Second guessing myself

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Hello all! I'm looking for some guidance I suppose. 

I had a high schooler hurt themselves at the end of last week. They jumped over a small stream while walking outside in class and apparently landed wrong. Got them up and to my office where I removed their boot and noticed some swelling. No bruising. Able to move toes without any issues. Pedal pulses present and strong. Kiddo not in any distress. Elevated the foot and put an ice pack on it. Had mom pick them up and encouraged her to have them seen by a physician for proper imaging. Today dad called and asked for our insurance as he stated he wants the school to pay for the treatment of the ankle. I am unsure how that is going to play out but now I'm second guessing my decision to remove the boot. My admin assistant is a retired athletic trainer and is certain I didn't do anything that could have exacerbated the injury but, looking back, I'm questioning if I should have removed the boot. I'm hoping to learn from the situation so any opinions are appreciated.

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Specializes in School Nurse.

I would have done the exact same thing. You were assessing the injury and I am assuming the student probably assisted somewhat in removing the boot so I am sure you had their consent. 

Think of what could have happened if you didn't remove the boot and assess. You may not have made the decision to call parent for pick up and the student may have walked on the injured foot all day. 

Dad is just likely fishing for some financial assistance that he assumes the school would cover. 

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Specializes in School nursing.
14 hours ago, KittyKatRN said:

I would have done the exact same thing. You were assessing the injury and I am assuming the student probably assisted somewhat in removing the boot so I am sure you had their consent. 

Think of what could have happened if you didn't remove the boot and assess. You may not have made the decision to call parent for pick up and the student may have walked on the injured foot all day. 

Dad is just likely fishing for some financial assistance that he assumes the school would cover. 

This. I also would have done the same thing. Also how can you assess the ankle without removing the boot? You assessed, immediately called the parent, recommended immediately follow-up for imaging. This sounds like pretty awesome care to me.

Dad just does not want to pay the medical bills I'm guessing. But I actually don't see this having any standing, especially because I am very much guessing the student may have been told to not do such a thing/stay away from the stream and did it anyway. 

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Unless there was something horribly wrong (like the foot was facing the wrong way) I don't see why you wouldn't remove the boot to assess.  I agree with those above, parents are just seeing if they can get someone else to pay.  You did everything by the book.

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Specializes in ICU/community health/school nursing.
16 hours ago, KeeperOfTheIceRN said:

Today dad called and asked for our insurance as he stated he wants the school to pay for the treatment of the ankle..

Bless his heart. That's not how it happens (at least in my district). That's why we offer the parent-purchased indemnity insurance. 

Any reasonable nurse would have removed that boot. You assessed pedal pulses (something I do not do regularly but may add to my list of interventions. Was it OldDude who used to talk about xray vision and how we generally don't have it?

Don't second guess. The kid made a choice. Dad is blustery. Make sure your documentation looks solid and go on. Also - if you have the chance to reassess the kid and the kid walks in with no gait impairment....yeah I'd do that, too.

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Your assessment was fine.  You are going to run into parents like this - doesn't matter how an injury occurred/whose fault it was, the parent will request the school pay for whatever the medical cost is.  Just make sure your documentation is good and if your school has an injury policy to provide the information to parent and then move on. 

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Thank you all for your comments!! I feel a little better knowing you all would have done the same thing. I did ask the student if they wanted me to leave the boot on and they said no. However, that part did not make it into my charting ? everything else that I did DID make it in though. I will be adjusting my documentation to make sure I have all of my bases covered for the future. 

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Specializes in Med-surg, school nursing..

You did the right thing. We offer an insurance to parents, but it doesn't pay 100% of the cost of injury. Parents' insurance pays and what it doesn't cover, the school insurance picks up. 

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Specializes in Pediatrics Retired.

Forget about it...you did the right thing.

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Specializes in Trauma, Teaching.

ER nurse and Scout (both boys and girls) leader (outdoor trainer) here:

you only leave the boot on but with loose laces if you have to hike out from the wilderness, because you can't get it back on if it swells and they have to walk on it.

On the other hand, leaving the boot on while it swells makes removing it very painful later, not to mention you can't assess it properly through a boot.  You did everything right.

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