"Guidelines" for Sending Students to Office

OldDude · Nov 2, 2018

I'd just leave it alone. It would only reinforce what some of the teachers are already doing and would fly over the heads of your "target" recipients. Plus, you don't want to give anyone ammunition to throw you under the bus, "Well, the nurse told me not to send sick kids to the clinic." I know that's not what you would say at all but you'd have to defend yourself regardless.

I think you'd have more luck, long term, by talking to the individual kids and their parents about excessive clinic visits and don't leave any health or medical or injury evaluations to the teachers.

pedi_nurse · Nov 2, 2018

I'm at a middle school. This is what I sent teachers at the beginning of the year:

I hope week two is going well so far for everyone!

I wanted to take a moment to touch base with you all regarding my goals for the year. I know this is a lot of information, but I appreciate the time you take to go over everything. Ultimately, it is my goal to assess and care for students as quickly as possible so they can get back to the classroom to learn. In order to accomplish that, I have attached some information for you that might help with some minor complaints from students and I am asking for your assistance with them. I will also be printing and laminating a few copies, if you would like them for your classroom. They will be in the "Nurse's Corner" folders on the bulletin board across from the mailboxes. If they run out, just let me know and I'll be happy to prepare more.

CLINIC HOURS: 8:45am - 3:15pm (Please avoid sending students from 12:45pm to 1:25pm as I try to take lunch during this time)

***I am available in the clinic from 8:00am to 4:00pm (3:45 on Fridays) in the event of an urgent/emergent need.***

STUDENTS MUST HAVE A PASS: Please use the passes that were provided to you. If you run out, you may use any paper pass. Please include the student name, date, time, and your signature. I will be ordering more duplicate nurse passes, but it may be a few weeks before I have them. Students will be sent back to class if they come without a pass, come during passing periods, or within the first and last 15 minutes of the day unless it's an emergency. (While vomiting is not an emergency, per se, no pass is necessary - feel free to just send your kid with a trash can!)

MANAGE MINOR PROBLEMS IN CLASS: Please refer to the attached documents to help you manage some minor problems in class. Headaches, stomach aches, old injuries, and nosebleeds are common issues that can usually be managed in class. I often see students whose has a headache that "just started" or a stomach ache that started after they ate hot chips for lunch. The only thing I do differently for these students than you can do in class is check their temp. I do not give out medications unless the parent has brought some to the clinic for the student, nor do I give mints or crackers (if a student missed breakfast/lunch, please call the CafÃ© Manager at ext 24808) or allow students to use heating pads without a doctor's order. Typically, students are allowed to rest for 10 minutes, given water, and sent back to class, which are things you can try first. Nosebleeds are another common complaint that could be handled in the classroom, see attachment for how to. Most of the time I see students for nosebleeds, the active bleeding has already stopped. There is no need to send a student to the nurse unless the nosebleed does not stop after 5 minutes of continuous pressure. Another common request is for ice for an injury that happened over 24 hours ago or that happened during athletics. Ice is not administered unless it is a new injury with obvious swelling/significant bruising. Anything other than that can be treated at home or during athletics.

PLEASE COME BY THE CLINIC DURING YOUR NEXT PLANNING PERIOD: I will be printing off health history notes for your students by class/teacher. When you come pick them up, I will briefly review the notes and point out any students with meds in the clinic, or conditions you should pay extra attention to.

Please let me know if you have any questions about this email! Thank you so much for working with me to ensure that we keep students in class learning. And remember, I am here for YOU as well! Please feel free to call or come by anytime if you have a question or concern.

pedi_nurse · Nov 2, 2018

I'm also big on telling teachers that they can call me ANYTIME they have a question about a student complaint. I also don't give them a hard time if they send kids for unnecessary reasons. I've told like two teachers this year that they didn't really have to send a kid for a minor scrape. The kid can just wash it in the bathroom. Also, I provide bandaids to every classroom out of my clinic budget.

Old Dude is right though. You have to be careful to not to tell a teacher NOT to send a kid, more like, "hey try this first, before you send them." And when in doubt they should send them. FF are a different story. After talking to the kid multiple times, talking with the parent multiple times, I'll formulate a plan parent agrees with and inform the teachers. Typically, it's "This student can't come to the clinic for complaints of headaches or stomach aches during class time. They can come during lunch or electives for temp checks." But that's don't individually.

Rizowe · Nov 2, 2018

I rolled my eyes when I read this because you're right and I know it! lol! I guess I just feel overwhelmed with the number of children coming to the office on a "daily basis". It's usually the same ones too. I do require a nurse pass unless it's an emergency or vomiting. I've also started saving the passes and am shocked by the number I get each day. I'll def take your advice. Thank you for taking the time to comment and help bring me back down to reality!

This comment is for Old dude! I haven't figured out how to keep the original post with my comment.

