Teachers and Staff Want To Be Taken Care Of

[Tocino]

I'm a new agency school nurse in a public HS in NYC. Lately, the teachers and staff are making me nuts, they want me to give them medication (which is not allowed even for students unless they have medication administration form), check their VS and even go down to their class to give first aid. There's even one incident that a teacher want me to change his wound dressing, which I said that he should go to any urgent care or go back to his doctor for that wound. I talked to my nursing supervisor about this and said that I can only call them EMS if they have abnormal vs or any injury which what I've been doing (most of the time they decline). She also said that I should never mentioned that school nurses are not for the staff or teachers but for the students only, but isn't much better to be transparent about it? Like I'm only here for the students, if you're not feeling well go home or go to the hospital, I don't get the "but don't tell them that". 

How do I handle this? Should I just be transparent? How can I say to admin, teachers and staff that I'm not here for them? 

[RatherBHiking, BSN, RN]

I can relate and used to get asked for advice (or diagnoses or reassurance they weren't dying) A LOT! And nothing annoys me more than some teacher thinking they can literally interrupt an assessment of a child to get their non-emergent blood pressure taken. ?

I sent an email to the staff saying just fyi  I'm here for the kids. I'm not allowed to diagnose, hand out meds, or do treatments for staff. No, I cannot "excuse you" to go home sick. It doesn't count as a Dr excuse like some seem to think. I also said you are to bring your own meds, bandaids, and pads etc because I have a very small budget to use on those supplies for the students and I can't afford to supply you as well. I also said I cannot "tell" if you are having a heart attack either. Doctors have to run tests to determine these things so if you're having chest pain for any reason you need to go to the ER. (I've had many that think I can just do a quick blood pressure and tell them if they are having a heart attack.) 

Then I limited blood pressure checks to one time a day (usually at the end) or by appt only. That cut them WAY down. When they came in after that and would ask about some problem I'd say wow I'm not allowed to diagnose but that sounds like something you better make a Dr appt about asap. Especially for the hypochondriacs. They are just using you to make themselves feel better. If you don't make them feel better they'll quit coming. Now we all know sometimes we CAN tell whether something seems serious or not but remember it does not matter. If they are worried they need a doctor to check them out and give treatment. If you ever get it wrong you'll never hear the end of it about how incompetent you are! Even if it was something they didn't even need treatment for. So be firm. And it's OK to say sorry I can't help you I'm too busy. Like seriously would we ever interrupt a class and say I need help figuring out this problem right now? Of course not!  Nor would they just barge into an urgent care and interrupt a nurse or Dr! So it's OK to set boundaries! 

[k1p1ssk, BSN, RN]

I think there is also something to be said about burnout/stress being driving forces in adults coming in. Everyone (the students and adults) want to be taken care of, loved, appreciated, and paid attention to, and I think I struggle with the adults because while we all are caring for the students all day and meeting their needs, they (adults) then ALSO seek care and affirmations from me but there is NO ONE that will reciprocate for the nurses.  Who do we go to? 

[Cattz, ADN]

Tocino said:

Thank you. Sure, with agency we have less attachment to schools since agency can pull out us anytime unless I really like the school or admin likes my job (I'm not so sure now LOL).

I was informed by my agency that I have to follow dept of health's policy and procedure, if anything medical I can call the agency nursing supervisor if anything related to admin or paper works I have to call the DOH nursing supervisor.

Yes, I am employed and paid by agency, they pay more but no pto, no health insurance or benefits. I will apply directly to DOH once I have more experience. 

I greatly appreciate your reply. 

It is difficult for school people/pretty much anyone that isn't in the medical field to really understand how our "nurse brains" work. I would just keep telling them that you have to follow your agencies policies and procedures - since you are not actually employed by the school system. You will get better at learning how to navigate the school setting. It is a special kind of atmosphere that takes some time to learn to navigate. Good luck and please update us.

[kdkout, BSN, RN]

These requests sound ridiculous. Has the staff ever heard of boundaries?

[seedanurse]

My job description actually specifies that the health office is a resource for students and staff. I get a lot of staff visits for OTC meds, band aids, temp checks, etc. I err on the side of caution, and never tell a staff member how much or what type of medication to take, they have to self-dose. 

I make it really clear that I can't diagnose/rule out/etc. But if it helps a teacher get through their day, I'm glad to be a support, mostly emotional support more than anything. They have tough jobs too. 

 

[NutmeggeRN, BSN]

kdkout said:

These requests sound ridiculous. Has the staff ever heard of boundaries?

Nope!

[k1p1ssk, BSN, RN]

seedanurse said:

My job description actually specifies that the health office is a resource for students and staff. I get a lot of staff visits for OTC meds, band aids, temp checks, etc. I err on the side of caution, and never tell a staff member how much or what type of medication to take, they have to self-dose. 

I make it really clear that I can't diagnose/rule out/etc. But if it helps a teacher get through their day, I'm glad to be a support, mostly emotional support more than anything. They have tough jobs too. 

 

Yes, I believe my job description says that too, but I draw the line at a staff member calling me before work hours - while she is ON THE WAY TO HER DOCTOR - asking me for every possible differential diagnosis based on her symptoms of diarrhea and abdominal pain... like, what?? 

[seedanurse]

k1p1ssk said:

Yes, I believe my job description says that too, but I draw the line at a staff member calling me before work hours - while she is ON THE WAY TO HER DOCTOR - asking me for every possible differential diagnosis based on her symptoms of diarrhea and abdominal pain... like, what?? 

That's a bit much, for sure.  Sounds like she might have some angst about possible diagnosis, and maybe turned to you as a friend.  Or maybe she just has bad boundaries ? Pre-work hour calls are the WORST! Ugh. 

[k1p1ssk, BSN, RN]

seedanurse said:

That's a bit much, for sure.  Sounds like she might have some angst about possible diagnosis, and maybe turned to you as a friend.  Or maybe she just has bad boundaries ? Pre-work hour calls are the WORST! Ugh. 

She's definitely a worrier. Unfortunately, I have no relationship with her other than when she has personal medical questions. I'm glad she trusts me, but she is the "if you give an inch, they'll take a mile" types, so I have to reinforce the boundaries frequently...

[NutmeggeRN, BSN]

kdkout said:

These requests sound ridiculous. Has the staff ever heard of boundaries?

Some, not so muchj!

[DallasRN]

beachynurse said:

I have 1 teacher that I think would live in the clinic. The current illness that she is concerned about is a brain tumor. I keep telling her to go see her MD, because I certainly can't diagnose, or even help her with that.

Maybe suggest she go see her psychiatrist?  I'm definitely not a school nurse - never even worked pedi - but using my best judgment I somehow don't think school nurses are qualified to handle brain tumors.  ?

[DallasRN]

Another thought - and again, I've NEVER had a school nurse experience (and I'm only reading this thread because I'm retired from nursing and too lazy to do my chores)...anyway...

For teachers that want the frequent b/p checks what about approaching it from the angle of "you (teacher) buy a b/p cuff (Amazon has some good but cheaper models) and bring it to the office for a lesson on how to use, keeping logs, etc.".  Teach them to take log to their doctor, use AHA guides...that sort of thing.  Perhaps even set up a couple of hours each semester for "teacher education" - with admin approval, of course.  Just a thought.