40 Students per day... YIKES!!

Specialties School

Published

Specializes in School Nursing; Nursing Education.

I am in my 1st year of school nursing and truly do love it so far. I read 100's of posts on here to get as many tips from you all that I could (THANK YOU!!) so I don't get in here and start feeling like I can't handle it. So, here's the deal --> I am seeing 35-40 students every single day. It's nuts. Most kids have to come to the health clinic with a buddy so then there's an additional 2 kids with each child that needs my assistance. There are times it's a madhouse in here. I have sent letters to the whole staff telling them things like a lost tooth or paper cut do not need to be sent to the nurse. I made each and every teacher (specials included) their own first aid box with supplies (bandaids, tooth boxes, etc.), but they still send kids that need nothing more than a band aid or a tooth box.

I can (maybe lol) handle the high clinic traffic, but I am expected to have 99% immunization compliance by November 1st and there are days I don't have time to even enter 1. I think the only way I will get them all in is to bring them home and do them there. I'm also nervous about when flu season comes and when it's time to start screenings. With this many students coming to see me every day I'm nervous I am not going to be able to get the "other stuff" done that I am required to do.

Have any of you fought this battle (asking knowing the answer is yes)? How do you deal with it? How do you get everything done while still seeing kids?

1 Votes

It might help to refuse to give those supplies out if they're already in the first aid boxes. Tell the children to ask their teacher for a bandaid/tooth box from their first aid kit. It should only take a couple days of that for teachers to realize you aren't giving them out. Heck, I'd even lie and say I put ALL of the tooth boxes in first aid kits so I don't have any left.

11 Votes
23 minutes ago, BiscuitRN said:

It might help to refuse to give those supplies out if they're already in the first aid boxes. Tell the children to ask their teacher for a bandaid/tooth box from their first aid kit. It should only take a couple days of that for teachers to realize you aren't giving them out. Heck, I'd even lie and say I put ALL of the tooth boxes in first aid kits so I don't have any left.

I like this approach, especially the last sentence :)

3 Votes

1) For grade school age kids, I would only allow a buddy if they are having a more severe issue. Tell the teachers this and if buddies keep arriving, immediately send them back. Use phrases like "maximize in-class learning," and "missing valuable class time"

2) No resting (absence of illness) in the nurse's office.

3) Review, in person, with the teachers what is in their first aid kits, have them all keep them in one same place (by the door, next to the clock, whatever). I don't think they read the emails because it wasn't until I did an in-person training and covered this, did my bandaid visits stop (almost completely!)

4) Like the pp said, anything you can outsource from your office, do it. I used to get multiple visits for school uniform issues. I literally removed all clothing from my room. Now they have to go to the school store. If there is a blood/body fluid issue I will give them a pass to borrow something from the school store. I am not a Forever 21 salesclerk, I don't have time to go shopping with these kids. lol. Same thing with kleenex boxes as and clorox wipes - this is all school stock stuff and I only keep what I need in my office. For re-stocking students/teachers have to go to the front desk.

5) Send unnecessary visits right back to class. Be straight-forward with the student that this is an unnecessary visit, and if it happens more than 2x in a week, start looping other people in - the adviser, principal, counselor, whomever would be the best point person.

These things helped me reduce my office visits and control my workload.

13 Votes

6) (I just remembered this) - I always try a non-pharmacological intervention first, whenever possible. So if they come with c/o headache, I advise them to drink water, move their seat from under the light, eat lunch, etc. This is super boring for them and makes visiting me less enticing.

7 Votes
Specializes in School Nurse, past Med Surge.

What age group do you have? How many in the school?

Why do kids need buddies? I send buddies back immediately. If a kid needs help finding their way back to class there's almost always someone around in the office to get them headed in the right direction.

The teachers may be "testing" you since you're new. Stand your ground. You may want to enlist the help of your principal to help remind the teachers what is & is not necessary to send to the clinic. They (teachers) may not realize how many kids you're seeing every day when they're only sending two or three themselves.

I would advise against taking student records home. Can you stay late but be off the clock?

2 Votes

Data and the phrase "missed instructional time" are your friend in this situation. If I see 40 kids daily, with each visit taking an average of 5 minutes (200 hundred minutes), plus 2 minutes of travel to and from the nurse's office(add on 80 minutes), plus each kid is bringing a buddy (so multiply by 2) and we are at 9 hours and 33 minutes of missed instructional time daily...

Institute a school wide nurse pass, include only acceptable reasons from visits as the options; review with each teacher the content of their first aid kit; call kids out on their ridiculous visits (even the little guys understand!); keep admin involved; involve parents as needed; oh and CLOSE YOUR OFFICE to get immunizations done! For real, the place will NOT burn to the ground because the teacher has to apply a bandaid

5 Votes
Specializes in ICU/community health/school nursing.
1 hour ago, BeckyESRN said:

Data and the phrase "missed instructional time" are your friend in this situation. If I see 40 kids daily, with each visit taking an average of 5 minutes (200 hundred minutes), plus 2 minutes of travel to and from the nurse's office(add on 80 minutes), plus each kid is bringing a buddy (so multiply by 2) and we are at 9 hours and 33 minutes of missed instructional time daily...

Institute a school wide nurse pass, include only acceptable reasons from visits as the options; review with each teacher the content of their first aid kit; call kids out on their ridiculous visits (even the little guys understand!); keep admin involved; involve parents as needed; oh and CLOSE YOUR OFFICE to get immunizations done! For real, the place will NOT burn to the ground because the teacher has to apply a bandaid

YAAAS. Also send the buddies out pronto. If the teacher is really worried about the little darling wandering back, call him/her as LD leaves.

3 Votes
Specializes in School Nursing.

I've had this problem. I sent out an e-mail of when/when not to send a kid to the nurse. I also REQUIRE a WRITTEN pass (unless it's a true emergency.) If they don't show with a pass, I send them back to class. It takes longer for a teacher to write a pass than it does to hand out a band aid. It has greatly reduced the number of kids coming to see me.

10 Votes

I have read so many good responses but wanted to add that I have worked elementary, middle school and high school. I saw the most in elementary and that's when I decided to go back to high school. In high school, it takes more time with practically adult size kids, but I see 15-25 daily. In middle school, I would see about 30-40. But,...wait for it, the elementary teachers and the kids drove it up to 60 a day! Yikes. They were cute, but many...whew. Throwing up, bumping heads while in line, accidents on themselves, #1 and #2, lol. I left after 13 months when I spotted a high school opening. I ran, not walked, lol.

3 Votes
Specializes in school nursing.

Yall, I saw 51 today. In HS. Even after emailing teachers today about what to send, I still had teachers bring me students AFTER DISMISSAL BELL TO CHECK TEMPERATURES ON A FRIDAY.

I quit. They don't listen.

2 Votes
Specializes in NICU/Mother-Baby/Peds/Mgmt.

I'm in a fb page called School Nursing and it's just ridiculous what the nurses are sent....poop on shoes, slightly wet clothes including spilled juice or milk, tangled hair, broken shoelaces.... And the nurses fix these things! And most of them complain about how much work they do but a lot of it is stuff like this. Refuse to do these kind of things and hopefully your visits will go down. No kid ever died from tangled hair.

2 Votes
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