Ride alongs

SDALPN · May 27, 2014

Never heard it called a ride along. Have always just heard school case.

When I do school cases, I bring foods/meals like lunchables, sandwiches with an ice pack, etc. Usually the school will let you use a microwave...sometimes in the teachers lounge. I've been to a few where it wasn't an option. The biggest issues I've run into are teachers with control issues or who think we do nothing but sit there and they get jealous. Parents who think "we don't need to carry all of that equipment" so they don't allow things we need to be carried. And if the parent is "friends" with the teacher, the teacher could be watching you and reporting silly things to the parent. With special needs kids, they sometimes have the same teacher for a few years. Make it clear with the bus driver that you are there to take care of kid. Bus drivers have a rule that they must stop the bus in a safe location before anyone stands. I get safety...but if my kid is desatting and needs emergency intervention, I don't care if the bus is moving or not. I had one driver tell me "too bad, it's my job"...my response in front of the childs parent was "this is a childs life which is more important than your job" The parent complained to the head of transportation after that.

Make sure you pack well and in a way that's easy to carry. If someone packs for you, double check everything. It's your license if someone forgot your emergency bag/equipment. Bring something to do, going to school all over again is as exciting as it was the first time you went. Don't forget that if you get sick, you don't have your car to leave...same if you have a family emergency. If you carry meds, some teachers want you to lock up the meds. I refuse to because if I need my inhaler, I don't have time to find the teacher and have them open the lock.

If you have a more functional child and they get in trouble at school, expect to be with them while they are punished. I've sat in detention and in school suspension with a kid.

systoly · May 27, 2014

on school days, I just bring water in a canteen

i eat at school. it's $ 1.25 and actually quite good

the water in the schools vending machines is very expensive

so i usually bring 2 canteens during the summer

ceebeejay · May 29, 2014

First day went well. I packed up a sandwich, yogurt, two thermos cups of coffee, a thermos of water and a bottle of water. Yeah, sounds like I packed for war, but I had a short school RN sub thing afterwards too. Teacher was fine, the teacher aids were faboosh. One is a little "aggressive" because I think they think that I am "taking" the old RN's job away. Hey, I just applied to a job, I am not involved in whatever. I just said, "I don't understand what you are asking me.". That stopped that line of questioning cold. *raspberry*

I call this a ride along, because when I say "school RN" everybody thinks of the classic RN that ensures health and safety of the children in a school. Just a distinction in my mind. There was a mix up somewhere about the days - I have the written schedule so it wasn't me - but I have on less day. You know what, I am actually happy about it. I was having mini anxiety attacks about having to get up so incredibly early three days a week. I feel good about this one. The advice about the reading material was SPOT ON! LOL! I am going to print out my readings for my class and bring with me. Thanks.

SDALPN · May 29, 2014

Good to hear it went well! I'd be careful with the aggressive one and watch things said. That never ends well. If the staff in the classroom are great, it's not bad. But they can make or break the case.

Adele_Michal7, ASN, RN · May 29, 2014

I would be very, very, careful. Keep interaction with school staff to a minimum. Ask the school what they expect of you.

Adele_Michal7, ASN, RN · May 29, 2014

And I am not allowed to use any type of microwave, because I can't leave the room unless my patient does.

SDALPN · May 29, 2014

And I am not allowed to use any type of microwave, because I can't leave the room unless my patient does.

According to the insurance companies we aren't supposed to leave the patient and we are supposed to be in the same room at all times. If we must leave, we are supposed to have a trained caregiver monitor while we step out. But that really isn't realistic. We are human and do need to eat and use the bathroom. I dare a supervisor or insurance company to challenge me when I go to heat up food or use the bathroom. The main reason the rule is used is because nurses will sit in the teachers lounge all day or in their car. In the home nurses will sit in the living room watching TV while the patient is in their room. They don't want that kind of behavior and that is the reason for that rule. Common sense still applies.

JustBeachyNurse, LPN · May 30, 2014

Fortunately there is a microwave in each of the classrooms I've been in. The bathroom is a few steps away and my most complex, fragile kiddo the school nurse (a very competent caregiver as this is a special needs school) will stop by and offer to sit so I can take a bathroom break. She so does this for the trach/vent students' nurses.

I will not do the TA job for them as I am not classroom staff. Many have tried and I've confirmed with my agency, school administration and class teacher that TA work is not my job.

