I'm feeling so deflated right now. On Friday, I had a teacher send me a student to get checked out after falling off the monkey bars. She hit her right arm so I checked it out. No complaints of pain, I touched her arm up and down and she denied pain and had no signs of pain on her face whatsoever. There was no swelling, no redness, no bruising, no changes in color. I did some exercises with her to test her ROM and she had full ROM, once again no signs of pain with movement. There were no changes while I had her there in clinic and the arm looked completely normal and equal to her other arm. So I gave her ice and sent her back to class and wrote on the pass for the teacher to send her back if she had any complaints. I did not call home as nothing in the assessment seemed abnormal and the student had no further complaints for the rest of the day. Mom comes in today yelling How did you not see her arm was broken? What kind of a nurse are you?†and all kinds of other stuff. Mom says that around midnight (12 hrs after the incident), she saw that her child was trying not to use her right arm and noticed that her forearm was white. She took her to the ER and it turns out it was fractured. I was truly shocked to hear this…the principal and teacher came in and we sat down to discuss the incident. I had my documentation with me and showed the principal and the mother. The principal agreed that I had assessed fully and appropriately and followed protocol and told mom that I don't normally call home for every bump/fall/pain and that based on my assessment, there would not have been a reason to call home. The teacher supported my findings by adding that the student not only had no complaints for the rest of the day (3 hrs) but that the student was also doing all her classwork/writing/coloring with the affected arm (she's right handed) and was doing so without difficulty and she had not seen swelling to the arm. The ER doc apparently told mom that the fracture would've bubbled up†right away so I guess this made mom feel like her child came in with all these obvious signs and I just ignored them when in reality this student had absolutely no signs at all and the assessment was normal and she even continued to function normally in class. Oh by the way, another reason mom's extremely upset is that the ER called CPS on her over the situation…
I just feel so terrible about this. Terrible because this poor little girl went 12 hrs with an untreated fracture and terrible for mom who now has CPS on her case. We told her we'd back her with whatever documentation CPS needed to explain that the injury did indeed happen at school but that doesn't take away the stress of the situation right now. I also am afraid of what this means for me…but at the same time I feel like I assessed properly and, short of having xray vision, there would've been no way to know it would turn into all this. I don't normally call for every fall on an arm, leg, knee, elbow, etc, when everything else in the assessment looks normal, but now I think I will just in case it could be a fracture.
