I've never been so pumped for a conference as I am for this one! First time in a 20+year career that I've seen a nursing conference host a 5k.
It's about time nursing world! Kudos to National Association of School Nursing for jump starting the national initiative of RN Health by walking the talk. Or running!
There are 2.8 million nurses in the United States- the nations largest group of health care professionals. We are striving to model self care and disease prevention by being physically active. It is powerful to watch groups of people show they mean it by putting words into action. In the case of school nurses, we are saying "Our health matters" "Your Health Matters" and so "Let's Move!".
Motivation can change so many aspects of our lives..and in a positive direction. Sometimes we are forced to examine what motivates us when faced with sad or life changing situations. Other times we are joyfully reminded of motivators when something wonderful happens.
How often do we look at what motivates us and use it purposefully? When thinking of happy, sad or life changing events- what motivates you? Was it something someone said or did? Was it a goal? An event?
RN Jessica Porter asked nurses via the Nasn (National Association of School Nurses) list serve how they would be celebrating School Nurse Day... Throwing all caution to the wind- I asked about the possibility of a virtual 5k, sure that no one would be interested. The virtual part was signing up on a 'live' google doc and then choosing whatever state, city, town or place you would walk/run. Nurses could watch the list of runner's/walkers grow each day.
Over 200 nurses from over 40 states participated in the virtual 5k, I was shocked and motivated! So many healthy nurses taking care of themselves with exercise and celebrating the students, staff and families we serve. The emails, comments and tweets that nurses sent me in regards to their virtual 5k day- left me speechless and motivated to keep moving every day.
Old School vs. New School Four legs, close to the ground and a chair? Nope. Not all the desks at Richmond Middle School are your typical furniture at which you plunk down for great lengths of time. Instead, you have a choice. A short desk (old school) or a tall desk (new school). A tall desk, as Richie Starr woodworking shop teacher calls it, is what I call a standing height desk. Mr. Starr guides students in planning and constructing community service class woodworking projects, tall desks can be requested by staff for their classrooms. Check out RMS creative woodworking classroom and the awesome tall desks they construct. Why The Makeover? A "Desk Makeover" seems to be taking hold for the health of it. Like all things in life, having choices makes for a much more pleasant experience. To sit or stand? In addition to choice, there is the healthy benefit of adjusting your position during a 40 minute period. Now I'm not suggesting you stand all day, moderation is key. Moving is key. Looking for a few fun reads on standing at work? How about: Is Sitting A Lethal Activity? and Five Benefits Of Standing Desks. Creative Health At Work Think you might try your own desk makeover? Here are two creative RMS tall desk "Make Overs" to inspire you. Robin Morley-Ploof (Administrative Assistant) and Judy Sterndale (Educational Assistant) made these desks themselves, ok so their husbands helped them a little bit. Look closely, one has a top that use to be a bowling alley floor (purchased at Vermont Salvage) and one table is store bought and modified to be tall. Have you seen a "Desk Makeover" at your place of work? I'd love to hear about it! Send me a message @rmsnurse #mydeskmo
Yesterday I met up with 900+ runners to give the Shamrock Shuffle 5k a go! Every year I look forward to the Shamrock Shuffle held in Lebanon New Hampshire. Here are some highlights.
Why my favorite race?
Location. Laughter. People. Post Race Party. Big race in a small town! Love the sense of excitement when 900+ people cram into tiny Lebanon NH for a 3mile race. The 30 minute drive to the race is just right. People wear the craziest fun outfits, it's impossible not to smile at some of them. Runners attracted to this race are so friendly and not hesitant to start a "running conversation" with a stranger. The post race party/raffle is epic, everyone gets a raffle ticket and has a chance to win. I've won some expensive awesome running gear over the years. Last year I won a pair of mens sz 11 running shoes, the guy next to me won a ladies purple Patagonia raincoat. We swapped. All was good.
This Guys Story
Speaking of runner stories. This guy was wearing a homemade pink tutu. I couldn't help but compliment him on his choice of running gear. He told me that he lost a bet and wearing the tutu was the result. We all lose sometimes, but it's how you handle the loss that matters. I think he did pretty well. Happy Running All! ps. see the guy in jeans? you can run in anything!
