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.
I always call if I"m on the fence. I disagree that we should make the final call for a kid that is *somewhat* ill. If a kid feels crummy (or says and looks like they do) I will let the parent make the call. Not only is this safer from a CYA standpoint, but I also DO think parents know their kids (and their own) lives better. For myself, for instance, I know my own kids very rarely go to the nurse. If they came down and requested to go home I would let them, especially if it was convenient for me to get them. If it became a pattern we would have a talk, but I trust them and I would not want a nurse to decide they weren't 'sick enough' if they were suffering enough to go to the nurse for the first time in over a year.
I always call if I have a kid come down twice, even if they symptoms are mild (exception for my extreme FF). If I was a parent and found out my kid went to the RN twice and was turned away without me even being notified I would be P*SSED.
I absolutely call on repeat visits to notify there was a repeated complaint, but still won't send home if it isn't necessary. Again, by the time the kid gets home, the complaint has almost always disappeared because it wasn't about actual illness, but an avoidance. This does 2 things: reinforces that you don't get sent home for every little thing and also the parent gets to question why the student was complaining all day but now seems fine... If during that phone call the parent decides to come get the kid, then fine, not my call, but I still in general, don't think a student should just get to say "I don't feel well, can I go home" and just go home after a benign assessment.
I absolutely call on repeat visits to notify there was a repeated complaint, but still won't send home if it isn't necessary. Again, by the time the kid gets home, the complaint has almost always disappeared because it wasn't about actual illness, but an avoidance. This does 2 things: reinforces that you don't get sent home for every little thing and also the parent gets to question why the student was complaining all day but now seems fine... If during that phone call the parent decides to come get the kid, then fine, not my call, but I still in general, don't think a student should just get to say "I don't feel well, can I go home" and just go home after a benign assessment.
I think this is too presumptuous. So let's agree to disagree. ?
This is the one of the my top reasons I'm so tired of school nursing-the fakers!!! I work in a middle school and no one seems to want to be in school. I haven't learned the kids and family's well yet so anyone that complained of puking or like they were going to I'd call the parent and they'd all come and get them and I was getting tons of visits a day so a couple months later I'd get the same kids with the same things and I'd say well I doubt you're really sick AGAIN, I mean it's not normal to puke every couple weeks, maybe we need to get you to the Dr and they'd shrug their shoulders but when they realized I wasn't sending them home as easily and sent a note home they needed to follow up with the Dr the visits subsided a lot.
Also, the week before Christmas with all the fun stuff going on I hardly saw anyone! Amazing how that works!
I also have a few that can vomit easily at will. Vomiting isn't always illness-related. Once I said nope you've missed more school than you've been here, you "vomit" every single time you're here, you aren't going home unless you have a fever (or truly look sick and not sitting there smiling at me). I have several parents who have truant letters but if I send their kid home it's excused so they don't care and will happily come and get them every single time so I've been playing the Dr card a lot lately and it's helping. I do have a few with ulcer issues and several with untreated anxiety. However, most are either truant or behavioral issues. Occasionally it's due to being bullied or a social issue and then we can help once we know.
I look at their grades, attendance, and the number of nurse visits. If I have a straight-A student, missed like once all year, and almost never visits the nurse I'm giving them the benefit of the doubt when they aren't feeling well with no obvious symptoms. Those are easy. I just call home.
The ones that are failing, miss a ton, and are constantly in trouble are pretty easy too. No fever or puking in front of me they stay. I had one that in Dec on a Wed said you'll be so proud of me because this is the first week I've made it every day (but I'm not feeling well today and want to go home). Wow! I'm very upbeat and encouraging that they can hang in there and I'll be so proud of them too!
It's those middle ground ones that are the trickiest. If this it's more than three times in three months I will either see how they're acting (like alert, color good, smiling or joking with someone in the office they go back to class) but if they truly are acting ill I'll call the parent and say this is becoming a habit and I'm not sure what's going on I think they need to follow up with the Dr. If they don't and they come back again in a couple weeks (or days) and they don't have any major symptoms and it's only the "I don't feel well or I feel like I might puke" I say well have you been to the Dr and they usually say no (if yes and no issue then you can reinforce that) I say well your parent is aware and you can still not feel well and be OK to be at school. If it keeps happening go to the Dr. (These are older kids so a little easier to talk to). Also so many times it's not related to illness or medical issues. It's problems with friends! Or problems with kids being mean to them that aren't friends. Also lots of peer pressure, drugs, vaping, alcohol, etc. I always ask are you upset with anyone or is anyone being mean to you or is there something going on with another student before I just send them back to class. I've asked that and had kids start crying. It's a daily battle. So that's why a lot of kids don't like school as well!
Also kids aren't always coping well with this whole pandemic. I've had kids with a lot of emotional issues from losing a loved one(s) due to covid or had covid themselves who can't seem to get their energy back and do feel ill all the time.
For those that say I'd better get a call if my kid pukes ,I'm sure you would take care of the issue if you kept getting calls every single week your kid was puking. You aren't the parents/kids we are talking about. Many times we don't see the puking and yet they managed to eat lunch, play in gym, and have a great day before and after the so-called "episode of puking". When you hear 10 times a day (no exaggeration here) I feel like I'm going to puke it loses any shock value and you have to investigate and assess. Kids lie. That's all there is to it. Kids lie to get out school, get out of trouble, look cool in front of their friends, etc. Not all kids all the time but many of the ones we see. I had a girl holding her stomach acting like she was dying so I made her go lie down for a few minutes (happens a lot during gym) and I caught her sticking her fingers down her throat. Uggh! Also there are kids I see every single WEEK for something. It gets old. They've been to the Dr, maybe on meds, but now got hurt (no visible bruising) or something in their eye, or need a bandaid or want ice or just some crackers...they just need tons of reassurance and attention.
