Second guess itis

[geminiwanderlust]

Working as the only medical person in a school setting is giving me a case of second guessing myself itis.  Every time an emergency happens I question if I did everything right.  Today I had a kiddo bust their mouth open—blood everywhere.  He ended up needing five stitches.  I'm kicking myself because I didn't tell mom to take him in.  But honestly with mouth injuries I know stitches are rare.  It's just hard because I keep beating myself up over all of these little things.  I've been doing this five years now and I felt pretty good during Covid but a few parental issues recently have gotten me down.  Now I'm questioning my nursing judgment.  I don't have a ton of floor nursing experience but did work in a pediatric office.  Wondering if I need more floor experience.  I don't know.  I'm probably just over thinking.  

[Whatthefrick, LPN]

Wow, are you me? We have the same background (peds office then school nursing)! 

I know it can be easy to beat yourself up but try to remember that school nursing is its own specialty. You are smart and capable! We can't possibly predict the ending of any injury or illness and even if we suggest the child be taken for further evaluation, the parent/guardian may not take them.

I, too, have been at the receiving end of parent fury and it's hard not to take it personal. You take care of students and staff all day every day. As far as being unsure if you need more floor experience, you could always try to pick up some PRN shifts to get your foot in the door and see how you like it. 

Don't ever forget your worth. 

[k1p1ssk, BSN, RN]

I went from subbing in schools to a peds office to a peds inpatient unit to outpatient peds specialty and then to school nursing. The office and specialty (plus the subbing experience) were, by far, the most valuable to my practice in the school. On the floor, you are seeing kids AFTER they are stabilized. You would never be assessing an open wound and whether or not it needed stitches, unless it happened on the unit (unlikely). Yes, I gained important respiratory/cardio/neuro/abdominal evaluation skills, but in my 5 years as a school nurse, I have come to rely more upon my sense of trusting my gut, and if I'm ever unsure, I refer. If you are considering any kind of change or feel you need some supplementary experience, I'd go for urgent care or the ED. You could also see about continuing ED programming around assessment - decide what systems/situations you're most uncomfy around and just do a Google search for ANCC CE! I know that Boston University's School Health Unit has some good ones online that are self-paced with webinars. 

I will also say, that I am finding more and more, that wounds that I would not necessarily say need stitches, will get stitches, simply because the person showed up for an eval and the doc/pa/NP doesn't want to get a poor review for "doing nothing" when the person doesn't take care of it and it ends up re-opening or getting infected. So, if the bleeding won't stop, the gash is large/deep, or if the edges aren't touching on their own (even if they probably could with a good dressing), I refer. 

All of this is to say, don't beat yourself up! You DO have good instincts. You've been at this for much longer than most nurses would last in this role and you know what you are doing. If you're ever unsure, refer, and don't forget, you'll never regret calling 911/EMS!

[heatherrmp, ASN, BSN, RN]

Whatthefrick said:

Wow, are you me? We have the same background (peds office then school nursing)! 

Hi, your long lost triplet here! Same background. I did a lot of peds phone triage, and figured I would be used to angry parents yelling at me all the time, but alas, not something that we ever get used to! All we can do is try out best. I will say we are our own worst critic, but that's because we start to care for these kids as if they were our own.

I had a HS'er come down after sustaining a laceration during gym. I bandaged him up, called mom, but was then second guessing whether or not he needed stitches. He was out half the next morning and my paranoia set in even more, thinking I should have recommended an eval (even though the laceration wasn't that deep/stopped bleeding easily, etc). He came to see me later that day and said he "slept in" cause...high schoolers. But it was already healing up nicely! 

Keep trusting your gut. You got this!

[beachynurse, ASN, BSN]

If I'm not sure about a wound needing sutures, I call the parent and have them pick up the student and let them make the call. This saves me from getting screamed at by parents that we didn't do anything, and puts the burden on the parent. The parents at my school are very verbal, and complain about the smallest most ridiculous issue. It's a fairly wealthy and entitled demographic area.