It's not a news flash that teens can have periods of rapid growth and pain. What might be interesting to know, is how this period of rapid growth combined with sports plays out in the school nurses office. A little background first, I serve a population of teenagers between the ages of 10-14 years old, in a district that has a thriving diverse sports program. Every sport imaginable. All year. On occasion both male and female students have presented with possible growth related pain, however males more often then females. Often a student (and it's usually an athlete playing 1-2 sports each season) will come to the health office initially because they are sore. I see them walking down the health office hallway with an altered gait, usually limping and with an expression of pain on their face. Most times they can point directly to the area that hurts. It's almost never described as a general all over pain. Sometimes there is swelling, tenderness and redness present in the painful leg/foot.
Now here is where my job as a school nurse always gets interesting. Most adolescence (developmentally appropriate by the way) do not fully understand their bodies yet, and are not able to communicate that they attribute their pain to one thing or another. Usually the complaint is that they have a specific pain and have NO idea why. I then ask students some carefully thought out open ended questions, examine their painful lower extremity and then attempt to put the pieces together. I spend some time going over anatomy and growth of their body combined with the impact of sports. We talk about ways to decrease the pain and prevent further injury. I contact the parent and relate what I've observed through examination, observation and conversation. I recommend an appointment with a pediatrician and to delay their child's sports or impact related activities until then.
After students are seen by their pediatricians, the two common diagnosis' I see are Sever's (primarily the heel) and Osgood-Schlatter (primarily the knee/shin). Generally speaking both are related to growth plates in the bone and over or frequent/repetitive use of leg/foot muscles/tendons. The result being pain, swelling and irritation of one or both legs or heels. Typically the student is monitored closely by a pediatrician or orthopedic doctor and treated with ice, medication, rest and physical therapy. Sometimes, a temporary cast is needed as well. Recently I read this article by Sports Medicine Pediatrician Dr. Loud, in which he advocates for a varied sports experience to decrease the physical impact on a growing body, I find this to be an excellent prevention strategy. Balancing the health benefits of being a student athlete with an eye for moderation can help reduce some 'growing pains' and or injuries. I enjoy helping student athletes explore their symptoms and find the right medical resource so they may get back on track!
Stress...the great equalizer. We've all got some! "Stress Management" seems daunting when you consider the many aspects of life we all manage on a day-to-day basis. Like a flooded river, stress can seep into all aspects of ones life and swallow up a person’s ability to see through the fresh lens that’s needed for each day. 27 staff at Richmond Middle School in Hanover NH completed an entire week of focusing on relaxing for 10 minutes each day. Although 10 minutes seems like a relatively short period of time to de-stress, it’s a starting point. And sometimes just starting is the hardest part. When I was training the first time for a half marathon, I chose finishing as my goal even if it took me forever to finish. Nothing wrong with setting the bar low and attainable. Some wellness experts say that making attainable tiny goals or habits can lead to the most success for people seeking change.
Last year when our staff did this wellness challenge I did not seek out weekly feedback, this year that changed! Week 2 staff "Stress Management" reflection highlights: -Taking time each evening to pet the family dog was a favorite for one staff member -A night without power was found to be refreshing, relaxing and allowed for some enjoyable reading. Unplugged tech free time using candles and flash lights! -Noticing that practicing relaxation activities before bed led to a smooth transition for sleep. -Scheduling time for self felt rewarding and appreciated that it was "required" -A moment to recall what was enjoyable to them and activities they wanted to try but hadn't
Stress. We've all got some. But how do we manage it? Here's to managing our stress in the new year and building tiny successful goals.
RMS teacher Patti Dodds & Family relaxing with their Dog.
