Rational for Notes

[fetch, BSN, RN]

I am butting heads with one particular teacher right now about requiring students to bring notes to the clinic. The teacher "doesn't have time" to write a note, she is "busy with other students." And after all I don't have a lot of kids in the clinic whenever she walks by! I get so heated about this I can't articulate myself clearly, so I was hoping I could get some other school nurses to help me wrangle together exactly why students need notes.

For me, a note:

- shows the student did not just wander out of class/tell the teacher he went to bathroom and instead came to clinic (both of which have happened)

- shows the teacher actually spoke to the student and didn't just send them to the clinic to get them out of the classroom

- provides me with a venue to communicate with teachers, as I cannot easily leave clinic to get to classroom all the time - teachers can express exact concerns, and I can let them know of any plans/communications to parents

- in cases of head bumps, gives me the child's name and the teacher's name, so that if I do not know the student I can ask those questions and determine if memory is affected

Beyond all this, that's just the rule that has been instituted for the clinic, and I think it's very poor for school discipline in general for a teacher to show students it's okay to break the rules if you don't want to follow them.

I honestly do not usually have multiple children in the clinic at one time - thankfully, as my clinic is small. But today it's been 4 at a time all morning so having this one teacher keep sending random children who burst in and start talking when I'm already talking to another student . . . let's just say I'm aggravated, and not being my best self right now. Just writing all this out has helped, but I would still greatly appreciate any feedback.

[NutmeggeRN, BSN]

The expectation in my (HS) is that no one is in the halls with out a pass. That said, if they are vomiting, bleeding or seizing.....Ill make an exception. Fortunately I am supported by administration on that. It is an accountability for all. I have sent kids back time and again and it is getting better. stick to your guns.

[OldDude]

I try to stress the importance of a note to establish continuity of the child's complaint; to make sure the complaint stated to the teacher is the same complaint presented to me. Even with a note I make the students verbalize why they are visiting me. Many times the stories are different and that's important to know when trying to triage the child to stay at school or not. Does this teacher send children to the principal for discipline with instructions to, "go tell the principal what you did." No note - no communication - nothing??????

[JenTheSchoolRN, BSN, RN]

The expectation in my (HS) is that no one is in the halls with out a pass. That said, if they are vomiting, bleeding or seizing.....Ill make an exception. Fortunately I am supported by administration on that. It is an accountability for all. I have sent kids back time and again and it is getting better. stick to your guns.

Same for me. I have sent student back to class without a note. Because 9/10 the student without a note: (1) did not ask their teacher to specifically see me, (2) visit me during passing period, making them late for the next class and missing the first few minutes of instruction (and is not allowed), (3) spend WAY too much time getting to/from my office (the pass has times on it).

Do HS teachers sent me student without a note? Oh yeah. I still send 'em back and they are getting better. Administration, thankfully, supports me on this. I also manage 7th and 8th graders - those teachers never send me students without a note, so no note from one those kids and I know something fishy is likely going on...

[fetch, BSN, RN]

Thank you guys. The difference between what they tell teacher and what they tell me is a good one. Since our school is small, and elementary, most of the kids being sent to the office are actually being walked down by the teacher or an aide. But the point is still the same - kids' stories change, even unintentionally. (God forbid I call someone's child a liar, no matter how much their pants are on fire.)

[SnowyJ, RN]

We don't use passes, but I REALLY wish we did.

The teachers do not want to use them. (K-5.) I tell them that if they are not willing to use a pass system, they can't complain if a student "sneaks" in to the health office.

[Farawyn]

It's a free for all here. Kids and teachers running amock. I feel ya.

[kidzcare]

Most of the teachers are really really great about sending passes. If anything, I slack off on sending the kids back with a pass. Often the passes only say the name and what time they left class, not what the student's complaint is.

I made up some passes to send back after a teacher got particularly upset when a student vomited in her room a half hour after visiting me. On my passes I have check boxes for:

__ no/small breakfast

__ no fever

__ no vomiting

__ rested x minutes

__ called home

So the teacher can plainly see that I did not just ship the student out of my office.

There are a few known "dilly dally" students that I always make sure to tell that I wrote the time on the pass and stress that it should take no longer than 2 minutes to get back to the classroom if it's upstairs. Then I call the teacher to tell them that the student is on the way- once it took one young man 10 minutes to get up one flight of stairs. I frequently see him in the principal's office as well.

[rbytsdy]

- safety: an adult must know where the student is. What is there is a fire and you run out with the child?? Are you sure the teacher knows the child is with you? I've had students wander out of classes to come see me. I find out when the teacher is frantically looking for the student

- Documentation: this is done for your safety and the teacher's safety. What if there is an issue with the student in 2 weeks and the parent thinks the child didn't have the opportunity to see the school nurse? You have it documented if you did!

- Ensures the student is giving the same story to both teacher and nurse

- Identification: I once had a child some in and tell me his name was "Junior." I searched madly and couldn't find anyone in the school named Junior. He was in kindergarten and didn't even know his last name or his teacher's name. I had to walk him to several different classes to get him identified.

[NutmeggeRN, BSN]

EEEK!

[SchoolNurseTXstyle]

Best reason of all: MY CLINIC, MY RULES!!! Go to nursing school, pass the NCLEX, get your school nurse certification and then you can tell me how to do my job!!!!

[Wave Watcher]

One of our schools had a child come to the clinic without the teachers knowledge. No note. Well, the nurse decided the child needed to go home cause he was sick. The nurse told him he would be going home. The little boy walked right out the back door and started walking home.....the teacher had no clue where he was or that he was missing and of course the nurse thought he was going back to class. A good samaritan saw the child within a few minutes by the road walking and called the police.

If the child had a note then the teacher would be well aware that little Johnny was out of the classroom and at the nurses office. Therefore, she might have called or stopped by the clinic looking for little Johnny after a few minutes of him not coming back.

Also, notes keep kids from coming to see me without a reason. Also, I send the notes back home to the parents so they know their child was seen in my clinic.