(Disclaimer: I freely admit this is a whiny post and have bolded my actual questions for any who prefer not to read it!)
I know this is a repeat question but I also know it's not the first time for a repeat question to be asked here, and I would like some guidance from those who have been at this for longer than me.
I like to be busy and I am in no way wanting an empty health office. However, an issue I ran into at the end of last year has continued into the beginning of my first full year and I (and seemingly every one else) am at a loss as to why or how to fix the issue.
By the end of last school year, we were seeing 70-90 children most days (not including ~10 meds and procedures). My prek-5th elementary school has about 800 children. This means that on the days we saw 100 we were seeing a whole 1/8 of the school. Even on those days, I think the most I ever sent home was 5. Already, I am seeing 40-50 every day this year. It only took 3 days to go from 20s to 30s to 40s. Sometimes I see nearly 20 in one hour of recess and most of them have no visible/palpable sign of injury and end up chit chatting and smiling, walking around to get water, etc. by the time I work through the masses and see them. I would say most of these students leave the health office without any intervention at all other than assessment. (I have all but stopped using ice packs because I have found that that has cut down on students coming in just because they want one.)
Any given time that I have 10 in my office, I usually only feel that 1 needs attention, and rarely is it urgent. I think the most telling fact is that the other elementary school nurse in my district sees around 10 students in a day even though it is about the same size. I asked if she has run into this issue before and she said no. Our front office is also shocked by my numbers and questioning out loud what is going on. In these first 8 days of school I have seen 180+ different students (many of them several times). This is 1/5 of my school. I have only had 1 legitimate fever, 2 serious injuries, 2 less serious injuries, 1 with asthma trouble, and a handful who have vomited.
My main question is what pointers have you given to teachers about problem-solving in the classroom? (And did it help?) Because some of my visits from classrooms are things like "blister" (intact) or "leg started hurting while sitting" or "foot fell asleep." A lot of walky talky smiling stomachaches all throughout the day. I am starting to suspect that some of our teachers are not really asking the children any questions before sending to me and I am hoping that I will be permitted to give them some guidance.
I have already started discussing with students the appropriateness of their visits ("I understand you fell, but your knee looks exactly the same as your other knee, and you are walking so well. Do you think next time we could rest and see if it feels better?"). I have become more stern and honest with them than last year because it has been suggested to me that the children come because they like me and I want them to know that the health office is not a place to go just because you feel like it. The students I have already seen 4 or 5 times in this first 1.5 week of school, I am also communicating with their parents about speaking with them to see if they need to see the doctor or if they need help identifying when they need to come see me. Children and parents have been somewhat receptive but I would also like to help the staff.
I know I have seen something like the "5 B's" here (breathing, bleeding, barfing??).Any other ideas for staff tips and/or other ideas would be greatly appreciated. I have so many things I want to do for the student body as its nurse (speak with parents to get actual information about food allergies, investigate the hundreds who have "asthma" noted in their history to see who is actually still at risk, etc.). Teachers ask me questions and I don't have time to get the answers. I love these kids and don't mind seeing them all day; the worst part of this for me is the constant traffic makes it impossible to actually assess school health, promote health, and plan for the year. I know having frequent flyers and assessing nonsense complaints is par for the course but I am concerned that this is more than that and don't want to contribute to the problem.
Posting this before Labor Day Weekend might seem like folly but maybe other people like me still have their minds at school. Thank you to anyone who takes the time to read this, I am open to any suggestions any time
Specializes in ER, Immediate Care, School Nursing.