I call these school cases (some involve riding the bus, a few meet child at school as parent chooses to drop off). I also do what my one office calls bus runs or "Diastat runs" mostly seizure precautions a few respiratory/O2 clients. Meet bus, ride to pick up child, chart & emergency meds, turn over child to staff & chart/emergency meds to school nurse. Ride bus back to car. Reverse in PM. Only " on duty" when child is present. Paid flat rate of 2hrs per run (but paid for actual time so if weekend traffic pushes the run to 2.5hrs that's what I'm paid, if it takes 30 min round trip I'm still paid for 2hrs per school contact with agency. When child not present I catch up on my reading. (Some schools are 30-45 min away plus other students to pick up/drop off)

Make sure your expectations are clear. One lazy driver expected nursing to secure wheel chairs...we aren't trained to do do and that if a driver/aide responsibility. My agency & the district transportation director cleared that issue up very quickly.

Always report any issues to clinical manager. They cannot help or support you of they don't know about it. I had one case where the bus aide wanted a schedule of nurses including full names & titles. My agency vetoed that idea as it was irrelevant to doing their job ( another nurse almost gave it to the aide not thinking). Our director clarified with the district (who our contract is with) right away.

SDALPN · May 30, 2014

Fortunately there is a microwave in each of the classrooms I've been in. The bathroom is a few steps away and my most complex, fragile kiddo the school nurse (a very competent caregiver as this is a special needs school) will stop by and offer to sit so I can take a bathroom break. She so does this for the trach/vent students' nurses.
I will not do the TA job for them as I am not classroom staff. Many have tried and I've confirmed with my agency, school administration and class teacher that TA work is not my job.
I call these school cases (some involve riding the bus, a few meet child at school as parent chooses to drop off). I also do what my one office calls bus runs or "Diastat runs" mostly seizure precautions a few respiratory/O2 clients. Meet bus, ride to pick up child, chart & emergency meds, turn over child to staff & chart/emergency meds to school nurse. Ride bus back to car. Reverse in PM. Only " on duty" when child is present. Paid flat rate of 2hrs per run (but paid for actual time so if weekend traffic pushes the run to 2.5hrs that's what I'm paid, if it takes 30 min round trip I'm still paid for 2hrs per school contact with agency. When child not present I catch up on my reading. (Some schools are 30-45 min away plus other students to pick up/drop off)
Make sure your expectations are clear. One lazy driver expected nursing to secure wheel chairs...we aren't trained to do do and that if a driver/aide responsibility. My agency & the district transportation director cleared that issue up very quickly.
Always report any issues to clinical manager. They cannot help or support you of they don't know about it. I had one case where the bus aide wanted a schedule of nurses including full names & titles. My agency vetoed that idea as it was irrelevant to doing their job ( another nurse almost gave it to the aide not thinking). Our director clarified with the district (who our contract is with) right away.

That reminds me, don't forget to document who secured the kid and chair on the bus to take liability off you if they don't secure the kid correctly or the mechanism that holds them in fails. I have been in a school bus wreck. It was very minor. Bus too close to center line, dump truck mirror over center line. And my documentation was looked at. CYA!

ceebeejay · May 30, 2014

Great advice. Thanks. I documented seat belts, but not who did them (the bus aid); so, I will do that next week. I am not a talkie, talkie person and I politely steer conversations of a catty or personal nature toward neutral topics. People tend to pour their hearts out to me (even before I became a nurse) and I will listen, empathize, but I don't offer advice. The teachers and the TA's actually politely asked me not to participate in the day, other than what I need to do as the RN. So, I have a lot of down time, just observing to make sure safety is observed, temps are correct, and there is not seizure activity or anything unusual. There is a microwave in the room and a kcup coffee thing. Bathroom is right around the corner. There has to be reasonable accommodation for such "human" activities. I have to notify everyone that I am leaving the room, the bathroom is situated right near the class, so I can be summoned in an emergency. It's like 10 minutes total out of the whole day. I eat lunch with the class. Everyone has been "doing their job" and doing it well. No wheelchair involved, but I am filing that in my mind for the future. I had a private patient in a wheelchair, so I "know" how to belt the chair down in an adapted van, but I would not be willing to do it on a commercial bus.

SDALPN, we just had a big double bus accident where I live. They large bus ran through a stop sign! T-boned a mini bus which turned on it's side, thank goodness injuries were minor. Scary stuff.

SDALPN · May 30, 2014

That is scary! Especially since most buses don't have seat belts.

Some classes have required that we assist our patients with schoolwork. Others have said it's their job. Mostly, the agencies I've worked for have gone with whatever the school has asked for. You know the agencies are so afraid to say no. I prefer to do nursing. I have another degree in education and I choose nursing, not education. So I stick to nursing tasks as much as possible.