Staff Members who refuse treatment ???

Trauma Columnist · Dec 18, 2009

That's my point.....don't even engage such a teacher.

I'm frequently asked for medical advice, scripts, care, etc from co-workers. Uh no, no way, no how.

My stock answer: "we don't have a pt/provider relationship and its in your best interest to discuss this with your provider."

End of discussion....

Purple_Scrubs, BSN, RN · Dec 18, 2009

It is a tough call. That is why we get the big bucks!!! :

Thank you so much for this...it made my day! :yeah: :yeah: :yeah:

At my school employee health is part of my job, although the kids of course are priority. I have found myself on many occasions counseling staff with very high blood pressures, and in all cases I managed to convince them to at least call their MD. A couple of times I convinced them to have someone drive them to the ED. Once I start telling them that their pressure is at a level that can cause a stroke at ANY MINUTE, it usually gets their attention.

I have never had one with ^BP and chest pain, though. I think in that case I would go with Martha's answer and tell them I have to protect my license and call 911, then let them duke it out with EMS, unless they agree to have someone take them to the ED immediately. Or I might go in the office and get the AED and tell them I just want to be ready for when they go down. Maybe that would get their attention? :eek:

bergren · Dec 18, 2009

I like the AED approach - very creative!!

tsansom · Dec 21, 2009

I am only a second year school nurse so bear with me. I would write an incident report to protect myself if she continued to refuse to seek care. We can't make anyone go to the doctor/ER against their will. All we can do is advise. Now, if she began having futher symptoms such as shortness of breath, increased pain, decreasing level of consciousness, and vital signs going down the tubes, then, we are obligated to take emergency action.

bergren · Dec 21, 2009

What would you put in the incident report? If it is not an emergency, you cannnot violate her confidentiality - the incident reports are reviewed by many staff. If it is an emergency, you need to call 911.

Did you mean write an anecdotal note?

I found this free full text NIH article about women's heart symptoms.

http://usgovinfo.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=usgovinfo&cdn=newsissues&tm=38&gps=505_350_1131_633&f=10&tt=2&bt=1&bts=1&zu=http%3A//circ.ahajournals.org/cgi/reprint/01.CIR.0000097116.29625.7Cv1

SchoolNurseBSN · Dec 29, 2009

A few years ago, I had a janitor who clutched her chest and slipped to the floor. She complained of pain radiating to the jaw and left arm, and was sweating profusely. I had someone call 911 before I even placed my blood pressure cuff on her because these were giant red flags. As I was assessing her status she stated that "I do not want the ambulance called." I just told her that as the campus nurse I found it necessary to call. The EKG was fine, she was not transported but was driven to her MD by her husband a little later. It turned out to be anxiety. She was not upset but thanked me for later for being proactive! As adamant as the was during the episode about not having 911 called, I thought she would have been upset with me when it turned out not to be an MI!!

CrazyTrainRN · Dec 29, 2009

It is a tough call. That is why we get the big bucks!!! :

1) I have never been in this situation before, so I was interested in all the responses just in case I am ever in this situation. Thanks for the posts!

2) I am an RN BSN and I am paid $15.00 an hour (about $10.00 an hour after taxes). Not what I would call "the big bucks" for what I am faced with daily. I took the job because I was a stay at home mom for 11 years and getting back into nursing after being out that long was a challenge. I also wanted a schedule that would fit with my daughters school schedule. I am starting to look for a school nurse job that pays more. If anyone knows of any openings 40 miles west of st louis, let me know.

safarirn · Dec 29, 2009

CrazyTrainRN.... your story sounds EXACTLY the same as mine, down to the rate of pay!!

bergren · Jan 4, 2010

If anyone was in doubt, the "big bucks" comment was a joke. I had the thrill of hearing Linda Aiken, PhD, RN FAAN (U Penn) present this year. Her research shows that school nurses are the lowest paid subspecialty, but the most satisfied!!

CrazyTrainRN · Jan 5, 2010

If anyone was in doubt, the "big bucks" comment was a joke.

OH OK! I didn't realize it was a joke. Actually, some of the school districts in my area pay their nurses pretty good. One district I looked at pays higher salaries if the nurse has her BSN or MSN. (I am not sure if this is common.) That particular district only hires RNs, where the district I work for hires LPNs and RNs and the pay is the same for everyone. I talked to my boss about this and she said we are a "poor school district." The other district's starting nurse salary (step 1) is almost twice as much as I am paid now. (My district started me out at step 10 for experience). It is just discouraging sometimes.

OH! A student just walked in -- gotta run!

linda1959 · Jan 13, 2010

I recently had a teacher come into my office clutching the door frame complaining of chest pain. I told her I was calling 911 and she refused. She actually got angry and kept saying "just give me a minute". No SOB, no cyanosis, and denied dizziness but I didn't believe her because she kept shaking her head as if to "shake it off".

She would not let go of my hand, but I managed to reach the phone and called my prinicpal. He arrived immediately, and told her he was calling 911. She begged him not to, at the same time crying that the pain was so bad (at this point I am getting annoyed with her!). He left the room and called anyway. While we waited she repeatedly said "no ambulance". Yet she continued to cry "it hurts so bad", and was almost breaking my fingers holding on so tight. I did not worry about getting a BP because it would have meant moving away from her and since she refused to lay on my couch and insisted on staying in the chair, I was more afraid she was going to go out on me and hit the floor. Getting vitals would not have changed calling 911, so I just worked no calming her down and staying in front of her chair in case she went down.

EMT's arrived, she still refused, but finally a friend convinced her to go the hospital. Paramedics arrived as they put her in the ambulance, and as they were doing an EKG the pain subsided. Initial EKG neg. so she signed herself out of the rig. THANK GOODNESS my principal refused to let her come back to school without md clearance.

I documented and documented and documented . . . . . glad she was ok but very frustrated by the stubborness . . . .she wasted so much of everyone's time arguing about going to the hospital . . . .that's why I care for kids . . . . adults are more frustrating!