Suicidal Thoughts in School

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Specializes in Emergency, Cardiac, & School Nursing.

Just curious what are your procedures/steps you take when a student (middle or high school age) comes to you (the nurse) and states they've been having suicidal thoughts?

Specifically interested in smaller schools who do not have a full time counselor on campus. What role does the school nurse play in maintaining a student's safety?

Thanks!

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Specializes in ICU/community health/school nursing.

Do you have a rapid assessment tool in the district to use? That question may be one to ask the head of counseling, just so counselors and nurses are using the same tool.

If no: you want one - and googling rapid assessment suicide or mental health will land you a few good ones.

It is my personal practice to assess for lethality and ability. "I feel like killing myself" is not by itself lethal. "I'm going to jump off the bridge onto the highway," "I have pills at home," "My dad has a rifle" are all examples where I'd never leave the kid alone, not for a minute. Not even if I had to summon the superintendent.

Brief physical assessment - any cutting marks, evidence of past attempts? I'm only looking at what I can readily see. No taking off pants to look at thighs (someone else can do that).

I call a parent every time and discuss assessments, observations, and referrals. If I believe the student is actively going to harm him/herself I will get district assistance to transport that student to the parent's place of choice- it's ridiculous for me to send a parent and kid to the ER if the kid is going to jump out of the car at a stoplight or some such.

Do you have a resource officer to help with an involuntary placement? What's your local intake/inpatient place like?

I look forward to hearing more about what some of our former MH nurses would add here.

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Specializes in school nursing.

We do not leave student alone at any time. Refer to counselor or school psychologist who accepts care of student.

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Specializes in School Nurse.

If you don't have any other support at school, you can use the Columbia Suicide scale. I was trained to ask the questions just as they are stated, don't be afraid to ask the questions.

Columbia Suicide Scale.docx

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Specializes in Emergency, Cardiac, & School Nursing.
30 minutes ago, ruby_jane said:

Do you have a rapid assessment tool in the district to use? That question may be one to ask the head of counseling, just so counselors and nurses are using the same tool.

If no: you want one - and googling rapid assessment suicide or mental health will land you a few good ones.

It is my personal practice to assess for lethality and ability. "I feel like killing myself" is not by itself lethal. "I'm going to jump off the bridge onto the highway," "I have pills at home," "My dad has a rifle" are all examples where I'd never leave the kid alone, not for a minute. Not even if I had to summon the superintendent.

Brief physical assessment - any cutting marks, evidence of past attempts? I'm only looking at what I can readily see. No taking off pants to look at thighs (someone else can do that).

I call a parent every time and discuss assessments, observations, and referrals. If I believe the student is actively going to harm him/herself I will get district assistance to transport that student to the parent's place of choice- it's ridiculous for me to send a parent and kid to the ER if the kid is going to jump out of the car at a stoplight or some such.

Do you have a resource officer to help with an involuntary placement? What's your local intake/inpatient place like?

I look forward to hearing more about what some of our former MH nurses would add here.

Thanks for this reply. Part of the issue is that I am at a private school, therefore, no district policies in place - only best practices. We also have a school counselor who is part time, and not even on campus everyday. Fortunately, the day this student came to me, our counselor was here and came right away.

I do have some experience with dealing with people in crisis from working in EMS and the Emergency Room, but I didn't realize there was a rapid assessment tool. Good to know! I'm definitely going to look for one to use.

I wish we had a school resource officer (for so many reasons)!

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Specializes in ICU/community health/school nursing.
2 minutes ago, MisRN said:

Thanks for this reply. Part of the issue is that I am at a private school, therefore, no district policies in place - only best practices. We also have a school counselor who is part time, and not even on campus everyday. Fortunately, the day this student came to me, our counselor was here and came right away.

I do have some experience with dealing with people in crisis from working in EMS and the Emergency Room, but I didn't realize there was a rapid assessment tool. Good to know! I'm definitely going to look for one to use.

I wish we had a school resource officer (for so many reasons)!

I am glad that the counselor "stopped the line" to come to you. I am glad your background is in EMS and ER!!! You are preparing yourself for next time - because there will be a next time and we need a plan in place and consistency! GdBSN's Columbia screening tool is the one I was thinking of. Best of luck!

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Specializes in Emergency, Cardiac, & School Nursing.
1 hour ago, SaltineQueen said:

This reference is pretty good. Page 71 https://ssom.luc.edu/media/stritchschoolofmedicine/emergencymedicine/emsforchildren/documents/resources/practiceguidelinestools/Guidelines for the Nurse in the School Setting 3rd Edition April 2017 Final.pdf

Thanks for this! What a great reference tool for a lot of things! ?

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Specializes in IMC, school nursing.

I have had this exact scenario, and I have no counselor now, but had one when this escalated. I called 911, then I called the parents.

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