40 Students per day... YIKES!!

[BooBooCrew]

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?

[SaltineQueen]

On 9/6/2019 at 4:58 PM, CanIcallmymom said:

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.

Our HS nurse was telling us last week that she had a day where she saw 120 kids!!

[CampyCamp, RN]

On 9/6/2019 at 12:55 PM, kelleyk1991 said:

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.

I love that rationale. Unfortunately, this is a long standing culture at my schools and I don't see this being instituted (and my numbers are ridiculous) I'm a float between buildings so it's not up to me anyway.

[CanIcallmymom, BSN, RN]

45 minutes ago, SaltineQueen said:

Our HS nurse was telling us last week that she had a day where she saw 120 kids!!

No way could I do that. My record is 72 I think, which is WAY too many.

[BooBooCrew, BSN, RN]

Y'all!!! There are so many good suggestions here!! Thanks a million. I am going to try out a few of these and see if I can't get the traffic down to a minimum. I spoke to the principal and she says only PK & K need a buddy and 2nd & 3rd only need one for the first 6 weeks (they are out in the portables). I'll definitely be enforcing this starting today!

[jnemartin, BSN, RN]

On 9/6/2019 at 9:30 PM, Elaine M said:

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.

I always struggle with office visits like this, because I know part of nursing is the soft skills, the psychosocial interventions, offering support and building trust with the patients/community, etc. But from a workplace/workload perspective, these visits are ridiculous and honestly kind of offensive/disrespectful.

This year (year 2 for me), I'm trying to take a middle-of-the-road approach, and really focus more on the serious health issues, and educate students (/teachers) on appropriate nurse visits in a kind and supportive way. Like... empower them to take ownership of their own wellness.

One thing I've done is some education with the students about different roles of nurses - I presented to the Health class and pre-med club about various nursing careers, and made sure to include info about how intense our education is, how autonomous we are and especially NPs are. I think this helped them to understand that nurses are not just bandaid applicators. I had a teacher tell me that my work outside of the regular clinic operations has built a reputation here for me being serious and professional. I was very pleased to hear that, because it's really what I was aiming for.

None of this is a suggestion on how to reduce office visits, per se, just an observation and commiseration about how the perspective of the school nurse can be so different than our actual work, and something that seems to be helpful for me ?

[Flare, ASN, BSN]

my average, once i get rolling, is about 35-40 per day. It was twice that when i started here. To me, the kids don't need buddies unless they are littles who don't know how to navigate the school or have a medical reason that would justify it (hypoglycemia, hit to the head, etc. ). Inevitably, the buddies (especially on the younger end) tend to realize that they are unwell too as soon as they realize that the kid they marched in is getting attention. Also - it really irks me when the buddy speaks for the kid.

...sigh... it's awfully early in the year for me to feel this salty...

[Nunya, BSN]

On 9/9/2019 at 8:37 AM, CampyCamp said:

I love that rationale. Unfortunately, this is a long standing culture at my schools and I don't see this being instituted (and my numbers are ridiculous) I'm a float between buildings so it's not up to me anyway.

But you can try to get it instituted. It also shows accountability as to where the student is, I'm sure there's more than one skipping out of class or being late and saying they were with the nurse.

[ChristmasNurse]

On 9/7/2019 at 12:30 AM, Elaine M said:

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.

I'm in a high needs system where nursing turnover is high for many reasons. But I have noticed that a good number of those that have grown to hate their jobs, are the ones who were doing a ton of non-nursing related things. I took over for one and it hasn't been easy...especially the wet clothing. I'm gettin there, but there always seems to be one staff member who hasn't gotten the message yet.

[BooBooCrew, BSN, RN]

To be totally honest (and maybe a tad vulnerable), I’m not sure how to refuse to do the non-nursing tasks. When I first started before the kids were in school I asked why teachers/TAs would bring a child to my office in soiled clothes, because that would mean they are making them walk down the hall like that. There was a MAJOR fit about me even questioning this. Since it is my first year, I don’t want to form an adversarial relationship with every teacher and administrator by refusing to do the things the nurse of 8 years before me did (love being compared to her daily). Then again, I don’t want to get run over and taken advantage of either.

[Nunya, BSN]

3 hours ago, NurseSears said:

To be totally honest (and maybe a tad vulnerable), I’m not sure how to refuse to do the non-nursing tasks. When I first started before the kids were in school I asked why teachers/TAs would bring a child to my office in soiled clothes, because that would mean they are making them walk down the hall like that. There was a MAJOR fit about me even questioning this. Since it is my first year, I don’t want to form an adversarial relationship with every teacher and administrator by refusing to do the things the nurse of 8 years before me did (love being compared to her daily). Then again, I don’t want to get run over and taken advantage of either.

Ya know, I think it's fine if you do these non-nursing things...as long as you don't have to stay late/come in early, miss breaks and lunches (esp lunches) to do them, and as long as you're willing to do them. The problem I'm seeing on the fb page is nurses doing these things and then not getting their required work done and missing lunch and staying late. And they're complaining about unpaid overtime/no lunch. One nurse asked who fixed eyeglasses and dozens said they did, several bought kits to do so. A kid can still see if the stem is broken, I know I did. A few didn't fix them, one said she didn't want to break them more. And one got out of the clothes business by refusing to have them in her office. And it seems that some nurses have had the problem of giving an inch and people taking a mile. If you're in a small school and you have the time, do it, but there's one nurse who's responsible for 5000 kids and several who have more than one school. Who has time to do non-nursing duties with a workload like that? Just remember, as you start out so it will become. It's much easier to add additional duties than to stop doing them. And you need to remind people you aren't the previous nurse. They'll get over it. Sounds like they've been spoiled...

[BeckyESRN]

I found that at least 50% of "the previous nurse did this" claims were untrue! People just don't like change and they're going to see what they can get away with. Nurse passes have made a huge difference. I got my principal on board first, then he presented the vague idea of an easy way to communicate with the nurse, and, ta-da! the teachers had this amazing idea for passes?

In my experience, teachers have this whole way of communicating that involves a lot of smiley faces and exclamation points. My first year, I would email them the same way I would email a nurse co-worker and they would say I was being mean. I've learned to add unnecessary exclamation points and "thanks so much", "thanks for your help..." ect and that seems to work.

It does get better.

[NurseBeans, BSN, RN, EMT-B]

I am a bit late to the party here with a comment, but we have two nurses here (MS, 900 plus students) and last year we saw...brace yourselves...150 students a day. Yowza...the other nurse has been here quite some time and she would put out an entire snack buffet for the kids, she had closets full of clothing, she would let them come in and fix hair and/or make up, she would let them come in and JUST. SIT. AND. TALK. Not a student in crisis who needed counseling, mind you, but just come in and visit.

Well by June I had enough and had come to the conclusion that what I was doing wasn't nursing, so I left the job. Circumstances are such that I find myself long-term subbing in the same school, in the other nurse's position, and the new nurse's mentor came in and absolutely demolished the clothing and shoe stash, and is teaching the new nurse not to feed them, not to give them mints or cough drops or lip balm or bottles of water...we see maybe 30 a day of legit health problems.

And this new nurse is AMAZING and we work well together and I am so so sad that I am but a sub and will have to move on eventually but that is another story for another thread. The point here is, they are like cats. If you offer food and clothing, they will show up in droves. If you just get rid of stuff like clothes and shoes and your answer every time is "I don't have any", they will stop showing up and you can focus on actual nursing.

The teachers are slowly getting the message. Patience.