When do I get to stop questioning my decisions...

[Purple_Scrubs, BSN, RN]

...and when will others stop questioning them? Just curious for those of you who have been in school nursing for a long time. Does that little voice in the back of your head that questions your every call ever go away? Does your staff ever get confidence in your abilities and stop second guessing you?

I guess I should elaborate why I ask. Just today I had a student with a hand injury. Minor swelling, no bruising, but student insists he can't move the ring or pinkie fingers and insists he is in severe pain. I have that gut feeling he is exaggerating, but as a precaution I call home and advise that due to intense pain and inability to move it I recommend he see a doctor to see if an x-ray is needed. I hate that dad had to take off work to do this, but I don't have x-ray vision so as a CYA I referred. Not only am I second guessing it, but my principal got in a good eye roll about it (after he assessed the student himself, grrr).

Second, a PK special ed kid was brought to me with a cluster of small sores on his chin. Teacher thinks impetigo (but I think she believes any wound on the face is impetigo). The sores are not oozing, bleeding, crusting, etc. They just look like he has been scratching his face with sharp fingernails. He has another long scratch on his cheek that is clearly not an impetigo-type wound. Teacher wanted me to write a note that this is not impetigo and that she will not catch it. Um, no, I do not diagnose. I assess for the s/s of illness, follow CDC and district guidelines and refer when necessary. She insisted that I document somewhere that this was not impetigo. I kept repeating that it does not currently have the symptoms that would require a referral. Now, watch tomorrow he shows up with that honey-colored crust and I have to refer him. I just kept thinking that a doc would think I was nuts for referring scratches that are not weeping, crusting, etc.

It seems like every day I have that voice nagging at me wondering if I am making the right call. About as often there are others questioning my judgment. Does it ever stop?

[Flare, ASN, BSN]

We all have days when we second guess ourselves. I think i've been doing this for 8 years and I still wonder sometimes if I made the right call. The bottom line is that you make a desicion and hope it's right.

I've had the kids where you want to shine up an Oscar for their performance in "I think I broke it, the musical!" But at the end of the day i live by those three little letters you alluded to: CYA. Sure it's aggrivating that dad had to leave work. But if you didn't call him, i am sure he'd be upset with you. And maybe if the kid is just crying wolf dad will take a moment while driving him home from the ER to encourage him not to come to you unless it's a real injury.

As far as teachers questioning you or the crackpot that wanted a guarantee that the kid didn't have impetego - stay your course. I remind them that I am not a doctor and tell them that it is my judgement and not theirs. I've even had to get a little snippy in the past and remind them that i've been doing this a while and that I don't come into their classroom and tell them what grade i think a kid desreves.

Take the good days with the bad - as usual, you are in good company.

[Purple_Scrubs, BSN, RN]

I've had the kids where you want to shine up an Oscar for their performance in "I think I broke it, the musical!"

This made me LOL! Thanks for the smile, and for the sound advice, as always!

[BunnyBunnyBSNRN, ASN, BSN]

"I think I broke it, the musical!"

Thank you for starting my day with a laugh!