Sir Isaac Newton, The Bathroom & Aqua Man all had their place in week one of our workplace wellness challenge. "For every action, there is an equal and opposite reaction" ...and this holds true for drinking lots of water at work (I'm talking a boat load of h2o, like half your body weight in ounces). Sir Isaac Newton probably didn't have water consumption in mind for equal and opposite reactions, but I can assure you for every 25 ounces of water taken in...I'll spare you all but one detail. By 10am Monday morning, one of our staff bathrooms was out of toilet paper. The kidneys were getting a healthy workout and I think our maintenance department should thank us for testing the strength of our septic system. I believe some of our staff developed "Aquaman" superpowers, a sudden ability to hear complaints and questions from students before they spoke or raised their hands. While others were on the verge of sprouting fins. The wellness challenge always generates enthusiasm and hope for better health, but humor and superpowers were two surprise additions. Follow our challenge here on my blog as we continue week 2 of 5, where we focus on..."Stress Management". Good times are ahead! Right?!? ps. some of the staff were feeling so amazing from their millions of gallons of water intake, that they shared their thoughts with us. Check it out!
Remember when flu season use to arrive around the same time every year? No? Me neither! Some years the flu virus arrives very early in September and other years it appears like March Madness. Thus the planning for flu clinics happens early on in the school year, a prevention attempt to cross the finish line before the virus. The race is on.
Richmond Middle School Health Office will be coordinating a Free Flu Vaccine Clinic with The New Hampshire Immunization Program (NHIP) and partnership between Dartmouth Hitchcock and The Upper Valley Public Health Emergency Preparedness Coordinator. Whew, it takes a village of people and organizations (with really long titles!)...and Registered Nurses who know the students. The NHIP supplies the vaccines, protocols, training and standing orders for our student clinic, as well as three vaccinators (EMT’s).
The above-mentioned organizations rely on Registered Nurses working in schools, to manage critical details that make or break the success of a student flu clinic. I have found the same set up and rules for an adult flu clinic do not work for kids and especially in a school building. Factors such as schedule, time of day, health history, peers, privacy, fear, trust and how to be efficient and safe all play in to a successful vaccination clinic. Imagine having over 200 preteen and teen students all in one big room watching each other get their flu vaccine… this I try to avoid for obvious reasons. Here are some factors I find important to consider when planning a student flu vaccine clinic.
Education. Prior to the clinic (and through out the school year) there is often time to educate students and staff on the WHY of flu vaccine clinics. Nice to know why most times right? Guest speaker/interaction in science class is one way to achieve this as a school nurse. Also important is a comfortable private setting with adults that teens recognize. Parent volunteers greet students, assist with paperwork, talk with them, ease any fears and make sure students feel comfortable. I am grateful to parents and teachers that assist, as student faces light up when they see trusted community members/parents and staff.
And as a parent myself, its wonderful to see a teen sent out the door to school (wanting "space”) still finds comfort in a parent now and then! Thanks parents and community resources for making theses clinics possible! Here's some data that I find interesting to reflect on as I plan this years clinic:
*6000 students from 101 New Hampshire public schools received a flu vaccination during the school day (2013 NHIP). *NH had a total of 411 elementary and secondary public schools in 2012 (ed.gov) *23% of 400 RMS students participated in last years flu clinic (I believe our school vaccination rate for flu to be much higher then this. Many students receive their vaccination at their doctors office or public weekend clinics. RMS is less then a 5 minute drive to many medical practices.)
*We administered both nasal and injectable flu vaccines at our school clinic.
A few questions never get old...and sometimes I hear them often. A sense of humor while reading this? Highly recommended. (Let’s frame this a little. I’m talking questions from 11-14 year olds and adults over 21yo)
What Is This? Sometimes I don’t even make it from the health office to homeroom before a flying arm or leg ends up within inches of my eyes for inspection. This is middle school, so yeah we are all still trying to figure out space sometimes! “Hmmm…”, one of my favorite responses to the hallway mystery. But seriously, this is one of my favorite questions, I love the required detective like skills need for some health issues and finding answers is NEVER EVER boring. Sometimes I know the answer to the mystery and sometimes I don’t. Recognizing most common illnesses/diseases/infections and when to say “This needs further attention”..that's what school nurses do so well. Often I am referring teens or adults to a Doctor or Nurse Practitioner or simply reassuring students/staff that it’s ok and this too shall pass. Other times I see people daily to help care for a minor ailment that could be major if they didn’t have access to a Registered Nurse during the school day. And sometimes I am sending someone to the hospital for emergent care. What Is This? This is my favorite question.