New school nurse here. My background is ER and Immediate Care. I am in a K-5 school, about 600 students and I am the only nurse. I average 55 student visits a day, some days close to 70, but very rarely less than 50. I am mentally exhausted, frustrated, and quite honestly aggravated with the things teachers send students to me for. I have had students come to me to clean their glasses, get their zippers unstuck, get food out of their teeth, put their earrings back in, put their hair clips back in- and these are in addition to the usual band aid, chap stick, and ice pack requests. I have 17 regular med visits scheduled everyday and several Type 1 diabetic students, one of which is extremely brittle. I have teachers send students to me to "take a nap"......is this a normal request? It's almost as if the teachers here are afraid to render basic first aid. But if they go on a field trip with these kids, they can manage, right? Most of them are parents and ALL of them are adults and I'm sorry, but they should be able to tell the different between a boo-boo and an actual injury. I get the feeling many of them are turned off by me because I don't baby and coddle the students like some of them do. I don't want students to think it's "fun" to go to the nurse's office. When I first came here, there were toys for the kids to play with. I promptly boxed those up and put them away. I am not employed by the school so I also feel like there is a power struggle with the principal here. I'm feeling like this is not my calling. I am 100% empathetic to the actual sick and/or injured kids. But I find it very hard to fake it for the frequent flyers and for the teachers who I feel are trying to roll over me or just get rid of a student for a while. I have teachers who send kids down for the dreaded stomachache..... get vital signs, ask about breakfast/lunch, when did the pain start, palpate, jump up and down, listen for bowel sounds, lay down in clinic for 10 minutes and then back to class- only to have teachers send them right back to me. Same with nausea- vital signs, PO challenge and then back to class if no vomiting. Teachers send them right back. This makes me feel like my clinical judgment is being questioned. Why did they think they would go into teaching and never have to deal with vomit, blood, or poop/pee? Am I being difficult? Is this how it will always be? A sub nurse stopped by last week and there were 11 kids standing around waiting for me. She said the school she had just come from saw six kids the day before. SIX KIDS! She told me she would never want to sub in this school. I'm also curious about the expectation of privacy for these kids? Sometimes a teacher will bring a student in and then just stand around, waiting for me to see them. I usually just meet them with a smile and a nod and say "OK, I'll take a look and send them back to class". Isn't it a HIPAA violation for all of these kids and teachers to be in the same room? If I have to call parents, I have to wait until the end of the day so I can shut my door and make the calls, trying to protect the students' privacy. OK. That's it. I know I sound whiny. This job may not be for me 😂
@BrandNewSchoolNurse You're facing multiple challenges! You're new, and kids and teachers are taking advantage of that - testing the waters so to say. You need to solidify your expertise and sort of "prove" yourself. Some school cultures will respond positively to you standing your ground - others will be more of a challenge to do this in, depending on how long the teachers/admin have been there with each other...
Early on in my days at my school with much fewer students (at the time we were around 190, I think, prek-6th), I would routinely see 35-40 students per day. Now, I average 15 (and we're at around 135 students now - we lost a chunk of kids when one of our feeding towns broke from the district).
I imagine in your setting, that many teachers are not even asking why the kid "needs to see the nurse". This was definitely the case in my building, so I implemented a nurse pass system, which helped immensely. Many students were coming down without asking their teachers. They would ask to go to the bathroom and then divert to the health office. The passes helped in that if they had no pass and were not actively vomiting, bleeding profusely, or having difficulty breathing, they were sent back to class to check in with their teacher - many never returned, because it turned out, their reasons were bogus. My passes had check boxes that the student or teacher could check off for frequent complaints, and it helped teachers realize who was asking to come more frequently and find patterns...
Another rule I implemented was no ice if the injury is over 24 hours old or there was no mark/swelling, etc. Same for bandaids - if its not bleeding/raw, no bandaid - I also supply the classrooms with bandaids, which prevents many visits for minor cuts. For stomach aches, unless they truly look like they might throw up or in the absence of any clinically significant signs of illness, they go back to class, possibly with a warm pack, and are instructed to return at recess to rest if it still bothers them - I don't let them rest in the health office. And if they don't come back during recess, then I can only assume they were fine to go outside and therefore will be fine to be back in class after. After time, the "new normal" set in and the kids stop asking to come for these things.
