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School Nurse: Managing a scene/coworkers

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laflaca has 5 years experience as a BSN, RN.

8,632 Profile Views; 365 Posts

Looking for advice.  I had a HS student who was assaulted by another another kid - punched hard several times in the face. Face is a mess, blood all over, kid is crying and freaked out.  Airway OK, no broken teeth and wasn't choked or anything.  Breathing fast but good color, crying and talking in complete sentences, sats good. A&o, recalls events before & after, no loss of consciousness, didn't fall or hit head against anything, steady drip of blood and a big visible clot hanging out but not gushing, nares patent after the bleeding stopped, nose already very swollen, eyes reddened and already starting to bruise but PEARRL and vision OK.  No palpable or visible injury to the rest of head, mouth, jaw, ears; no pain in back or cspine, no changes in sensation; no obvious asymmetry or fractures in face, wasn't struck anywhere else. Not nauseated, vomiting, dizzy or confused. Not on anticoagulants, no worrisome medical history.

So, a terrible situation requiring monitoring until he went to a provider (it took his group home over an hour to arrive, despite saying they were coming immediately.  Vitals OK and he remained a&o managing OK with Tylenol and ice.  But I gave them a stern talk about going straight to the hospital, and wished I would've just called 911 to get him going).  But not appearing to be immediately life threatening. 

I never worked pre-hospital or in community settings like this before; I'm used to being around other nurses.  So running through my ABCDE checklist seems logical and obvious, but I'm thrown off by my coworkers who say and do completely unexpected things (three of them  hassling me about the blood while I'm trying to assess the kid - insisting floor should be cleaned up and his clothes changed immediately - while I of course am not concerned with the floor.  I want to make sure there's not some c-spine problem or other injury before anyone moves anything).  One of them actually yelled out from behind me mid-assessment that the kid should tip his head way back so the blood would stop dripping (um, no). 

I'm not used to managing onlookers on a scene.  Also not used to a setting where freaked out teenagers can crawl underneath a shelf, making assessment a challenge.  I probably should have just kicked all the staff out. 

How do you handle your coworkers in these situations?  And what else could I have done for this kid?   We don't do debriefings at work (we should) so I'm going over and over in my mind about it. 

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beachynurse has 35 years experience as a ASN, BSN and specializes in School Nursing.

139 Posts; 1,257 Profile Views

I ignore them. I worry about the student first. The last things I am going to worry about is cleaning up the blood, and a change of clothing. Once I establish that the student is ok, and has been brought to the clinic, I will call for the custodian to clean up the blood, and take care of the clothes. I will also address the situation about my coworkers challenging me about how I do my job with my administrator, and let him handle talking to them. It was inappropriate for them to tell you whaat to do. Do you go into their classrooms and tell them how to teach> I doubt it.. 

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SaltineQueen specializes in School Nurse, past Med Surge.

1 Follower; 821 Posts; 6,194 Profile Views

I've, thankfully, never had a situation like that.  But I'd feel completely within my rights to tell them the best way to help is to clear the area so I can do my job.  Wouldn't feel bad about it at all.  

Edited by SaltineQueen

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35 Posts; 940 Profile Views

I feel you.  I've had many situations that I feel have escalated since everyone wants to 'check in'.  I think in some regards they are just curious but also think maybe they feel they 'have' to do something since there is clearly a crisis going on.   Everyone will come to check on the (bleeding/wounded) student including (without my asking) going to fetch the sibling so they can 'comfort' this student who I have already calmed down once.   I try to bring them into the furthest recess of my office ASAP and give teachers who hover around something to do (get her stuff/call parents/ page janitor/ get rid of other kids) but it definitely is an added challenge, esp if it is the trying to be helpful....

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7 Followers; 3,340 Posts; 23,269 Profile Views

Not a school nurse but in one of my lives I deal with emergencies out in the public. I have been doing it for quite a while and have learned that the best way to handle interfering crowds is to give the worst of them "something" to do. For me it would be to send the most obnoxious ones uphill to "guard the scene" and direct skier traffic which makes them feel important but more importantly gets them away from me. I have been known to send some on wild goose chases for "supplies". All of this done in my most authoritative voice of course. Generally speaking once all the others see that I am putting people to work they start to shrink back and become less of a problem. 

