school nursing tips

Purple_Scrubs, BSN, RN · Sep 2, 2009

A few of my tips:

1) Vomit does not count unless I witness it (or the teacher does)

2) If you are well enough to ask me for a book or crayons that are on my bookshelf, you are well enough to go to class

3)It is better to call the parents to let them know about something relatively minor than to have them upset that you did not call (I call for anything on the head or face, anything involving the eyes, and I send notes for bruises that the parent might wonder what happened. Little scratches I generally don't worry about notifying them, but larger cuts I would let them know.

4) If a class has a substitute teacher, expect to see half of that class over the course of the day.

5) Even frequent flyers really get sick, so assess everyone thoroughly.

6)The amount of pain is inversely related to the amount of whining about the pain. I.e., worry more about the kid complaining of a stomachache who is eerily silent than the one moaning around (in general).

7) Assume the limb is broken until proven otherwise

8) Watch every head injury closely, even seemingly minor ones, and always call home to give them a heads up about it.

9) A child's self esteem is more important than a few missed nits (I read this on another school nurse site and had to steal it, so so true!)

10) If you think it might be pink eye, it is. If you think it looks a little like scabies, it is.

That is all I can think of for now!

The emergencies I have dealt with have been relatively minor, thank God. A few asthma attacks with no inhaler on campus (and unable to reach mom, that was fun). A few broken bones. A few pregnant moms with issues (one fell, one got dizzy from the heat). Thankfully nothing more serious so far, but we have to be ready for anything.

I have an elementary school, and I like the little ones, but some of the little pre K kids can't always verbalize what is going on. Requires a little detective work, but they are also the best huggers so it is worth it!

Good luck!

Keepstanding, ASN, RN · Sep 2, 2009

really awesome tips purple scrubs ! thanks ! :yeah:

praiser :heartbeat

luvschoolnursing, LPN · Sep 2, 2009

Great tips, Purple. As soon as I think of some I will post them. For now, all I can think of is always question "severe diarrhea" It often means "I have to poop and don't want to use the public restroom"

frann · Sep 3, 2009

another guestion

what do you'll do with the kid that is obviously sick-fever or what ever and can't reach parent?

or no parent can come? does that happen where there isn't anyone to pick up sick kid?

luvschoolnursing, LPN · Sep 3, 2009

In my school district this doesn't happen often, but it does happen. I have had kids lay in the health office most of the day sleeping because they were really sick and no one to come. I remember one specifically when I worked elementary. Kids temp was >102 and NO ONE on the emergency contact card answered their phone. Finally got in touch with dad right before school was out. He did take home, so I didn't have to sent the poor kid on the bus.

In the event of an injury or more serious illness, EMS would have to be called if no one could be reached and you felt the child needed medical care, not just TLC at home.

Purple_Scrubs, BSN, RN · Sep 3, 2009

Sadly, this happens frequently at my school. We have a low income, transient population and cell numbers come and go as fast as underwear, so I rarely have a good working number. I try every number I have, and if the kid is really sick my campus monitor will drive to their home and knock on the door to try and get someone to come to school (I try to save this tactic only for really sick ones).

If we have no luck, they spend the day in my office napping on the cot. I have someone bring their lunch tray in and we eat together. I have a small office and only 2 cots, so this is a big hassle but we make do. If all else fails and I have to send them home on the bus, I send a note home stating that I attempted to contact them and I give them a new emergency card to fill out.

Of course, if the fever starts getting up there or the kid is otherwise not doing well, I would have no alternative but to call 911. So far I have not had to do this, but I once had an asthmatic with no inhaler at school and no way to get in touch with mom. That one was touch and go for a while, but thankfully she did ok.

Don't forget to ask the teacher if they have a more recent number. Often the parent will update the number with the teacher but neither the teacher nor parent think to update with the office.

bergren · Sep 4, 2009

NASN ran a quick poll last month:

Has a parent ever told you that they could not pick up a sick child for fear of losing their job?

Yes (372) 95%

No (18) 5%

http://www.nasn.org/Default.aspx?tabid=613

This week's poll is about school nurses getting a flu vaccine:

http://www.nasn.org/Default.aspx

kidsnurse1969 · Sep 4, 2009

This type of situation will be all too common if/when H1N1 becomes prevalent. How can we isolate sick kids on 2 cots in one little room?

bergren · Sep 4, 2009

"Recognizing that space is often in short supply, early planning on the location for a sick room is essential"

The CDC has recommended that there be a completly separate room, not a room that will be used during the day, like the cafeteria, where the kids and staff with flu symptoms are kept at least 6 feet apart. They assume that the person monitoring that that room is not the same as the one monitoring the nurse's office. The person monitoring that room should not be going back and forth into the well population.

http://www.cdc.gov/h1n1flu/schools/technicalreport.htm

SchoolNurseBSN · Sep 4, 2009

another guestion
what do you'll do with the kid that is obviously sick-fever or what ever and can't reach parent?
or no parent can come? does that happen where there isn't anyone to pick up sick kid?

I had one on Wednesday - was with me form 9:00-3:00 on my one little cot right next to my desk. Parent had no transportation and the poor kid vomited intermittently throughout the day. Just kept her comfortable and hydrated...