KelRN215, BSN, RN · Nov 3, 2018

I rolled my eyes when I read this because you're right and I know it! lol! I guess I just feel overwhelmed with the number of children coming to the office on a "daily basis". It's usually the same ones too. I do require a nurse pass unless it's an emergency or vomiting. I've also started saving the passes and am shocked by the number I get each day. I'll def take your advice. Thank you for taking the time to comment and help bring me back down to reality!
This comment is for Old dude! I haven't figured out how to keep the original post with my comment.

Hit the quote button instead of reply. That's how you do it.

RatherBHiking, BSN, RN · Nov 3, 2018

I require a pass with student's name, time and reason being sent (I have ones I give the teachers with blanks for this info). Once I assess the student I write my findings on the pass like temp, anything I've done or think they need to do (bathroom, eat lunch, gave crackers, see dr if continues, whatever and I make the teacher send it home at the end of the day. That was the parent knows their child was sent to me for complaining and is aware how often they are visiting. Now if it's a serious issue like a head injury or whatever I also call but that's beside the point.

You are always going to have some teachers who send lots of kids. I've tried educating the teacher and even letting the principal know when it's excessive . I once had a teacher who would send 3/4th's of her class every single day and sometimes the same kid several times for invisible scratches or whatever. Nothing I tried made her stop. In her mind it was my job and quite frankly she didn't want to deal with them. She finally retired thank goodness. I also get very irritated at the kids who are not complaining and the aides will bring them to me daily complaining they just don't look well, don't you think they should go home and rest? Umm no, I can't send a kid home for a week until he gets over his cold because it bothers YOU. So annoying! Anyway, I've learned, the passes home help. Parents can help stop unnecessary visits because if the kid doesn't complain, the teacher won't send them for that little stuff. In extreme cases call the parent every single time their kid visits. In about one week the frequent visits will come to an end.

Secondly, start refusing treatment for that stupid stuff. No boo boo, no bandaid. No swelling, no ice. No fever, back to class. Bloody nose that already quit, send to bathroom to clean up themselves. It's hard to NOT do something. We are wired to help. We are helping these kids a different way. I don't send home for nausea or stomach aches. Bad headaches and cramps get a phone call to parent to bring med. I've been at the same school for 5 yrs of 400 kids. I see around 10 kids a day for first aide/illness. I have one teacher who was sending lots of kids until somehow she found out I have to chart on every single visit. She was shocked and it improved after that. Now to just get the aides to quit searching for problems...

cec0007 · Nov 3, 2018

OP, as a former teacher I do understand your dilemma, and I have no doubt that a few teachers may go overboard. A minor scraped knee or paper cut can be "doctored" fairly quickly in the classroom. A brief nosebleed requiring just a couple of tissues can as well, but a real gusher is hard to handle and is very distracting to the other two dozen students in class, never mind bringing the lesson to a full halt. (Aide? What aide? Most of us, except for Pre-K, K, and SpEd, don't have them.)

Please consider that teachers are not trained medical personnel, and sometimes sending a student to the nurse is just erring on the side of safety, and there can admittedly and understandably be some CYA involved, too. Are some students just trying to avoid classwork? Yes, but we can never know for sure that that's the case for any given episode, especially when the student continues to complain and request the nurse.

In my experience, many if not most student complaints were stomachaches and headaches. For stomachaches, I always asked them if they needed a restroom break, and also asked them if they could wait a few minutes, or until after lunch if it was close to lunchtime, to see if the tummy ache went away. Sometimes though, after a few minutes they would repeatedly complain and ask to go to the nurse. At that point, I usually sent them even if I had doubts the complaint was serious. (Unless, for example, I had a note from the parent requesting that I NOT send them to the nurse for such-and-such routine complaint.) I could absolutely be wrong in my "diagnosis," and it could be appendicitis or some other medical problem. Also from the classroom, even if there was time, I cannot call and have a discussion with the parent as you are able to do.

Same thing with headaches. If the student continues to complain after waiting a few minutes and keeps asking to go to the nurse, I'm usually going to send them to you. I have no way of knowing whether they also have a fever or some other meaningful symptom that I don't even know to ask, whether it could be the beginning of meningitis or other serious illness, etc. Rare stuff happens sometimes, and I'm not willing to risk putting a child's health in danger nor willing to be sued for refusing, after multiple requests, to send the child to the school nurse--who is presumably there (in part) for the purpose of making medical decisions.

I know you also have to care for the diabetic child, accidents and broken bones, allergic reactions, medications, etc. But still, I'm not medically trained, and you are, and I have other responsibilities going on just as you do. For one, I am held tightly responsible (probably far more than you'd imagine!) for using instructional time for teaching.

I know dealing with numerous, minor, and possibly fictitious tummy and headaches significantly increases your work load, and I always tried to do my best to keep it to a minimum. But you are the person trained and qualified to determine whether the complain is legit or not. I don't really have a solution or suggestion, other than to just count it as "comes with the territory." It doesn't make your work any easier, but maybe it makes it less frustrating if you also look at it from the teacher's perspective. Yes, we may "think" it's nothing, but we aren't really qualified to know that for certain. And if we were to be wrong--well, oh boy! It's also doubtful we'd receive any administrative support for our "negligence." Never mind we'd feel like crap for ignoring a truly sick child's complaints.

