Re wrapping splints?

[Shellaaay10x]

Hi everybody,

I work for an elementary school as one of the support nurses. today a student came in with her finger splint off wrapped in coband/some sort of elastic wrap tape. We have no documentation/doctor's note whatsoever about her having a splint. Anyways we put the splint back on her finger but I didn't not want to wrap it because of liability, plus I did not even know why or how she got this injury! I called moms work and when she came, she was super upset yelling at me. Stating that she is the "athletic director" at the high school and how she doesn't understand how I can't wrap her daughters poor finger. She also said she wraps athletes frets "all the time" and does treatment. As for as I knew, athletic directors aren't doctors? Anyways, I explained to her how she needed a doctors note, how I can't apply ace bandages or wraps. It's like a prescription. She continued to yell at me stating that "she knows my scope of practice" and what I can and cannot do. Then she continued to yell at me for keeping her daughter there and missing class.

I told her she can talk to my district nurse and she threatened to "email her".

I talked to my district nurse right after the incident and she was right on my side about everything, how she will talk to the parent/"athletic director" about our rules and policies.

Just wondering what you guys would have done.

That ended my day. Lol!

[BeckyESRN]

I will reapply a wrap/splint as needed. I usually call home after to let a parent know that I rewrapped, especially if it was on incorrectly when I saw the kiddo(most often because said kiddo was messing with it!). The only time I've called a parent to come apply a splint was a girl who came in with a 5 piece achilles' splint that she had removed before coming to my office and I had no idea how to reassemble it! Oh, and for wrap jobs that I suspect the kiddo did without the parent's knowledge.

However, if it's your schools policy not to reapply without an order(which isn't a bad policy) then you did the right thing. No matter what, the parent was out of line.

[OyWithThePoodles, RN]

If it was previously wrapped, I will re-wrap. I usually give the parents a heads up via phone or email. I've made a make-shift finger splint or two for broken fingers that parents were coming to take to the doctor.

I had a kid bring an ace wrap to me and say "Mom wants you to wrap my ankle before PE." Nope. If it needs to be wrapped, you don't need to play. Called mom and let her know the same, she was cool with it.

As others have said, IF YOUR POLICY SAYS NO, THEN DON'T DO IT! It doesn't matter what we say, because if you wrap it and something goes wrong, telling the judge that a bunch of anonymous nurses online do it so you thought you could, won't get you far.

[Shellaaay10x]

If it was previously wrapped, I will re-wrap. I usually give the parents a heads up via phone or email. I've made a make-shift finger splint or two for broken fingers that parents were coming to take to the doctor.

I had a kid bring an ace wrap to me and say "Mom wants you to wrap my ankle before PE." Nope. If it needs to be wrapped, you don't need to play. Called mom and let her know the same, she was cool with it.

As others have said, IF YOUR POLICY SAYS NO, THEN DON'T DO IT! It doesn't matter what we say, because if you wrap it and something goes wrong, telling the judge that a bunch of anonymous nurses online do it so you thought you could, won't get you far.

I know, I know!

[ruby_jane, BSN, RN]

Here's the thing...if I have no policy to do something, then I have no coverage when I am accused of practicing medicine without a license or whatever. Yes, it's just a splint. It probably doesn't fall under first aid (since the injury is not new). There are nurses who have a comfort level reapplying splints because of a previous job (or just really good parenting skills). But if you're not comfortable and there is no policy - you don't have to. Do I even want to know why sweet baby took the splint off?

[JenTheSchoolRN, BSN, RN]

I've wrapped splints. Kids pulls at the coban wrap around 'em a lot. I've also re-wrapped ace bandages if student came to school with it.

And I've also applied a splint to a finger (nothing else) and buddy taped, but I always call home as well to make parent aware and typically recommend follow-up if a finger splint was needed. It isn't often at all that I do this. And when I get a student request to it, I tell them I'm calling home so parent/guardian can make a doctor appointment and sometimes the student changes their mind and suddenly their finger is magically better! (And if I really think it is an injury that needs follow-up, I'm calling anyway.)

