What would you have done?

[LACA, BSN, LPN, RN]

here's what happened: on monday, a 2nd grade girl bumped her head into the back of another child's head. she came to the clinic and was not crying or upset. her eye/upper cheek was red, and somewhat bruised. i applied an ice pack and sent a note home saying she might end up with a black eye because its bruised. i figured this covered me on letting the parents know. she wasn't upset, crying, or anything. her teacher said that she kept the ice pack on her cheek for a little while and then got rid of it and was playing and laughing and acting completely normal.

the next morning, my principal tells me that he got a call from the parents and they took her to the er (no way had i even thought it would require anything--especially not a trip to the er--a bit dramatic to me) he said that dad was upset and would i please call him? i called the number that the principal gave me, got no answer, and left a voicemail asking him to call me. i never heard anything from him. (she was absent that day- tuesday)

wednesday- heard nothing. the little girl was back in class, her eye looks completely normal.

this morning, the girl's teacher brings back the signed copy of the note that i sent home (i usually ask for signatures so i know the parents seen it) with a note on the bottom from mom that she was very very very upset, she had to take her child to the er, why didn't i call her, and that she is sending the bill to me.

if i thought this was a serious injury, i would have dropped everything and called. the child was fine. she wasn't even crying. the only reason i even mentioned black eye on the note was because i wanted them to be prepared in case it did bruise. the principal and teacher both agree that it wasn't a serious injury and that she was fine, and acting normally. the teacher says that both parents are over the top protective and have given her trouble in the past over seemingly non-issues.

**i just showed the note to the principal--he backs me and the teacher up 100%. he said that we are in no way responsible for paying the bill, the injury was not severe, and the note home was sufficent.**

[Flare, ASN, BSN]

Let them try and come after you. You absolutely did the right thing. I am surprised they are not trying to come after the kid that she bumped into also. Take things like this at face value, not personally. If it were that dire of a situation they should have returned your call. And you can bet that the ER staff was probably also annoyed that they brought her in for no good reason. I'll bet that poor kid was also subjected to an unnecessary x-ray. It's unreasonable that they would expect you or the school to pay the er bill (my district offers a health insurance).

[CT Pixie, BSN, RN]

I'm a mom of a 3rd grader and a nurse (albeit not a school nurse). My daughter is FOREVER banging her coconut on everything. I see no problem with a note home. Why did they bring her to the ER anyway? Was she displaying any s/s and what was the final dx?

Anyway, as I said, a note home should suffice. Our school nurse calls me each and every time my accident prone girl hits her head..so I average about at least 2 calls a month. She also sends a note home. I have told her that a note is sufficient and not to bother calling me and wasting her time. She informed me that school policy is to call for any head "injury". So she and I have become telephone buddies, I see the school name on caller ID, she says this is so and so the nurse at XXX school..and I say..and you're calling to tell me "Grace" smacked her head on something..correct?

Even if you did call, how could you prove it? I'd not worry too much. Sounds like these parents are well know for causing drama where there need be none. You have the backing of the principal thats one for you.

[LACA, BSN, LPN, RN]

They told the principal that the side of her head was swollen and that's why they had to take her to the ER...apparently they x-rayed her face! Mom thought the cheekbone was broken--there were NO s/s of anything of this nature!

[Flare, ASN, BSN]

:icon_roll

i'd be willing to bet that if it happened on their watch they wouldn't have done the same thing.

[CT Pixie, BSN, RN]

Me thinks someones parents are looking for a lawsuit..and will try anything to get one.

And let me guess, the X-Ray was (-) and child had no concussion..correct..

People crack me up.

[LACA, BSN, LPN, RN]

X-ray was completely negative...Dr. told them that it was a bruise and she may end up with a black eye....something that I (A MEDICAL PROFESSIONAL!!!) told them for FREE!!!!

[bergren]

Don't underestimate the value of your education and expertise. A lay parent does not know what you know about the signs of a dangerous versus a benign head injury. Don't diminish the time and effort it took for you to learn that skill.

Having said that, ..............sigh,.................... I am going to be the stinker here, and since you ask, what would you have done, honestly, I would have called the parents and discussed with them that I was sending the child back to class and given them the opportunity to ask some questions and potentially object and come see her for themselves. In one of the districts I worked in, there was a policy that any head injury that warranted a visit to the nurse, left a mark or the child complained of pain, there was to be a honest attempt to track down a parent to tell them what happened and to thoroughly document each phone attempt to contact the parents, even if the bump was considered to be minor.

