Vitals question

LikeTheDeadSea, MSN, RN · Jan 19, 2018

I can do all this, but I'm not sure when to do this, or when I'm over reacting on something.
I only do vitals if there's an emergency or something is going on. But if the child has chest pains or anything like that I do hear their chest. I don't use my pulse oximeter much, because it seems to act up sometimes and I can get a better reading doing respiration counts myself.

In my state, MAs can be delegated to take vital information, but cannot interpret the numbers. They are given guidelines for when to get a staff member for immediate assessment/interpretation. From some responses, it looks like your job is "Take vitals, call parent and let them interpret what you find," but a staff member is not nearby for follow-up.

If I was a district RN in this scenario, I'd be very nervous related to my license with how much is being delegated, especially with the increase of chronic conditions in the school setting. The Pulse Ox / Respiration Rate statement is a good example of assessment tools to help narrow an issue - but although they compliment each other, they are not interchangeable and doing both is necessary to narrow down certain issues. If I got an abnormal number for either, I'd definitely want to know the other. Based on this, I'd request a WRITTEN policy/guideline for what vitals should be done for what symptoms. In a hospital you would be told which ones and at what frequency, so I feel like it is reasonable to request this as protection for both you and the nurse.

Best of luck in your job hunt! Hoping you get somewhere with more supports!

EDIT addition: Saw you clarify the pulse ox/ respiration error above (Thank you!) - I'm not removing it from my post because I think it is a good example that I'm sure is a decently common error among people. I remember really needing to focus when learning about the differences and if I was charge over people, how do I know they're not looking at it that way?

Amethya · Jan 19, 2018

Why not a temp on a stomach ache? Thats one of the few things I always get a temp on. Sorethroat, stoamch ache. Temp temp.

Because most of the time it's mostly related to the student didn't eat or it's a restroom thing. But you're right, I may have to do temp for everything.

Amethya · Jan 19, 2018

I do have the Operations manager who was a MA like me, so she's my second opinion if something happens.

As I said, that was a mistake, I meant heart rate, not respiration. But I will ask them on what we should watch with vitals.

Edit: I saw your edit. It's okay! I know I make mistakes like any person would. But I seriously would need to get a new pulse ox... Do you guys know when exactly you have to change batteries?

JenTheSchoolRN, BSN, RN · Jan 19, 2018

I do have the Operations manager who was a MA like me, so she's my second opinion if something happens.
As I said, that was a mistake, I meant heart rate, not respiration. But I will ask them on what we should watch with vitals.
Edit: I saw your edit. It's okay! I know I make mistakes like any person would. But I seriously would need to get a new pulse ox... Do you guys know when exactly you have to change batteries?

Another MA as a second option doesn't sound like a great option - your district RN would be better. But as you have mentioned before, it appears the school system you are in does not provide you with ample support.

In Texas, can a MA interpret vitals? I understand taking them, but in my state a MA cannot listen to breath sounds and assess an asthma flare-up, for example. It took me 2+ years as a RN to feel more confident doing this, to be honest, and I had some great training behind me.

If you can't interpret the data, giving it to the parent may not be useful as they often can't interpret the data either and may assume it is alarming when it may not be. When I give parents vitals data, usually it is combined with my assessment as that is what the parent wants and expects.

LikeTheDeadSea, MSN, RN · Jan 19, 2018

My pulse ox has a little battery picture in the middle like a cell phone that says when it is low, the previous nurse in my building was a little bit of a supply hoarder, so I have lots of batteries, when it goes on and I feel like it starts reading sloooooowwwww, I change them out.

Amethya · Jan 19, 2018

No it doesn't. My school health manager gives enough support, but sometimes she doesn't even know so we have to go higher in ranks. But my OM is the next thing I got for a second opinion in minor things since she did this longer than me (5 years I was told)

If it's an emergency I gather the vitals and give EMS the data, then perform basic first aid if needed.

But what I do usually if I have a child with issues, I don't give the parents the data by phone, I just let them know that sometime is up and if they can come get them and it might be better to take them to a urgent care or physician.

I can interpret vitals, but I can't diagnose. So I can tell the parent that the child's BP is elevated in my machine (Depends on age, but let's pretend it is) and they aren't feeling well. I would like if they can take them to the doctor and see what's going on because I'm not a nurse, so I see or get on my tools here, can be complete different at the doctor's. Then I print out the office visit I got and it comes with the vitals, and I give it to the parents to let the MD know what I got.

But I can't tell them I think the child has a heart condition because of it, because I'm not a doctor or a nurse and I don't have the education for diagnosing. This is why I always let parents know I'm not a nurse, so they know that what I say can be challenged by a doctor, and I rather them do that because I want to make sure the student is healthy and fine.

Amethya · Jan 19, 2018

My pulse ox has a little battery picture in the middle like a cell phone that says when it is low, the previous nurse in my building was a little bit of a supply hoarder, so I have lots of batteries, when it goes on and I feel like it starts reading sloooooowwwww, I change them out.

It reads well on me sometimes though. I'm not saying this out of racism, I'm far from racist, but when I did the pulse ox on the girl I talked about that was lying to me, it was hard to read on her. I'm not sure if it's because of her darker skin or it was the machine wonking out on me, but when I do it on me or someone with lighter skin, it reads easily. Can skin color effect it? I read on this and some say yes and some say no.

tining, BSN, RN · Jan 19, 2018

Skin temperature can affect the pulse ox. Warm fingers and then place in pulse ox.

So back to your MA colleague - 2 MA's do not equal an RN :nurse: . What credentials does your "school health manager" have?

OhioBPH · Jan 19, 2018

Nail polish and artificial nails are the biggest problem in accuracy of a pulse ox

Forest2 · Jan 19, 2018

Vitals signs typically means TPR and B/P. If you are an aide or tech, then you must have passed the skills test before doing any.

OyWithThePoodles, RN · Jan 19, 2018

A lot of littles with strep throat will only present with a stomachache (and temp of course). You do you, boo, but I might suggest getting a temps on those stomachaches, if nothing else, at least if one comes back truly sick the parent can't throw it in your face "Well, she told you she had a stomachache and you didn't even check her temp, then she got home and was 101!" You know those types. If you check the temp you could say with certainty that they were fever free in your care.

Amethya · Jan 19, 2018

Skin temperature can affect the pulse ox. Warm fingers and then place in pulse ox.
So back to your MA colleague - 2 MA's do not equal an RN . What credentials does your "school health manager" have?

I'm not sure. All I know she's in charge of us.

And I know what you are going to say, I been told this a lot of times in this forum. So please let's not start this again.

I am currently looking for a new job and hopefully, I find something better as soon as school is done.