What to do with Freq flyers?

topsyturvy · Nov 6, 2008

Hang in there! I have been a school nurse for 17 yrs and I still battle this problem. It is getting better for me though. Remember it is your clinic! Send a note to the teachers every year with what to send and not send. Send it with a bag of bandaids and a stack of referral forms. I use referral forms as a great way of communication to teachers and parents. It also helps cut down a little on FF because if the problem is that minor teachers will not take the time to write one out and I will not see a student without one unless it is a injury from PE or recess. Also I've had parents put a stop to thier kiddos making frequent trips to the nurse for nothing when they have gotten several parent copies of the referral. I could go on and on about this subject!!!!!

mustlovepoodles, RN · Nov 7, 2008

I haven't been a school nurse all that long, only 2 years, but I have gotten a pretty good handle of frequent flyers. In middle school kids learn to keep asking to go to the clinic until they find the teacher who's the soft touch. I require a hot pink pass, unless it's a true emergency, otherwise I send the child away.

If I see a student more than 4 times in a month for trivial or nonquantitative illness(headaches, stomachaches, don't feel good, etc.), I first ask the student why they think they keep coming inI let them know that I think they're coming in too much and I will be contacting all their teachers by email to let them know that. I also copy in their counselor and their principal. That usually puts the brakes on it.

If I continue to see the student after I've emailed the teacher, I touch base with the parent. If there is no medical reason for the child to keep coming to the clinic I send a Second Notice Email. The upshot of that is: I've already notified you once about this. If I keep seeing this student I will evaluate him AND take him to his principal. I have had exactly 3 students for whom I needed to go that far. Most principals aren't going to put up with this for long.

I'm lucky that I have some teachers who have a decent head on their shoulders. I know if they send a student, the kid has to be half dead. I also have a very few teachers who will send a kid for just about anything. I have one who would easily send 25 students a week, except that I keep tabs on her. If she exceeds 10 students in any 2 week period I send an email to her principal. :smokin: Problem solved.

On a separate note, however, frequent flyers don't always come for nuthin. I have accidentally uncovered child abuse and mental illness amongst students who were FFs, so that's one reason I email their principals and counselors. They need to know that a child is coming too often so they can look a little deeper themselves. It creates a team and the child only comes out on top. :nurse:

cowgirlBSN · Nov 7, 2008

Thanks for your help. I do need to send letters about what to send to the office. I guess I'm afraid of making enemies or people thinking that I don't want to do my job... so I don't speak up when I should!

SchoolNurseBSN · Nov 7, 2008

1. Call their parent every blessed time they walk in the door - this gets real annoying to the parent after a while and they threaten the kid with their life "do not go to that nurse again or I'll........."

2. If the student has been to the physician and no medical condition is found - I send a note to the teachers stating that he needs to be kept in class unless it is an emergency.

SchoolNurseBSN · Nov 7, 2008

Thanks for your help. I do need to send letters about what to send to the office. I guess I'm afraid of making enemies or people thinking that I don't want to do my job... so I don't speak up when I should!

I know it is hard - but we are in a position that if we don't speak up and let teachers know what are role is..........we will be taken advantage of.

topsyturvy · Nov 7, 2008

I know it is hard - but we are in a position that if we don't speak up and let teachers know what are role is..........we will be taken advantage of.

So True!!!! You have to run the clinic! Don't let the teachers run it for you. I was timid when I first started 17 yrs ago but not anymore. This is my clinic and we do things my way.

mustlovepoodles, RN · Nov 7, 2008

So True!!!! You have to run the clinic! Don't let the teachers run it for you. I was timid when I first started 17 yrs ago but not anymore. This is my clinic and we do things my way.

Absolutely! And keep in mind that you are probably the only healthcare expert in your school. Educators know education, not nursing. You set the rules, whatever you're comfortable with. Of course, it helps if your admins are on board--I give them a copy of any rules & regs that are going into effect in the clinic so they can help enforce it.

My volumes are high year-round, easily 55-65/day up to 110/day during flu and allergy seasons.) If I didn't set lunch breaks in stone I would never get one. And guess what happens? Miraculously, kids don't get sick between 12:15 and 1: 00! (and when they do you can bet your boots it's bad :uhoh3: ) Even if the worst happens at 12 o'clock I have made it clear that once the emergency is over I *will* have my 30 break.

Aneroo, LPN · Nov 8, 2008

On a separate note, however, frequent flyers don't always come for nuthin. I have accidentally uncovered child abuse and mental illness amongst students who were FFs, so that's one reason I email their principals and counselors. They need to know that a child is coming too often so they can look a little deeper themselves. It creates a team and the child only comes out on top.

I was going to add this as well. I have a lot of kids who try to test the water and see how much they can trust me. They'll come in for something trivial a few times, and then they drop the bomb on you (pregnancy, abuse, depression, STD). I had a coworker who sent an email to the teachers about what to send vs. what not to send- that is the biggest problem I have with it. You never know when they're lying to the teacher about a headache to really come talk to you about something big.

bergren · Nov 15, 2008

I posted this 3 years ago in allnurses.com:

The research (so far ) shows that when compared to the average student, frequent school health office users who do not have a chronic health condition :

usually female

a lower GPA

hungry

mental health problems and suicide ideation

been in a fight at school

High risk family situations and

high risk Peer relationships

in middle and high school have more high-risk behaviors such as alcohol use & sexual activity

in one urban study, 50% of frequent users knew someone who had been murdered.

CONCLUSION: studies suggest that frequent clinic users have significant health needs that may require a higher rate of utilization.

bergren · Jan 18, 2010

Journal of School Nursing offers OnlineFirst by which forthcoming articles are published online before they are scheduled to appear in print.

Frequent visitors: Somatization in school age children

In the 2010 Journal of School Nursing, Shannon, Bergren and Matthews describe the phenomenon of frequent visitors to the school health office with recurrent unexplained physical symptoms. This subset of students with medically unexplained symptoms accounts for disproportionate use of primary care and school health resources. Common somatic complaints in school-age children are associated with anxiety and depression, childhood adversity, and school stress. Effective approaches require identification, appropriate referral, screening for associated conditions, and individualized treatment plans. http://jsn.sagepub.com/cgi/content/abstract/1059840509356777v2

OncallRN · Jan 22, 2010

due to the small size of my school ( 260 kids pk3 to 8th grade) since my overall volume is moderate to low I try to think about why my FF are there.

they are there because of a problem... it my not really be a problem I can fix, but the child is looking for help. sometimes it's that they need a break from the classroom, sometimes the teacher need a break from the kid and their complaining.

I often tease the 2nd and 3rd grade teachers that they have a compition going for the lamest reasons for kids coming down to my office.

but I can imagine in a nurse has a high caseload of kid who need nursing care that the non issue become a burden.