Students Faking Illnesses

[MsNurse1997]

Hi! I’m a new school nurse. I’m currently in a long term substitute position for a K-5 school. I've been at this school for 3 weeks now so I've gotten the feel for everything and have my routine down. I have noticed a large problem with students coming to my clinic faking illnesses, especially vomiting. I have at least 5 students a day come and say they threw up in the bathroom. I try my best to follow the “if you didn’t see it happen it probably didn't” rule. 90% of the time this works out for me. Give them some tums and crackers and they are fine and don’t return.

This past Friday I was slammed busy, like every Friday. A teacher sent a student in at lunch saying he vomited in the bathroom. Well this students sister I actually sent home at the very beginning of the school day for strep throat symptoms and fever. He heard wind of his sister being sent home and I’m 99% sure he was faking just trying to go home. The kid was acting completely fine, talking other kids ears off in the clinic and playing around with another student. So I gave him some tums and sent him back to class. No fever or anything. Not even 10 minutes later he comes back and says he doesn’t feel any better and wants to go home. So I decide to call mom, not to send him home but just to talk to her about the situation. No answer but left a voicemail so I sent the student back to class again waiting for a call back. I got a call back about 20 minutes later and I told her the whole situation and she agreed that he is just trying to go home early as he overheard her talking to his sister that morning saying that if she felt worse during the day to go to the nurse. I was about to pick up the phone and call the students teacher and tell her what was said when she walks into the clinic with the student and demands that I send him home. I told her what the mother said and asked if anyone actually witnessed the student vomiting and she said no. I then explained that if it wasn’t witnessed, no fever and he’s acting completely fine there is no reason to send him home. She then goes over my head and asks the principal about it and she said to send him home so I eventually ended up doing so. Mind you it was one hour until school was over. I was so furious. This is why I have so many students coming to the clinic. They see one get away with it and the teacher enables it so they all do it. I want to confront the teacher about it but I’m unsure what to say. 

[Flare, ASN, BSN]

Around these parts, we call that "bigfoot vomit".  We're not saying that the episode of vomiting didn't exist, just that no one saw it to confirm.  Generally, I have them take in 3 little cups of water (about 9 oz) and rest in my office for about 20-30 minutes.  If they can hold down the water then they're deemed OK to go back, although I may give them a mint to settle their stomach before they go if they seem a bit hesitant.  The teacher should not be going above your head.  I would definitely have a discussion with them.  I would discuss your procedure of making a decision with them and the interventions you use.  I am certain they will be quick to say  "I thought if they threw up, they HAVE to go home."  My usual reply to that is "In many cases, yes.  However, the student still needs to be assessed to determine the degree and presence of illness.  There are a lot of students who come in reporting that they are sick and have vomitted, but in reality are fine."

[nursekoll, BSN, RN]

With time and experience, you'll learn which students and teachers need to be assessed more closely for BS and called on it! In the meantime, don't take it personal, they're learning to trust you as you're learning to trust them too. Stand by your decisions, explain them when asked and let the drama go.

[Jedrnurse, BSN, RN]

Re: your post title:

These days, with the ease of manipulating COVID protocols I have some teachers faking illness...

[RuralMOSchoolRN, ADN, RN]

I think you did exactly the right thing and I'm sorry the staff didn't back up your decision.  I work at 3 different schools and they run the gamet from wanting them to go home for any little thing to wanting them to stay if they aren't dying.   Usually office staff knows the "chronic nurse's office" kids and will back you up. 

I would probably sit down with the principal first and get her take on why she wanted the kiddo sent home.  And take the time to explain the situation again and emphasize the importance of kids being in school.  Sometimes if its almost the end of the day and I have a bounce back type kid if I have room I'll just let them finish the day in my office.  Usually I will call the teacher to send work and have the kid work on it.  Sometimes when they realize being in here doesn't get them out of their work they will just go back to class.

Its definitely been harder than usual with Covid.  A lot of the kids are getting wise to what will earn them a trip home or a quarantine.  And some teachers treat anyone that sneezes like they have the plague. I've seen a definite uptick in "minor issues" being sent to my office.

[AdobeRN]

I like "Bigfoot vomit" LOL.....

I usually just call the parent and tell them exactly what the kid tells me and I tell parent my assessment findings - put it in their lap about whether they want to pick up the kid or not, I will say something like "on my end X is allowed to be at school so its up to you, I will call if it continues....".  50/50 about whether parent picks up kid or I send back to class.  If sent back to class I will call or email teacher the situation.  

What does your school policy say about vomiting?  We have a vague policy - basically states students can be sent home with one episode of vomiting or may stay in school if cleared by nurse - so either way I as the nurse, is covered by whatever the decision that I and/or parent makes. 

[Jedrnurse, BSN, RN]

On 12/8/2021 at 10:27 AM, AdobeRN said:

What does your school policy say about vomiting?  We have a vague policy - basically states students can be sent home with one episode of vomiting or may stay in school if cleared by nurse - so either way I as the nurse, is covered by whatever the decision that I and/or parent makes. 

I like the flexibility. As you know, sometimes it's a "one and done" with no signs of infectious process- no need to go home.

[AdobeRN]

1 hour ago, Jedrnurse said:

I like the flexibility. As you know, sometimes it's a "one and done" with no signs of infectious process- no need to go home.

Yep and sometimes it is just a kid coughing up mucous, over did it at PE/recess after lunch or what one kiddo told me once was that he had a "wet burp" - basically acid reflux or a spit up. Not a true illness vomit. 

 

[amoLucia]

Ooooo, I like that 'wet burp'. I've heard of 'wet farts'.

[RuralMOSchoolRN, ADN, RN]

On 12/8/2021 at 4:04 PM, AdobeRN said:

Yep and sometimes it is just a kid coughing up mucous, over did it at PE/recess after lunch or what one kiddo told me once was that he had a "wet burp" - basically acid reflux or a spit up. Not a true illness vomit. 

That is often what I see in my office.  I had one kid earlier in the year throwing up outside my office (in the garbage thankfully!) turns out her was running in PE (August) and then drank THREE water bottles in a row when he came in.  Ice pack to his neck to cool him down and cursory exam of the vomit (all water) and he was good to go to class.  And this time of year some kids don't handle all the snot very well or it hits an empty stomach.  Just a cold with a kid with a sketchy gag reflex.

[Jedrnurse, BSN, RN]

On 12/8/2021 at 4:04 PM, AdobeRN said:

Yep and sometimes it is just a kid coughing up mucous, over did it at PE/recess after lunch or what one kiddo told me once was that he had a "wet burp" - basically acid reflux or a spit up. Not a true illness vomit. 

Ah, the infamous "I threw up in my mouth" syndrome...

[MsNurse1997]

That’s for all the advice! The teacher actually came and apologized to me yesterday for it. She said the secretary actually confronted her about it cause she saw how the kid was acting in my office and it made her mad as well. Our school policy for vomiting is very vague unfortunately. All it says is episodes of vomiting with contagious symptoms need to be sent home otherwise it’s up to the nurses discretion. Same thing with Covid symptoms now unfortunately. And I live in an area that is notorious for seasonal allergies so it’s so hard to tell. Half of the school would be home if we were following the old Covid protocol.