[Bob Loblaw]

My kid has been out of school for years but they had a policy- anything your kid has that the nurse needs to know about has to come with a note and instruction. They took the onus off the school nurse and put it back on the parents where it belongs.

[akulahawkRN, ADN, RN, EMT-P]

We have no policies prohibiting this so I certainly am not saying you should have done something differently. But because no one says we can't, I re-wrap anything that needs it. MD diagnosis or not. I'm a parent of 4 boys and have often applied splints and elastic wraps for a couple days to see how an injury is going to evolve; along with a request for them to sit out of PE or sports for a day or two. If no better after then it's off for xrays.

Occasionally, I'll have a student show up with a splint or wrap that was applied incorrectly, parent or medical facility, and could actually cause circulatory issues; for instance non-elastic tape applied around a swollen digit or crutches not adjusted correctly. On the flip side of this subject I'd be negligent if I became aware of the condition and didn't intervene.

The parent behavior you describe above is pretty pitiful.

This is another reason I'd re-wrap. Once you become aware of a splint or wrap that has been misapplied or has come off, if you do nothing about it, you risk being negligent by omission. This is because by you not doing anything about "it", you now are potentially now at least partially liable if the injury is further aggravated to the point where additional injury occurs.

I agree, the behavior of the parent was well out of line.

I will rewrap but I am also not quick to buddy tape or apply a wrap after an injury at school - I call the parents.

ETA...I hate to say this but once you start wrapping all the kids want to be wrapped for any little injury.

In a non-athletic trainer position, this is the position I would take, and why.

I will reapply a wrap/splint as needed. I usually call home after to let a parent know that I rewrapped, especially if it was on incorrectly when I saw the kiddo(most often because said kiddo was messing with it!). The only time I've called a parent to come apply a splint was a girl who came in with a 5 piece achilles' splint that she had removed before coming to my office and I had no idea how to reassemble it! Oh, and for wrap jobs that I suspect the kiddo did without the parent's knowledge.

However, if it's your schools policy not to reapply without an order(which isn't a bad policy) then you did the right thing. No matter what, the parent was out of line.

Be careful about a school policy that requires you to NOT reapply something without an order, for reasons I noted above. I can almost guarantee that if you do not reapply an item for which there was no order and the student sustains further injury because of it, the school / school district will likely drop you like a hot potato because you failed to prevent further injury, regardless of what the policy says. On the other hand, if you have such a policy, it's also a very good idea to require the parent to come in and reapply the item or obtain their permission to send the student out for the item to be reapplied by someone authorized to reapply it. Whatever you do in that situation, your worst option is to do nothing and send the kid away.

As to the parent's aggravation, if she was actually a certified athletic trainer, then I can guarantee that doing splinting, padding, and bracing is a very basic skill for her and she likely assumes that this skill is also a basic one for you too. One last thing, in most states (>40 of them), athletic trainers are licensed or certified at the state level and their title is usually very protected as ours is. Because of this, if you know her legal name, you should be able to search for past certifications.

[Shellaaay10x]

This is another reason I'd re-wrap. Once you become aware of a splint or wrap that has been misapplied or has come off, if you do nothing about it, you risk being negligent by omission. This is because by you not doing anything about "it", you now are potentially now at least partially liable if the injury is further aggravated to the point where additional injury occurs.

I agree, the behavior of the parent was well out of line.

In a non-athletic trainer position, this is the position I would take, and why.

Be careful about a school policy that requires you to NOT reapply something without an order, for reasons I noted above. I can almost guarantee that if you do not reapply an item for which there was no order and the student sustains further injury because of it, the school / school district will likely drop you like a hot potato because you failed to prevent further injury, regardless of what the policy says. On the other hand, if you have such a policy, it's also a very good idea to require the parent to come in and reapply the item or obtain their permission to send the student out for the item to be reapplied by someone authorized to reapply it. Whatever you do in that situation, your worst option is to do nothing and send the kid away.

