School Medical Aide- Looking for some ground rules for teachers

[Amethya]

I just started this job at a public charter school, I'm still new at this job. I really like it and it seems to suit me a lot. But it seems to me that the teachers are sending these kids for EVERYTHING. I understand by their outlook which is they don't want to be liable for anything if something happens to the child, but it seems to me like that. Last week, which was the first full week of school, I saw 253 students.

I don't know if this is normal or not, but I told this to the Medical Aide manager and she told me I should establish some ground rules for the teachers, especially since my office is really small (Only one bed and 3 chairs). I was wondering if anyone can give me some ideas or tips on this, as well as some advice for me.

Thanks!

[BeckyESRN]

I few things that I've found helpful: Send a baggie of bandaids to each classroom for minor injuries- paper cuts, bandaid fell off, and such. Also, I will tell older kids to go back to their classroom and put a bandaid on. The occasional "You must be out of bandaids" note helps too:sarcastic:

Another life saver has been Yucky Buckets aka a sand bucket. This is mega helpful with the little guys. My kinder and 1st grade teachers tell any kid who complains of a vague belly ache to hold onto the bucket for a few minutes and the belly ache magically gets better.

If you're new, the kids will smell fresh blood! Be consistent, don't let them hang around, send them back to class for all but the worst of the worst, and call them out on their abuse of the nurses office when needed.

For teachers: Nurse passes are an amazing thing! I had a few teachers who would send me 30+ kids a day (with a class size of 18, that's impressive!), I emailed the teachers and put copies of nurse passes in their mailboxes. They hated having to fill out passes, so the visits took a drastic nose dive:) plus, I think making them write out the ridiculous reason for the visit drove home the point.

Let the teachers know when you are available. I had several diabetic kids that came in at the same time a few times a day, so I let everyone know that I would not tend to kids during those times, also lunchtime, and the very end of the day. This really helped with office traffic. If you start seeing the same kiddos over and over again, touch base the teacher (they may not realize how bad it is especially if the kid is leaving a special area-library, computer, music, PE, recess, lunch) and call the parent. If you are seeing someone that is consistently "ill" a guidance referral may be helpful.

Most importantly, keep your principal in the loop! If you are seeing too many kids, let the principal know. If teachers are sending you dumb stuff, let the principal know. If you've tried to curb the craziness and it hasn't worked, an e-mail from the person in charge is sometimes necessary.

Good Luck! It does get better!

[BeckyESRN]

If all else fails, send this to the teachers!

[Amethya]

Sounds like good plans! I'm doing the zip lock bag thing soon. As for the same kids, I'm going to have to let the teachers know. Because I seem to see a lot of frequent fliers and I only got like 3 chairs and one bed. I only have one diabetic kid and his mom is just a pain but I see him at least 3 times a day because of carbs and his PE class and to pick up his machine.

I'm thinking of doing a lunch time thing. Like from 1:30 to 2:00. I already contacted my supervisor on rules or boundaries and we are in the process of thinking some.

[littleINlpn]

I was having the same problem for the past couple weeks and I finally sent an email out telling teachers when to students down, I have not had one student today! It has been great getting work done than putting on unnecessary band-aids and such. Good luck!

[Amethya]

I get to pick a lunch time, which from 12:25, since that's the last kid I give their meds come in. I was thinking either, 12:30 to 1 pm, 1 pm to 1:30 or 1:30 to 2 pm. I get out at 4, so I guess the 12:30?

[nursetlm, ADN]

I was given a letter that a fellow nurse uses to give to her teachers- can I copy and paste that here? Or is that against the rules?

[Amethya]

I don't know to be honest, I don't post things here yet but if you can edit out the name of the school or name of the nurse, maybe?

[grammy1]

1:30-2:00 makes for a nice short afternoon!!

[nursetlm, ADN]

Here's what I use:

Guidelines for Nurse's Office

Reasonable Expectations for Self-Care in Classroom:

As the new school year begins, it is a good time to educate the students as to when it is appropriate to come to the nurse's office. This will help prevent students from misusing their education time by spending it in the nurse's office for minor complaints.

Our mission is to provide a safe, healthy learning environment in our school and to keep the student in CLASS for optimal learning. All students sent to the nurse's office MUST have a Nurse Referral Slip filled out with both first and last name, primary complaint and room number. We understand that emergency situations occur where this is not possible, but is the expected daily procedure.

Each classroom teacher will be given a Ziploc bag of gloves, band-aids, gauze pads and other items to allow for minor cuts/scrapes to be handled in the classroom. If you are in need of band-aids, gloves, etc please notify the nurse and she will provide them. Each teacher will be informed of students in his/her classroom with chronic health conditions or potential for emergent conditions.

Questions to ask students before sending them to the nurse's office during class: Have they used the restroom? Hungry? Tired? These are not emergent reasons to see the nurse.

Students should stay in class:

-Approximately the first 45 minutes of instructional time UNLESS they are vomiting, have hit their head, are having breathing issues (including known asthmatics), broken bones, pink eye, injury to eye, loss of consciousness or seizure, lice or bleeding profusely.

-When an old, healed abrasion (scab) is merely sore or itches. This is part of the natural healing process.

-When there is soreness from an old injury. If no bump, bruise, swelling or redness or it is more than 24 hours old- no ice should be given- it will not help at that point.

-If a student has a bandage that was applied by a physician-I am not able to reapply or change it (without doctor's written orders) I can only reinforce it.

-When a student regularly finds excuses to leave class and rarely has to go or stay home because of illness.

-When a student frequently asks to go to the nurse at the same time of day.

Reasons to call Nurse to site/location for assessment:

-Loss of consciousness

-Bone/Joint injury (possible dislocation/fracture)

-Seizure activity.

-Serious falls/accidents that involve head/neck/spine.

-Signs of allergic reaction: Swelling of mouth/lips, hives, vomiting, nausea, hoorificeness, and wheezing or abdominal pain.

Valid reasons for leaving class and coming to nurse's office:

-Vomiting (not just spitting up phlegm)

-Bleeding (minor scrapes can be handled in the classroom)

-Breathing difficulties (wheezing, shortness of breath)

-Bone/joint injury (I can also come to location if needed)

-Undiagnosed rash.

-Splinters- imbedded splinters cannot be removed, but will be cleaned/covered.

-Nosebleed- student should pinch own nose closed with Kleenex, breathe through mouth and walk to clinic.

-Suspected head lice/excessive head scratching.

-Human or animal bite.

-Injury to eye

*For students who complain of headache or stomachache, and it is close to their lunchtime (these symptoms may indicate thirst or hunger): 1. Give them a drink of water, 2. Have them put their head on desk for a minute or two (if possible) and when time, 3. Have them go to lunch. 4. If they continue to complain after lunch/recess, then they should be sent to the nurse's office.

*As a reminder, I am out of the office daily from 12:15 to 12:45 for lunch and from 10:30 to 11:30 when I am at the High School to cover their nursing needs. Please refrain from sending children during these times unless absolutely necessary as the office staff is swamped with their own tasks. Thank you!

[Amethya]

I like this a lot. Exactly what I need to tell everyone.

[JenTheSchoolRN, BSN, RN]

I use this visual when I send notes to teachers. I also have a copy up on my office door when I take my lunch or I'm teaching health.