Vent/Question

[tictac]

What do you do when you have a student who has received clearance by their doctor to attend school, but the teacher doesn't agree that they should be here because they continue to feel sick? The teacher usually comes to me and stands there waiting for a response, but I don't know what to say in these instances. I usually tell them I'll call the parents to let them know, but there's not much else I can do. Is there something else I should be doing?

I feel like I just got bullied by these 2 teachers who came in together and told me they were concerned about a student who is continuing to vomit occasionally, but his doctor determined it was most likely something viral that would take a while to clear. They were clearly not satisfied with this diagnosis and stood there and stared at me. I did get a little irritated and said if his physician couldn't figure it out, I certainly couldn't. I told them I would call the mother and let her know their concerns. I saw them roll their eyes at each other when they walked out. I really wanted to ask them, "What do you want me to do!!!!??" I understand the concern about vomiting in the classroom, but I'm not sure why they don't relay these concerns to the parents themselves. In another case, this went on for weeks and weeks, with me sending the student home, letting the parents know the teacher's concern through phone calls and letters, and asking them to have their child re-evaluated. The doctor doesn't always have a clear-cut answer, but it seems like they expect me to. The teachers come to ME and complain day after day, never saying anything to the parent.

Another problem is, many, if not most of our parents are Spanish speaking only. The teachers speak Spanish, but I don't. I do have a clinic assistant who speaks Spanish and translates for me, but then we're just adding another person into the mix. Am I wrong for thinking the teacher should communicate their concerns to the parents and not always put it on me? Seriously, is there something I should be doing that I'm not? I'm open to any suggestions, criticisms, whatever. I just need to hear it from a school nurse's perspective. Thanks!

[Flare, ASN, BSN]

stand your ground. Teachers tend to look at things like vomitting and diarrhea in black and white - these things can't occur and should be excluded from thier classroom... (these are the same teachers that will hem and haw about poor attendance in these kids... but that's another story) they don't realize that these are often symptoms that are in the gray zone of another issue. Again -stand your ground - if the child has been cleared by the doctor, and feels well enough for school, then there is not much the teachers can say.

As far as translations and communications go - appropiate communications from the health office via your assistant are certainly within reason, but that should'nt give the staff the green light to make every communication for every inconvenience your problem.

On a related note, i have probably thought about buying a rosetta stone program a hundred times. maybe i'll get a little cash windfall one day and the time will be right - i hear it is very effective.

[psu_213, BSN, RN]

Not being a school nurse I have never faced this situation (as an ER nurse it is usually the opposite: "I can't go to school with this cold...I need an excuse note." Anyway, I digress.). It seems to me that if a doctor clears the student to go back to school, is going to take precedence over a nurses view...and certainly over a teachers opinion! If the teachers want to exclude everyone with a communicable infection, then half the school would be out. I would say to preach good hand washing and have the teachers preach it too.

[Purple_Scrubs, BSN, RN]

I always play the "CDC guidelines and district policy for exclusion" card. Sorry, it's out of my hands. If they do not meed criteria for exclusion and the parent sends them to school, my hands are tied Of course we all know that we have a little more discretion than that, but the black and white method can work for some teachers.

With something ongoing like this, I will usually give the parents a call (with a translator if necessary...my population is about 85% Spanish speaking) and work out a plan with them for when I will call them and when the student will need to go home. For instance, if vomiting is the issue and it has been ruled that they are clear to return, I might suggest to the parent that for a single episode of vomiting we will let the child rest for a while and return to class, but for two or more episodes within an hour, I will call and we will discuss whether the student needs to go home.

While I understand that no one loves a child puking in their class, I think this is a decision that needs to be made between the parent, their physician, and the nurse. The teachers can gripe and moan about it, but I do not think than an inconvenience to them is reason to put a child out of class.

[rdsxfnrn]

I totally get where you are coming from! One would think, that as teachers, they would have thought about the germ issue prior to making that career choice. Some teachers hold me personally responsible if they get sick from someone in their class that I have cleared to stay. They want me to send q sore throat, stomache ache, cough HOME. Sorry nope. :)

[morte, LPN, LVN]

Cyclic vomiting syndrome - MayoClinic.com

Maybe?

[tictac]

Cyclic vomiting syndrome - MayoClinic.com

Maybe?

Probably not with this student, since I also sent his sister home with a fever and stomach ache. Although I have a couple other students where this may be the case!

Our district policy states that a student must be sent home for vomiting, but as we all know, there are a thousand reasons kids throw up, not just a contagious illness! Teachers like to throw that policy in my face all the time, but I won't send them home unless I truly believe they are ill or have vomited more than once. I'm just tired of all the hemming and hawing and complaining about how sick so and so is. I'm just going to ask them, "What exactly would you like me to do?", and go from there. Doesn't mean I'm going to do what they ask, I just want them to cut to the chase and put them on the spot.

I just had one sent down because she threw up LAST WEEK! I really wanted to send her back with "AND?" written on the slip. Ugh, I'm so ready for summer. These teachers are working my last nerve!

Thanks everyone!

[SchoolNurseTXstyle]

Half the time theses kids aren't even vomiting - most are spitting up phlegm! Post nasal drainage run amok! Imagine that, phlegm during allergy season? If i sent every kid home the teachers thought i should, none of us would have a job - school would be empty! My job is to keep kids in class. Period.....end of story! If a teacher doesn't like my PROFESSIONAL opinion, they can go to nursing school, pass the Nclex, become a certified school nurse, and apply for my job.