As to the parent's aggravation, if she was actually a certified athletic trainer, then I can guarantee that doing splinting, padding, and bracing is a very basic skill for her and she likely assumes that this skill is also a basic one for you too. One last thing, in most states (>40 of them), athletic trainers are licensed or certified at the state level and their title is usually very protected as ours is. Because of this, if you know her legal name, you should be able to search for past certifications.

Of course I would not just send her on her way without doing anything, that is why I called the parent up to come reapply it. No way I would be aware of something and not do anything about it. We had applied the splint back on her finger, I just did not want to rewrap. This student also had full rom, but I still wanted somebody who was knowledgeable of her injury to come and take a look. If she came in uncomfortable, fractured and needed first aid care of course I would have done something to stabilize said finger and I still would have called parent!

I understand that may be basic training for her, but the way she acted I believe was out of order. i have no problem re applying a wrap if I had an order/if it was obviously too tight or was not being kept in place. We have a policy for not using wraps - unless regards to first aid tx - and I would have informed my supervisor (which I always do, and did also with this case). This is the first time I had experienced this where a student came in with a splint off her finger, specifically said the "doctor applied it."

if she was athletic director she should have known to provide proper documentation of her daughter's finger, especially if it required any limitations, how long she may have this for, etc.

Thank you all for the insight!

[CoffeeRTC, BSN, RN]

Athletic directors can be anyone with a sports background and don't always mean they have any medical or athletic training. My husband is an AD and he is clueless on these matters.

[janetpa]

I have rewrapped splints also especially if they are too tight---I do not "buddy tape" and I do not have xray vision to tell if something is definitely broken. I had a student come see me after PE because the teacher told her she "jammed" her finger. It looked more than that and I called mom. Doctor visit confirmed it was broken and a splint was applied at their office. She was sent to my office before a game so I wrap it without the splint so she could play--that I would not do. The coach did though and she was put in the game.

[JenTheSchoolRN, BSN, RN]

I have rewrapped splints also especially if they are too tight---I do not "buddy tape" and I do not have xray vision to tell if something is definitely broken. I had a student come see me after PE because the teacher told her she "jammed" her finger. It looked more than that and I called mom. Doctor visit confirmed it was broken and a splint was applied at their office. She was sent to my office before a game so I wrap it without the splint so she could play--that I would not do. The coach did though and she was put in the game.

I wouldn't either. Kid should have worn the splint with note from doctor that it was okay to do that if she wanted to play. Wrap without the splint and kid injures it further is just a lawsuit waiting to happen.

[akulahawkRN, ADN, RN, EMT-P]

Athletic directors can be anyone with a sports background and don't always mean they have any medical or athletic training. My husband is an AD and he is clueless on these matters.

This is very much correct. My understanding is that coaches are at least encouraged to attend a basic "Care and Prevention of Athletic Injuries" course. This was required at my University of all students in a coaching program. The AT students went much further. The AD is there to coordinate facility use (among other admin duties) among all sports so that "collisions" don't occur where two teams end up attempting to use the same facilities at the same time.

I have rewrapped splints also especially if they are too tight---I do not "buddy tape" and I do not have xray vision to tell if something is definitely broken. I had a student come see me after PE because the teacher told her she "jammed" her finger. It looked more than that and I called mom. Doctor visit confirmed it was broken and a splint was applied at their office. She was sent to my office before a game so I wrap it without the splint so she could play--that I would not do. The coach did though and she was put in the game.

You not wrapping the finger was the correct call for you to make. You're likely not an AT so you don't likely have any knowledge/training in how to prevent further injury for that kid and allow that kid to play. In addition, AT's have to be aware of each sport's rules regarding permissible splinting and bracing so other athletes aren't endangered by that splint or brace. The coach that did the wrap took on some potentially significant personal liability for what was done.