School Nurse Perspectives     GerriSchoolNurse.com

 

Teachers Who Question Your Nursing Judgement

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By Gerri Harvey, RN. MEd. NCSN 

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Sometimes it is just about teachers needing time to build trust, especially if you are young or new. 

Sometimes it's about past experience with a nurse who sent every sniffle home. 
Sometimes it's about having had a parent upset with them for not sending their child to the nurse when the child asked. 

Sometimes it's about an overly-mothering philosophy, ie, "If this was my child, I would want him home resting."  

Sometimes it's about germ phobia, ie: "If I get sick I am holding you personally responsible."

Sometimes it's a Teacher Badge of Honor, ie "Fifteen of my students had to go home sick today! Poor me, right?""  

Sometimes, it's about not recognizing that theirs is a classroom from which kids constantly want to escape. 

Sometimes it's because certain kids wheedle to see the nice nurse and they just need them out of there so they can teach. 

Sometimes, it's a system issue, and the class has too many kids.

Sometimes it is about society today with many children needing adult attention for behavioral or unmet needs and there are 30 kids in the class. 

Sometimes, the teacher is just feeling on overload and wants you to DO something. 

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No matter what is behind the teacher who questions, the teacher who over-sends, the teacher who boomerangs the same kid right back, or the one who sends condescending notes, all of the above are stressful for you, the school nurse. Setting firm boundaries, ie refusing to change your position, going to the principal, sending nasty notes back, invoking policy are all  things we want to do in situations like this, but none of us really want to be in open warfare with out staff. But there are also some effective and professional ways you can address this frustrating issue. 

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First, keep in mind that you are not responsible for the teachers' competency in handling their classroom or their students, that is the principal's job. You are responsible for the well-being of the students. 

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Secondly, although you are there to ensure that children are safely in class and ready to learn, you are the professional support, not the enforcer to make sure children are in school learning. Enforcing is the principal's job.

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Thirdly, although it is easy to get into an adversarial position with staff about who can stay in class or not, using policy as a reason sends a message that policy trumps nursing assessment, begging the question do you really even need a nurse at all, or can the school secretary just refer to the policy and decide what to do?  The policies guide you, the nurse, but your teachers may not understand policy. 

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Some things to try if the child is well enough to be in class but the teacher keeps sending him back or wants him to go home.

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1. Assign each teacher a number. Only you know the number. Create a spread sheet and enter the monthly visits by teacher and grade.  At the end of the month, distribute the report titled "How Are We Doing?" to your teachers and principal. Let each teacher know their number privately, perhaps in an envelope in their mailboxes or by email. Perhaps give Kudo's to the healthiest classroom. This is professional, non-confrontational, non-embarrassing, non-punitive. When I did this, teachers who whose numbers were the highest came to me privately and said they had no idea. Also, let the principal come to ask you if he needs to know whose number is whose. Because that's really his job. 

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2. If you have boomerang kids who are driving the teacher crazy to see you over and over, try giving them recheck appointments. an hour or so out. Put it on the return to class slip. Tell the child they are not to ask to come before that time. Make those rechecks at times the kids don't want to miss, like recess, gym class, or before lunch. I will never forget the 5th grader who was laying down in my office feeling too sick for class (I was not yet convinced) who realized it was time for PE and asked if he could go to PE and come back after that class!

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3. Make house calls to the classroom if it appears that the entire class wants to see you (it's catching, you know!) Bring your stethoscope, thermometer, and note pad. Out in the hallway, triage the kids army style who say they need to see you. Make sure you smile at each kid you see and dont hesitate to tell them you are so proud of how healthy the kids in the class are. Take the rquestionable ones back to your office.

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4. If a teacher is pushing to send a kid home when your assessment is they are ok to stay, have one page best practice handouts pre-printed for the most common conditions like pink eyes, sniffles, and send them back with the child, but with a recheck appointment time to come back. 

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5. If you have insistant teachers about send-homes for any of the reasons listed above, especially if the teacher is one who calls parents for pick up herself, call the parent when you have the kid with you, let them know the complaint and your findings, and ask if they would prefer to come get their child or would they be comfortable with you rechecking the child in an hour. Most parents will even want to talk with the child. They know their children best. Then, let the teacher know you didn't come up with anything, but called the parent, who would like the child to stay and you will monitor. Give them a recheck time. 

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6. In the worst of cases, if you feel able to do this, ask to meet with the teacher privately at the end of the school day. Not confrontational, not boundary-setting-mad. Be on the teacher's side. Example: "I can see you are really concerned about (sniffly kids, SusieQ, kids needing to go home, etc) and I want to be supportive of you because I know you want those kids in class learning, and you are obviously concerned. Let's talk and see what we can come up with." 

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7. For those kids whose mission in life seems to be to get sent home, always assume there is something going on. Maybe it's happening at school, maybe it's happening at home. Maybe it's academic, maybe it's not. One school nurse I know used the term, "intentional interviewing" with the goal not just of keeping the child in class, but finding out why they didn't want to be there. That will help you in the next step, whether it is to talk with the school team or the parent. 

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8. Separation anxiety from parents, especially if something that distresses or worries the child is going on at home, is a powerful emotion, and is sometimes behind too many missed school days or constantly trying to get sent home. In my middle school, where I wrote Classroom Individual Health Plans for students with various health needs, I came up with a Frequent Flyer IHP. (I didn't call it that, but the teachers did!) I will have to say, it was one of the most effective tools I ever developed, relieveing the parents who were dealing with school avoidance and the teachers who were dealing with the same child in class. You might call it a School Attendance Support Plan or  SASP IHP. It involved the teachers, guidance, the parent, the child, sometimes the principal and me. I will post a copy of that plan within the next few days and anyone who would like to use it can get an editable copy from me. 

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I hope these ideas helpful.