New to school nursing...Please help with a few questions!

SaltineQueen · Mar 13, 2017

Hi Beth,
Did you decide and come up with a policy that the physicals are no longer needed? Thanks. :)

That was the policy when I started last year, so I'm not sure if it's a district decision or state decision. Sorry. We don't tell people they're not required any longer, if anyone asks we tell them we strongly recommend one. Most people end up getting one anyways because they still need that last round of vaccines.

Farawyn · Mar 13, 2017

1. Do you keep a daily log and that is the only way you track what type of visits come through? Or do you do both and chart electronically? This school only has kept a daily paper log.

I keep an electronic log of every child I see. If I have a sub, we keep a paper list.

2. How many visits approximately do all of you see? And do teachers send the same students back to see you that day? There is about 300 students and I see anywhere from 30 to 45 a day.

750 kids, 20-40. Yes, I have many repeat offenders.

3. Are you responsible for going into the system and changing absences to unexcused absences because you have a doctor's note stating " was seen in my office today?

No, that is the job of Attendance

4. Do you send kids home who have a fever of 100 degrees or more home?

Yes. I also send home afebrile kids, depending on my assessment.

Lots of luck, and welcome to the BEST BOARD ON AN!

nursetlm, ADN · Mar 13, 2017

* I use a paper log daily. (This is only my second year and it's always been done this way.) We do use Campus (electronic system) to log immunes, incident reports, contact with parents.)

* Front office/ clerical handle entering attendance.

* I started using this letter (borrowed from another nurse) and this year has been smooth sailing for the most part. Last year I allowed myself to be taken advantage of, but never again.

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.

According to the School District Blood Borne Pathogens guidelines, 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, 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.

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

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

-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 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.

*For students who complain of headache or stomachache, and it is close to their lunch time (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 from 1130-1200 for lunch and from 1:25-2:30 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!

RNLisaC · Mar 13, 2017

Massachusetts is the state. We can delegate but right now we are having subs do it because I need to attend some type of training and then train the people I delegate to. There's nothing complex, really about the kids but they do get daily meds during the trip.