Wanted to add that most of these bystanders are at various levels of inebriation so if I can get them out of the way I'm pretty sure the teachers will be a piece of cake. 😂

Edited by Wuzzie

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2 Followers; 5 Articles; 4,122 Posts; 35,203 Profile Views

It never fails!  Your co-workers can be the biggest rubber neckers full of suggestions, but these are NEVER the people that are willing to sign up for epipen delegate training or stay late for CPR or ALICE training.  In time you'll learn to filter them out, you'll learn who you can lean on, and you'll learn who to send right away to get the backpack and find the custodian.  Another favorite trick of mine is to clear my office / the area during the initial assessment and have the biggest PITA be my bouncer. Tell them to stand at the door and keep everyone else (including themself) out.  Ahh peace and quiet.  

It sounds like you managed this pretty well.  You know for next time (which hopefully there won't be with this child) to send out instead of relying on group home to come right away.  I know, none of us wants to rely on ems for what was most likely just some minor injuries from the fight, but sometimes you need to push.  

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LikeTheDeadSea has 6 years experience as a BSN, RN and specializes in School Nursing.

1 Follower; 544 Posts; 5,027 Profile Views

I have routinely turned, made eye contact, and pointed directly at people and have calmly said, "You need to leave this room/area." No shame in my game. I can explain how they were being distracting/useless later. 

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BiscuitRN has 4 years experience as a BSN, RN.

584 Posts; 2,429 Profile Views

I agree with all the above.  Ignore if possible, tell them to back off, give them a job to do.  Maybe a debriefing is necessary.  Might want to talk to administration about having a meeting with staff regarding emergency situations.  Are these staff members first aid trained or CPR trained?  Tell administration these staff members could be a liability in an emergency if they're disregarding and trying to override your medical judgement.  Otherwise gotta let it slide off your back.

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Nurse Jen is a BSN, RN and specializes in School Nursing.

53 Posts; 142 Profile Views

Ditto to all of the above!  Ignore them in the moment and perhaps address it at a later time.  You are the medical professional in the building and they need to allow you to use your knowledge and expertise to handle the situation.  I have a fantastic staff that tend to look for me to take direction in the emergency.  It is not often I run into an issue such as yours but it has happened.  Once everything is calm, call a quick meeting.  I start by thanking them for their cooperation and then go into what they could have done differently to help facilitate a smoother moment.

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12 Followers; 3,815 Posts; 28,781 Profile Views

8 hours ago, laflaca said:

Looking for advice.  I had a HS student who was assaulted by another another kid - punched hard several times in the face. Face is a mess, blood all over, kid is crying and freaked out.  Airway OK, no broken teeth and wasn't choked or anything.  Breathing fast but good color, crying and talking in complete sentences, sats good. A&o, recalls events before & after, no loss of consciousness, didn't fall or hit head against anything, steady drip of blood and a big visible clot hanging out but not gushing, nares patent after the bleeding stopped, nose already very swollen, eyes reddened and already starting to bruise but PEARRL and vision OK.  No palpable or visible injury to the rest of head, mouth, jaw, ears; no pain in back or cspine, no changes in sensation; no obvious asymmetry or fractures in face, wasn't struck anywhere else. Not nauseated, vomiting, dizzy or confused. Not on anticoagulants, no worrisome medical history.
 

Just wanted to say nice job on the assessment of the situation. Very thorough despite the chaos.

👍🏽

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21 Posts; 492 Profile Views

I'm blessed to have an administration who recognizes that I am the only licensed person, the only one with medical training/education in the building. My principal has told all staff during emergencies "Heather is the boss right now; do whatever she says or get out of the way". 

I agree with others give them something to do (call home/911/etc, retrieve student's belongings, get the custodian, crowd control, flag down the ambulance if called, etc) or tell them to back up. And anytime someone is giving potentially harmful advice (tilt head back during a nosebleed), this person needs to leave the area immediately. A simple, firm "That will hurt more than help. We can discuss this later. Right now, you need to go somewhere else" seems to work well in my experience. 

Debrief is a must for any emergency in any setting. Even something as simple as an emailed list of "things that went well, things to improve, and things that cannot be repeated". Definitely speak with your administration about the best way to hold a staff debrief. 

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pennyeary has 2 years experience as a CNA.

75 Posts; 653 Profile Views

First hand experience, stand up and tell them what you need or expect.  right at the moment if its get out..... build a wall to protect privacy...What ever you need they are not their to question you however they will all have advice ignore them and do your job.

This year we had a very serious accident at our school and their were many parents and students around.  I arrived on scene and began assessing student 911 was already in route.  There were people everywhere (we were out side of the school building).  I had staff form a barrier wall with their backs turned to the injured student to protect privacy. 

As for debriefing this incident was 8 weeks ago and we are still having weekly debriefings how can we do better, how can we prevent this from happening again, who needs to be where, when, and how. You have to have support from your administration and co workers or you will be absolutely miserable.

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