What would you have done?

[LACA]

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.**

[bergren]

"Now for little bumps on the head area..with nothing visible or palpated...I just give them ice and send them on their way. Do you think I should send home a head injury sheet for that? It just seems overkill. "

I agree with Noreen above. From a risk management standpoint, you are better off following through on the "overkill", it is the safest practice. If heaven forbid there was ever a problem you would not have a leg to stand on if you had not followed the policy.

[NO1_2NV]

I call for EVERYTHING! It is becoming more and more difficult in this "there are not accidents" environment to treat and "send them back to class". Often when I call, the parents want to know the name of the child that their child accidently bumped heads with or whom, while playing basketball, threw the basketball at their kid (isn't this how you play basketball?), or why did their child fall from the slide, etc. There are many times phone calls are made by parents to the teacher or the principal demanding information regarding who is at fault and demanding that their child not be allowed to play if we can't supervise children and assure they do not get hurt. I call this the "bubble" mentality.

You state that you sent a letter home. We too have them but I do not trust letters. If the child forgets to give the letter to the parent and the parent does not see it and a problem arises this becomes problematic. Call, call, call. I have also learned over time that the more I call the more the parent trust and trust is so vital in this day and age. If a problem ever did arise the parent has some confidence in your ability to assess and treat knowing that you tend to error on the side of caution and always call. I have been guilty of telling the parent I would rather feel stupid because I recommended the child see a doctor than to not suggest it at all and have a problem and the parent come back and say you told me it was something "minor".

Remember as nurses (a medical professional) we cannot diagnose. NEVER EVER. The fact that a parent chooses to seek medical attention is always their choice and you should never ever take it personally.

Thank you for what you do.

NO1_2NV

[rainstorm83]

You better believe I call for EVERYTHING now. I guess I learned my lesson...still haven't heard anything from those parents though....Guess that's a good sign! Oh well, you live and learn! I guess that's why they call them mistakes, you're supposed to learn from them....

Maybe she tripped in the ER, and needed a 2nd slew of tests. Then of course, the only logical course of action would be to send the bill straight back to the Hospital that treated her.

[rainstorm83]

I do agree with everyone that from a professional standpoint you should always call and people have offered very good reasons as to why this is.

However, I don't think that would have changed what they believed to be the appropriate response. The fact is that they were concerned that she might have a broken cheek and wanted an x-ray. That is not likely to have been altered by the form of communication you used to discuss the incident with them. So, unless you pushed the daughter, sending you the bill was very optimistic on their part. I too taken my child the ER over an emergency that turned out to be something small. If their instinct told them it was serious, they weren't going to rest until they made sure she was okay. So, although they were upset by your form of communication, it did not cause their ER trip.

[BettyGirard, BSN]

I don't get this "I'm sending you the bill" thing. Any other option that would have ended up with the kid in the ER (you call mom, and mom takes her or you call 911 and they take her), they'd still get the bill (perhaps even higher).

[bergren]

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[SchoolNurseBSN]

From my experience, if it happens on the face, head, neck ALWAYS call to CYA! I also tell them about the head injury form I am sending home with their child. AND most importantly, make sure your documentation is very detailed!