Naps are not allowed in my office except during recess/non-academic time, unless a kid is waiting to be picked up. Most kids would prefer to go outside, even when they're tired. This is a trend because kids don't seem to have "bedtime" anymore and many get very little exercise and have low tone. But being tired during the day is what I call a natural consequence. I have suggested to teachers that if a student cannot keep their head off their desk, they sit away from it with a clip board to do their work.
Many students do need reassurance, especially the youngest kiddos and yes, the teachers could do this, but think about the time it takes you to address all of them, how much time away from teaching it would take them. Make the teachers know you are trying to support them, and that you hope they do the same for you and when you send a kid back, it's not because you don't care, but because in your professional opinion, they do not need to be out of class.
New school nurse here. My background is ER and Immediate Care. I am in a K-5 school, about 600 students and I am the only nurse. I average 55 student visits a day, some days close to 70, but very rarely less than 50. I am mentally exhausted, frustrated, and quite honestly aggravated with the things teachers send students to me for. I have had students come to me to clean their glasses, get their zippers unstuck, get food out of their teeth, put their earrings back in, put their hair clips back in- and these are in addition to the usual band aid, chap stick, and ice pack requests. I have 17 regular med visits scheduled everyday and several Type 1 diabetic students, one of which is extremely brittle. I have teachers send students to me to "take a nap"......is this a normal request? It's almost as if the teachers here are afraid to render basic first aid. But if they go on a field trip with these kids, they can manage, right? Most of them are parents and ALL of them are adults and I'm sorry, but they should be able to tell the different between a boo-boo and an actual injury. I get the feeling many of them are turned off by me because I don't baby and coddle the students like some of them do. I don't want students to think it's "fun" to go to the nurse's office. When I first came here, there were toys for the kids to play with. I promptly boxed those up and put them away. I am not employed by the school so I also feel like there is a power struggle with the principal here. I'm feeling like this is not my calling. I am 100% empathetic to the actual sick and/or injured kids. But I find it very hard to fake it for the frequent flyers and for the teachers who I feel are trying to roll over me or just get rid of a student for a while. I have teachers who send kids down for the dreaded stomachache..... get vital signs, ask about breakfast/lunch, when did the pain start, palpate, jump up and down, listen for bowel sounds, lay down in clinic for 10 minutes and then back to class- only to have teachers send them right back to me. Same with nausea- vital signs, PO challenge and then back to class if no vomiting. Teachers send them right back. This makes me feel like my clinical judgment is being questioned. Why did they think they would go into teaching and never have to deal with vomit, blood, or poop/pee? Am I being difficult? Is this how it will always be? A sub nurse stopped by last week and there were 11 kids standing around waiting for me. She said the school she had just come from saw six kids the day before. SIX KIDS! She told me she would never want to sub in this school. I'm also curious about the expectation of privacy for these kids? Sometimes a teacher will bring a student in and then just stand around, waiting for me to see them. I usually just meet them with a smile and a nod and say "OK, I'll take a look and send them back to class". Isn't it a HIPAA violation for all of these kids and teachers to be in the same room? If I have to call parents, I have to wait until the end of the day so I can shut my door and make the calls, trying to protect the students' privacy. OK. That's it. I know I sound whiny. This job may not be for me 😂
A lot of these are not health concerns and should NOT be what the nurse is utilized for. This is incredibly dangerous. What if there is a medical emergency? Are you supposed to leave 15 children waiting while you try to get your bearings and get to another part of the school? This is an administration problem! They need to handle their teachers because these numbers coming to the clinic keep real medical issues hidden behind broken zipper visits. This is at the very least a liability and at most a situation that is racing towards someone getting very hurt or not taken care of in time during an emergency.
I was also seeing ~100 students per day, and my "biggest" sent home day ever (16 years of school nursing) was 5! I just finished the data survey and of the more than 12,000 visits I have already logged this year, only 202 were sent home by me due to illness/injury!