Btw, sending a student to the nurse causes more work for me, because upon their return, I have to "catch them up" as best I can while continuing on schedule with my lessons for the rest of the class. I'd much, much rather they never had to leave class.

Please understand that I tried not to send students needlessly, and most days I didn't send anyone. I've even had school nurses tell me they appreciated my not sending "ten students a day." I wish I had a solution for both teachers and nurses!

Just...God bless all of you for what you do.

Jedrnurse, BSN, RN · Nov 4, 2018

I rolled my eyes when I read this because you're right and I know it! lol! I guess I just feel overwhelmed with the number of children coming to the office on a "daily basis". It's usually the same ones too. I do require a nurse pass unless it's an emergency or vomiting. I've also started saving the passes and am shocked by the number I get each day. I'll def take your advice. Thank you for taking the time to comment and help bring me back down to reality!
This comment is for Old dude! I haven't figured out how to keep the original post with my comment.

If you track the FFers, you can call the parent/guardian and say something like "Little snowflake needs to leave class everyday for such-and such. I strongly recommend that they see their pediatrician to make sure everything is okay. If they have an undiagnosed medical condition, it would be helpful to know how we could support (L'il Snowflake) so they can feel better and not miss class. Because of course, that affects their education."

stephrooth · Nov 4, 2018

I'm at a middle school. This is what I sent teachers at the beginning of the year:
I hope week two is going well so far for everyone!
I wanted to take a moment to touch base with you all regarding my goals for the year. I know this is a lot of information, but I appreciate the time you take to go over everything. Ultimately, it is my goal to assess and care for students as quickly as possible so they can get back to the classroom to learn. In order to accomplish that, I have attached some information for you that might help with some minor complaints from students and I am asking for your assistance with them. I will also be printing and laminating a few copies, if you would like them for your classroom. They will be in the "Nurse's Corner" folders on the bulletin board across from the mailboxes. If they run out, just let me know and I'll be happy to prepare more.
CLINIC HOURS: 8:45am - 3:15pm (Please avoid sending students from 12:45pm to 1:25pm as I try to take lunch during this time)
***I am available in the clinic from 8:00am to 4:00pm (3:45 on Fridays) in the event of an urgent/emergent need.***
STUDENTS MUST HAVE A PASS: Please use the passes that were provided to you. If you run out, you may use any paper pass. Please include the student name, date, time, and your signature. I will be ordering more duplicate nurse passes, but it may be a few weeks before I have them. Students will be sent back to class if they come without a pass, come during passing periods, or within the first and last 15 minutes of the day unless it's an emergency. (While vomiting is not an emergency, per se, no pass is necessary - feel free to just send your kid with a trash can!)
MANAGE MINOR PROBLEMS IN CLASS: Please refer to the attached documents to help you manage some minor problems in class. Headaches, stomach aches, old injuries, and nosebleeds are common issues that can usually be managed in class. I often see students whose has a headache that "just started" or a stomach ache that started after they ate hot chips for lunch. The only thing I do differently for these students than you can do in class is check their temp. I do not give out medications unless the parent has brought some to the clinic for the student, nor do I give mints or crackers (if a student missed breakfast/lunch, please call the CafÃ© Manager at ext 24808) or allow students to use heating pads without a doctor's order. Typically, students are allowed to rest for 10 minutes, given water, and sent back to class, which are things you can try first. Nosebleeds are another common complaint that could be handled in the classroom, see attachment for how to. Most of the time I see students for nosebleeds, the active bleeding has already stopped. There is no need to send a student to the nurse unless the nosebleed does not stop after 5 minutes of continuous pressure. Another common request is for ice for an injury that happened over 24 hours ago or that happened during athletics. Ice is not administered unless it is a new injury with obvious swelling/significant bruising. Anything other than that can be treated at home or during athletics.
PLEASE COME BY THE CLINIC DURING YOUR NEXT PLANNING PERIOD: I will be printing off health history notes for your students by class/teacher. When you come pick them up, I will briefly review the notes and point out any students with meds in the clinic, or conditions you should pay extra attention to.
Please let me know if you have any questions about this email! Thank you so much for working with me to ensure that we keep students in class learning. And remember, I am here for YOU as well! Please feel free to call or come by anytime if you have a question or concern.

Can I copy this?

Daisy Joyce · Nov 5, 2018

One of the districts I sub for has a policy that there are certain office hours, and when the office is "closed", the types of situations you describe are to be handled by the teacher.

Apparently, the walk-ins were getting way out of control.

However, this is a district wide policy, not just the fiat of one lone nurse.

Most districts don't have this policy.

Amethya · Nov 5, 2018

I sent guidelines the beginning of the year and I enforced them. I don't get many friends in my office, but it's mostly like 14 in a day, including medications? It's not bad for a 533~ student population. I guess it's because not only was this enforced, it's because the kids know me already that unless it's something bad, I can't do anything. I can call their parents, but like 80% of the time their parents will tell them to go back to class.