One thing you have not mentioned is was the bump observed by an adult? Did anyone see that bump happen? Did you tell the mother that it was observed by an adult and the adult did not think it was a significant hit? The child did not lose conciousness etc.

Plus, I assume the parent read the note saying that the hit her head hard enough for you to suspect she may get a black eye AFTER you and the teacher had left for the day. So there was no way the mother could call and ask you the details of your assessment.

And I suspect this is a well child whose parents don't know you. They have no relationship with you. They do not know what a good nurse you are.

How did you sign the note? Did you add RN and your credentials? A number to call with questions?

Honestly, assuming the mother is not a health professional and cannot evaluate the child herself, I don't think the mom taking the child to the ER is necessarily completely wrong. Not sure what you put in the note, but in your description you don't mention that the note said how you evaluated that the child was OK. If my child was not a good historian, some 2nd graders are, and some are not, and I was not a nurse, I might have taken my child to the ER too. I probably would have felt foolish, and I certainly would not have asked the school to pay, but I cannot tell if you gave the mom enough information to go on faith.

Here is a link about how some parents (over)react when they hear their child bumped their head: http://www.kidsgrowth.com/resources/articledetail.cfm?id=52

We had a long conversation a few weeks ago about calling parents and the consensus was, you can never go wrong calling.

[luvschoolnursing, LPN]

Every time a parent c/o my judgment, I get worried. I posted here once about a situation parents were upset with and everyone agreed I did the right thing. You did the right thing, too. There are always parents out there that won't be happy no matter what.

[safarirn]

This is one of my biggest fears. I honestly try to call for *every* head injury... even the minor ones. If I don't get an answer, I leave a message detailing the incident, my findings, & instructions to 'watch' the child for 48-72hrs.

With that said, there have been CRAZY BUSY days where I have not called for really minor head 'injuries.' You know, the ones that didn't even leave a red mark, much less a bruise or a bump. But on my less-crazy days, I call on those too.

I practice C-Y-A nursing! That's the only way I can leave school each day & NOT WORRY about a student, or a 'coulda, shoulda, woulda' situation. Assess, observe, call, move on.

[Nurse_Ziba]

I agree with bergen. If it was me I would have called the parents to inform them that the student's eye/upper cheek was red, and somewhat bruised after accidentally bumping her head with another child's head. Although it doesn't appear to be serious it is best to inform the parent especially since you've noticed something. By doing so you'll ensure continuity of care at home. I would also attached to my note a pamphlet about head injury - It includes things to what out for. Frankly I think if it wasn't for the bruise the parents would have shrugged it off.

Please don't get me wrong. I too don't call every head injury unless the situation/assessment calls for it.

I would like to share an incident that happened to one of our nurses. She handled a student who was accidentally hit by a soft ball at his right cheek during practice. Upon assessment the student was negative for swelling, skin discoloration (He has a dark color skin tone that made it hard for the nurse to assess for redness), vomiting, dizziness, for short no warning signs. Despite having a negative findings, she followed her gut feeling (Ironically a soft ball is not really soft) and advised the student to have it checked by a doctor. The student did see a doctor and the physician just shrugged it off. After 3 days, the right cheekbone appeared slightly sunken and uneven compared to the left cheek. This made them to seek a second opinion and the x-ray revealed a fracture of the cheekbone.

[LACA, BSN, LPN, RN]

I signed the note with my name, LPN. Comparing what she looked like before and after (when she came back to school) there wasn't any reason to take her to the ER. She was acting and feeling fine. The area might have been slightly bruised, but it obviously wasn't bothering her according to what her teacher reported about how she acted. Techincally, I don't consider injuries on the face to be head injuries, unless they occur in the forehead area. This was literally on her cheek, below her eye. The adult who was in the hall with her was the one who brought her to the clinic and said it wasn't a hard hit at all. The child in front of her leaned back his head to look at something and she leaned forward at the same time and the back of his head hit her cheek. Like I said before, had I thought there was any reason to call, you couldn't have gotten to the phone any quicker than I would have, but she wasn't crying, she was doing fine.