes keeps them on track.

That being said, some of them just like to not be in class, plain and simple. For those, once I reach out to the parent and principal, visits cut down considerably.

I work with time limits and education to the staff. I have one other nurse in my district and we just send out a quick and dirty list of when and when not to send a student to the nurse's office. If I do have a frequent flier who I know have some emotional stuff going on and needs that check-in with me, I work with the team here to set time limits. For example, I have one frequent flier that gets 1 ten minute nurse's pass a day to use when she needs the break. One it is used, she is set. It has worked very well and the student has been far more productive throughout the day.

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scrubsrn24 specializes in Pedi.

74 Posts; 2,127 Profile Views

Cayenne06, you are right on. I didn't elaborate in my first post, but the goal is to decrease these "frequent flier" visits through collaboration with other school staff (counselors, admin, SPED, etc.) I was just hoping to get a feel for how many visits other nurses consider to be "frequent" as a baseline for my goal. My hope is that through collaboration with other staff we will be able to better meet the needs of kids with social, emotional, behavioral and health needs.

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JenTheSchoolRN is a BSN, RN and specializes in School nursing.

2,664 Posts; 24,457 Profile Views

Cayenne06, you are right on. I didn't elaborate in my first post, but the goal is to decrease these "frequent flier" visits through collaboration with other school staff (counselors, admin, SPED, etc.) I was just hoping to get a feel for how many visits other nurses consider to be "frequent" as a baseline for my goal. My hope is that through collaboration with other staff we will be able to better meet the needs of kids with social, emotional, behavioral and health needs.

I always have this goal - but I am actively tracking with monthly spreadsheets/etc. this year. I'll be curious if you have success, OP, and hope you do!

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coughdrop.2.go has 3 years experience as a BSN, RN and specializes in School Nursing, Public Health Nurse.

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For my frequent fliers I try to refer them to the counselors. However, at one school our counselors don't want to counsel unless it has to do with a schedule change. I also try to talk with the Vice Principals, the teachers, and parents. But some parents just want to pick up the student whenever they have the vague stomach ache and I try to advise them against it. Or the student calls the parent directly from their cellphone and I have no control over that. My bigger problem with teachers is that they want me to screen half their class for vision or hearing problems. I am also working on having the Administration let me see grades and not just schedules so I can check the progress of a student when they see me during a particular class or time of day.

To deal with my FF and their "vague" symptoms I give them 5-10 minutes in my office, water, crackers, and/or a heat pack to soothe the tummy aches. No vomiting or fever you go back to class after the time limit. But if they want to call home I have to let them. I just try to talk to the parents and talk them out of picking them up. Just don't ever make exceptions. They are like elephants. They never forget.

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OldDude specializes in Pediatrics.

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When I have a student visit more than 3 to 4 times a week, that qualifies them to be in the "Platinum Club." The first thing I do once they attain this highest level of frequent flying status is call their parent everytime they visit and let the two of them talk. Sometimes the parents get it and put a stop to it and sometimes they play right into it and nothing ever happens. Oh, well, that's why I get the big bucks!!

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