Resetting dislocating WHATS?

[WyVy, LPN]

So this afternoon I sat in on an IEP for a new preschooler. Mother sts child frequently has finger joints dislocate and would like for us, the school staff (ie ME) to fix it whenever that happens. Principal sees that as a liability and sts we need to call 911 in any instances, mother is very disappointed in that decision, as she sees it to be very easy to relocate said joints and that the child is in a lot of pain until that happens. Obviously I have to go with whatever the bossman says, but what do you think, would you do it?

[Scottishtape]

Absolutely not! I would never reset any bone, because I have not been extensively trained to do such, and I'm pretty sure that is not in my scope of practice.

I would be be very surprised to hear this is in your scope of practice, and am very surprised this was even considered.

I do not think it warrants a 911 call, but I would definitely call mom and send the child to a DOCTOR to have it reset.

Also, I would be FURIOUS if a school nurse attempted to reset anything on my children. I realize that wouldn't be an issue in this circumstance, just sayin..

[WyVy, LPN]

District Rep (principal was out of the building) instructed mother to get written order from doctor on what would need to be done in this event and we would review it, but I just shook my head. Since mom is comfortable doing it herself, is it inappropriate to say then we will call YOU to do it, if you refuse a 911 call.

[OldDude]

I would not call 911 but I certainly would not attempt to manipulate any suspected dislocation. I would immobilize it and call mom and recommend MD examination.

[OldDude]

It would be outside of the nurse practice act in my state.

[WyVy, LPN]

So since Principal is adamant that calling 911 is the answer, how would you suggest that it is unnecessary and just make a call home? What's the rationale? I'd run it past my district nurse to see what she would recommend, but I'm afraid Principal would see that as going behind his back. (New to this job, been here a month!)

[BunnyBunnyBSNRN, ASN, BSN]

Stand your ground and call your nursing boss! Do not allow your school administration to dictate nursing practice - that is what your district head nurse (and your state BON) is for. Do not pass go, do not pause, have a conversation with your nursing boss today. If you believe your principal would be upset, let him know before you call that you would need to talk with the nursing side, the call. Do not let the principal talk you out of calling.

good luck and come back and tell us what happens!

[ohiobobcat]

Yep- I would NOT be reducing dislocated joint, even with a doctor's order.

I feel that calling mom would be appropriate in this case, and SHE can come in an reduce the dislocation (like you said). If mom is unavailable, then have a back up person and/or call EMS.

Absolutely call your nurse supervisor on this one. You need a nurse back up on this one. Like chiefswife said, tell your principal ahead of time that you are making the call if it makes you feel better. Hopefully you can get the principal on board with the plan once you explain the rationale behind it and why EMS probably doesn't need to be called every time this happens.

[OyWithThePoodles, RN]

Nope.

You do not have to do anything that you are not comfortable with and no one can force you to perform a task.

Maybe compromise with admin (who sounds ridiculous if you ask me). Tell him that you will first call mom, and then if she cannot make it to the school within 30-45 minutes you will call EMS. I still think EMS is a stretch, and we do whatever we can in our district to NOT call. I could be wrong but I think our district has to pay when EMS is called. So calling every time the kiddos finger pops out of place would be costly.

Stand firm and speak with your nurse boss.

[NutmeggeRN, BSN]

Ya, no way!!

Get the MD to write

"If dislocation is suspected and child is in no imminent danger, call parent first. If parent or (other adult is listed in emergency contacts) is NOT available, EMS may be called if it is determined there is risk for further injury"

Do the assessment, have permission to talk to MD, have a written care plan. EMS if no other option.

[Flare, ASN, BSN]

I wholeheartedly agree. Resetting joints falls way outside the scope of practice and is a huge liability, doctor's order or not. I would be surprised that a doctor would even suggest that a school nurse would take on this task, knowing that it would be a resounding NO across the practice. Mom's options are to come herself when this happens to reset the joints, since she apparently knows how to do this procedure or to take him to a doctor. I agree that if she does not come within X timeframe that EMS would be called as a compromise, if the child is in a lot of pain, you can't expect him to wait there if mom is an hour away. I think that the best plan would be to draft an emergency plan stating such. The parent may not like it, but you can not risk your license and liability to the district to appease one parent.

[JenTheSchoolRN, BSN, RN]

Ya, no way!!

Get the MD to write

"If dislocation is suspected and child is in no imminent danger, call parent first. If parent or (other adult is listed in emergency contacts) is NOT available, EMS may be called if it is determined there is risk for further injury"

Do the assessment, have permission to talk to MD, have a written care plan. EMS if no other option.

THIS. This is what I would do. I am not resetting a joint. I cannot do so legally #1 and #2, I do not have the training to do nor any way to ensure that if done, it was done correctly. Nope, nope.

I totally get not calling EMS as this appears routine for this kid if Mom (or another designated adult in the care plan) can get there within a determined reasonable amount of time.