12.3.13

Whose shoes do you want?

I'll be the first to admit my job is pretty easy sometimes, but I maintain that most people wouldn't want my job at other times. Today, Spitfire diabetic was absent, allowing me to get back to my other elementary school ten minutes early after lunch. I walked in to hear the secretary call my name and ask me to step in the main office for a few minutes. I found a student I didn't recognize in a wheelchair, appearing to only be semi-conscious. She had been running outside and ran into the side of a wall (don't ask me how kids do these things), reportedly lost consciousness, and needed assistance to get to the office. Dad had been called, but he'd only said he was going to try to track down mom with no promises of someone arriving, and the secretary had told him if he didn't get here quickly an ambulance would be called. Upon seeing me soon after hanging up the phone with dad, the secretary said with relief, "I'm so glad you're here, I didn't want to make that decision." 

I tried to talk with the student, and although she was oriented when answering questions, it was a challenge to keep her awake enough to do so. Just as I was opening my mouth to direct the secretary to call 9-1-1, the student's mom walked in. Ugh. She said she had insurance but it didn't cover ambulance rides, and that she would take the student to the hospital herself. In the next town. We told her the local emergency department was closer, and that she could still go to it, but the message wasn't getting across. The student's teacher was also present, and telling me that the student's lethargy seemed out of character. So, I made the executive decision, with mom standing there disagreeing with it, for the secretary to call 9-1-1. A few minutes later the paramedics were packing her up, and they were on their way. (We acknowledged that the student was oriented, but also lethargic. Mom protested that her daughter's always shy and lethargic.) Side note, I know I've finally reached the point of being quite comfortable and feeling competent at this job because I don't think my heart rate increased a beat through any of this. Two years ago I'd have been dripping sweat. 

Later, the principal asked me if I thought she had a concussion. I told him she'll probably be fine, but I don't take chances with head injuries. "Good call" were his words on it. When mom gets the bill for that ambulance ride, she'll be none too happy with me, but I'd rather have to deal with a dispute over money than the health of a kid. Regardless of the outcome of this situation, one thing is for certain: no one wanted to be in my shoes. 

8 comments:

  1. This comment has been removed by the author.

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  2. Hello Mrs. Nurse Blogger,

    You're right - you have a unique work and a unique blog! Thanks for these exciting stories (which I would otherwise ignore had they been written in a smug manner!).

    As an editor for Nursing Explorer (www.nursingexplorer.com), I know what it entails to accomplish a nursing degree and eventually build an impressive portfolio so I truly comprehend what you're going through.

    Thanks for your posts and I look forward to reading more posts from you soon!

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  3. Anonymous13/3/13 04:49

    Wow, what a difficult decision. Doesn't your school have insuracne that would pay for the studen's ambulance ride? Our school has accident insurance for each child which would kick in when regular insurance isn't available... It helps keep people happy when there is a question of who's fault an accident was etc. I hope that she is OK. Nancy

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  4. Anonymous13/3/13 11:21

    I'm sure it's possible, but insurance that doesn't cover emergent ambulance rides seems pretty odd to me. Most insurance companies know that patients fare better (and ultimately cost less) when they get faster emergency care. Not to mention that I think most insurance companies wouldn't want to be held liable if a patient didn't call an ambulance in an emergency because it wasn't covered by insurance.
    Also, remember that in most emergency depts, ambulance patients usually get seen before walk-in patients, because they can't turn away an ambulance but they can make walk-ins wait in the waiting room. If the mom took her to ER, the triage nurse would have noticed she was A&O x3, and mom would have told triage nurse her lethargy is normal- and then the kid could have sat 1-4 hours in the ER waiting room just to be seen. By calling the ambulance you ensured she was seen sooner, and also ensured the paramedics were able to pass on your assessment and the teacher's assessment of how she was acting differently. Good call.

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    1. Anonymous13/3/13 18:20

      Actually that is a common misconception. Stable patients that come by ambo can and do get sent to the waiting room. Any prudent triage nurse would get a patient seen quickly regardless of how they got there if they came with lethargy following a head trauma especially with a loss of consciousness.

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  5. You wear your shoes well!

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  6. Anonymous16/3/13 06:03

    Love your blog! I am also in the middle of an unhappy parent situation as a school nurse. It's always nice to have a clear conscience that what we're doing is the best thing for the student!

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