I decided in February that changes were coming! I had begged and pleaded and sent out countless "frequent flyer" list to no avail. So, I closed and locked my office door. It has been posted on the door and every syaff member received an email to let them know that no student will be allowed entrance to the nursing office without a call from their teacher and approval from the nurse!
You and I would not accept other people walking in on our visits when we go to the clinic, so we need to treat students with the same respect and attention! It is too easy to miscalculate an insulin dose or to grab the wrong bottle if attention has to be split 10 different directions at once. And, we have the double onus of protecting HIPPA and FERPA!
Generally, even the "every new day brings a new illness" students end up staying in class and seem to "forget" how sick they are once they are asked to sit and drink a bottle of water, wait 20 minutes before c/o headache to nurse, etc. I have cut my visits in half and I know that I am still seeing those that truly need help, scheduled meds, diabetics, enteral feedings, etc and ultimately helping the others to learn some self coping skills!
I will make sure to include headaches, stomach aches, sore throats, old bug bites/bruises/invisible injuries, and paper cuts in my note. I'll also mention I don't extract fully embedded splinters or pull loose teeth.
I have the very firm rule that I will only treat injuries, cuts, abrasions that happened at school today! If they got a skinned knee at the park at 4pm yeaterday then they have had ample time to clean and bandage before school! And, most of the time when they complain of random pain for X amount of time, it turns out they have never taked to parent(s) about it. So, I don't treat pain/illness that is specific to Monday-Friday between 8-4:00!
BrandNewSchoolNurse
1 Post
New school nurse here. My background is ER and Immediate Care. I am in a K-5 school, about 600 students and I am the only nurse. I average 55 student visits a day, some days close to 70, but very rarely less than 50. I am mentally exhausted, frustrated, and quite honestly aggravated with the things teachers send students to me for. I have had students come to me to clean their glasses, get their zippers unstuck, get food out of their teeth, put their earrings back in, put their hair clips back in- and these are in addition to the usual band aid, chap stick, and ice pack requests. I have 17 regular med visits scheduled everyday and several Type 1 diabetic students, one of which is extremely brittle. I have teachers send students to me to "take a nap"......is this a normal request? It's almost as if the teachers here are afraid to render basic first aid. But if they go on a field trip with these kids, they can manage, right? Most of them are parents and ALL of them are adults and I'm sorry, but they should be able to tell the different between a boo-boo and an actual injury. I get the feeling many of them are turned off by me because I don't baby and coddle the students like some of them do. I don't want students to think it's "fun" to go to the nurse's office. When I first came here, there were toys for the kids to play with. I promptly boxed those up and put them away. I am not employed by the school so I also feel like there is a power struggle with the principal here. I'm feeling like this is not my calling. I am 100% empathetic to the actual sick and/or injured kids. But I find it very hard to fake it for the frequent flyers and for the teachers who I feel are trying to roll over me or just get rid of a student for a while. I have teachers who send kids down for the dreaded stomachache..... get vital signs, ask about breakfast/lunch, when did the pain start, palpate, jump up and down, listen for bowel sounds, lay down in clinic for 10 minutes and then back to class- only to have teachers send them right back to me. Same with nausea- vital signs, PO challenge and then back to class if no vomiting. Teachers send them right back. This makes me feel like my clinical judgment is being questioned. Why did they think they would go into teaching and never have to deal with vomit, blood, or poop/pee? Am I being difficult? Is this how it will always be? A sub nurse stopped by last week and there were 11 kids standing around waiting for me. She said the school she had just come from saw six kids the day before. SIX KIDS! She told me she would never want to sub in this school. I'm also curious about the expectation of privacy for these kids? Sometimes a teacher will bring a student in and then just stand around, waiting for me to see them. I usually just meet them with a smile and a nod and say "OK, I'll take a look and send them back to class". Isn't it a HIPAA violation for all of these kids and teachers to be in the same room? If I have to call parents, I have to wait until the end of the day so I can shut my door and make the calls, trying to protect the students' privacy. OK. That's it. I know I sound whiny. This job may not be for me 😂