Also, the longer I've been doing this the less "good parents" there seem to be. You know the ones that either truly follow up with the Dr for a potential issue and/ or get onto their kid because they know it's behavioral. The ones that make sure their kids have their homework done, have clean clothes, make sure they are well fed. So many anymore just don't care if their kids are failing, truant, in trouble all the time. I mean if they cared they'd work with the school on these issues and put their foot down with their kids and they don't . I hear so many times from kids I was late because I couldn't get mom or dad out of bed to get me here. My parent doesn't care if I drop out when I get to high school. I don't need to work when I grow up because my parents don't and we have plenty.... We have many that get almost no attention at home, don't have proper shoes, have to threaten CPS to get them to the eye Dr or dentist...So sad and it's hard. Also CPS doesn't seem to help much unless a kid is in a truly life-threatening circumstance. There are a lot of kids that are obviously neglected and being damaged because of it and nothing is done. So as the school we try to make sure these kids have plenty of food and clothing, school supplies, extra encouragement because school is the only place they get attention. So no I don't want to send those kids home for feeling sick if they aren't truly sick. I try to impress upon them that in order to have a great future to get what they want out of life it starts with their education and that right now school is their "job".
One last tip, for a student that comes to see you several times a week for something and you know they are fine, it's helpful if you can have them "check in" with you every day like first thing or at lunch just to say hi, tell you about a test they took, just to say hi or something. When I've done this I see them for like a minute and they are usually happy (not pretending to be sick), get the attention they need and a lot less charting. I just ask how was breakfast or lunch, what they did on the weekend, comment on something they are wearing, ask about tests, encourage them to have a good day and be nice to someone etc. Like one or two questions a day-just a quick conversation, some encouragement and get to class. I don't usually say "how are you" because they will start thinking of all the ways they may not feel well. Sometimes I do have to take their temp to reassure them they are OK. Eventually, it seems the visits start decreasing from every day to every few then every week etc because when they feel like someone cares they get more confidence and seem to do better. Or maybe they're just tired of me asking about their homework. LOL!
Specializes in ER/School/Rural Nursing/Health Department.
I agree with RatherBHiking. I have a group of kids that I check in with and its amazing how less I see them for "sick" issues. These are kids who parent isn't involved for whatever reason and just need a "mom check". They are also the kids that if they do come in sick I do my assessment slowly while talking to them--and do all the things-temp, pulse ox, pulse, listen to their heart and lungs and stomach, etc. Honest to God I think some of my younger kids just don't get attention or hugs at home.
Also--utilize your school's guidance counselor. If I have a FF I will usually go down the hall and talk to the counselor. They may know a change in situation or another issue going on in the child's life. A lot of times this helps me know how to proceed with the child and be able to ask questions that allow the child to talk about what is stressing them or the anxiety over a home change or whatever.
This is our first day back and one of the elementary classes has a sub. I've seen the whole class for some variety of "illness" this afternoon. Knowing there was a sub I assessed everyone (totally fine!), gave them a peppermint for their "stomach ache" and sent them all back. Just walked by the room (knowing this was when they usually have a free time activity) and high fived everyone and put an eye on them to just double check it was substitute-itis. All good. LOL.
Who are you to say my kid is not resilient enough? Do you know in particular what families are going through? They are not adults. How do you know there is something coming up for that child? You're assuming too much. How do you know the kid is not really sick? Do you have testing? You just diagnose they are faking it?
I'm going to go out on a limb here and assume you're not a school nurse?
Ooh I feel your pain. This happens to me all the time. I see this is an old thread but wanted to tell you just to stand up to the teachers. You're on the same team and sometimes they act like youre against them when you're really trying to just do your job to the best of your ability. It's very hard when you think someone is faking and the teachers get all annoyed at you. Just being professional and kind is what I do. The kids sometimes drive me up a wall with the lies though. "I threw up in the bathroom" is like the number one go to excuse I have here.
We have many students who come in all the time claiming "they feel sick" and want to go home. I have learned to weed out those who are faking and those who are truly sick. I communicate a lot with the counselors and attendance which helps and we work together to keep the students in school. We also keep the parents informed and work out a plan to deter frequent absences. Absenteeism is a big problem right now in middle and high schools.
Anytime my child complains AND vomits, I better get a call! I'm coming to pick my child up. Do you work when you vomit? How are they suppose to focus on learning?
SAME! I get so upset when my daughter reports feeling sick and the school doesn't allow her to call me. School nurses are not the parent, we are not the attendance police.
I truly think it is important to put our assumptions aside, when a student walks in the health office door.
arlingtonnurse
134 Posts
I always call if I"m on the fence. I disagree that we should make the final call for a kid that is *somewhat* ill. If a kid feels crummy (or says and looks like they do) I will let the parent make the call. Not only is this safer from a CYA standpoint, but I also DO think parents know their kids (and their own) lives better. For myself, for instance, I know my own kids very rarely go to the nurse. If they came down and requested to go home I would let them, especially if it was convenient for me to get them. If it became a pattern we would have a talk, but I trust them and I would not want a nurse to decide they weren't 'sick enough' if they were suffering enough to go to the nurse for the first time in over a year.
I always call if I have a kid come down twice, even if they symptoms are mild (exception for my extreme FF). If I was a parent and found out my kid went to the RN twice and was turned away without me even being notified I would be P*SSED.