Am I Ok? So mostly this is a question I hear from 11-14 year olds, but honestly don’t we all wonder this sometimes? Developmentally and physically, teens sometimes(?!) change at rapid rates. Its hard to know from one month to the next what is normal when your shoe size changes from an eight to a ten in four months. Or when you grow six inches in two months. Or getting ten hours of sleep but feeling like you could sleep for another five. Or just needing space. Am I Ok? This question gets a lot of air time in many school health offices all over the word.
Do You Hand Out BandAids All Day? First of all if you ask a school nurse this, you might want to duck! Just kidding you won’t get hurt but you might see steam pouring out from the top of their head. Sometimes I don’t even want to use the term “School Nurse” due to the association of being a bandaid dispenser. Often I introduce myself to students/staff and community members as “Abby, the Registered Nurse who runs the Richmond Middle School Health Office”. School nurses are often independent in their roles (I am the only health care professional in a building of about 500 people). School Nurses manage office budgets, screen and monitor for illness, educate, assess emergent situations, anticipate potential safety issues and enable teachers to do what they do best. Teach. So yeah, I do hand out bandaids. Just not all day :0)
The 10 minute mile run is my happy place and 5K’s always seem to embrace that. Short and sweet, enough exercise to get your heart pumping, enjoy the outdoors and get home in time for something else. But I’ve ventured outside the 5K club twice now, once last year (SmuttyNose) and this year at the Twin Lobster Half. I can no longer say I only run 5K’s, however they are still my favorite (sorry distance runners!).
I have a like/dislike relationship with the 13.1 mile race. Like because the feeling of finishing something so strenuous is overwhelming. Like because the body feels strong and healthy with such dedicated training. Love because running that many miles make me crave pizza. Like because some day I won’t be able to do this.
Dislike because the port o potty lines are always ridiculously long. Dislike because I spend less time with my family (12-14 week training with long runs on the weekend).
So I guess the likes outnumber the dislikes and that’s why I ran another half marathon in June this year. Plus I like to think that I could inspire other average runners (ok. slow) to pursue the longer races. You can do it! The 10 minute mile and over runners are my favorite group, you guys rock! Happy Running.
Sugar? YES. Students with diabetes can eat the same healthy diet that everyone 'should' eat. Large amount of some foods (such as sugar & carbohydrates) that are not covered with injectable insulin can be harmful over time for students with diabetes. If you see a diabetic student eating an occasional cupcake or candy, it’s ok. However, large amounts of sugar/carbohydrates every day can lead to long term health problems. Most times students with diabetes will be covering their sugar or carbohydrate intake with injectable insulin. Please check with your school nurse if you have a health observations or concern. Some teens with type 1 diabetes check in with the school nurse at least once per day if not 2-3 times.
Living with Diabetes Most teens living with Type 1 diabetes either have a continuous insulin pump or give themselves insulin injections. Everyday (no vacation!) diabetic teens endure needle sticks 4-8+ times per day. Some nights they must wake up through out the night for blood sugar maintenance. Patience and understanding of “Living With Diabetes” is greatly appreciated. I honestly don't know how teens living with diabetes do it! But they do. Most adapt and move forward with the never ending injections, carbohydrate counting, doctor appointments, occasional lack of sleep, blood sugar testing and every day life of attending school as a teen. Discretion Please know the signs and symptoms of hypoglycemia and hyperglycemia in case a student needs your assistance and talk to them with privacy in mind. Teens are appreciative that you are looking out for them and learn best when they feel safe and respected. Middle schools students (especially) with diabetes value their independence and want to “fit in”. Discretion via talking privately with the school nurse, student or family is a must for a teens healthy identity and over all compliance with diabetic care.
Why Tweet? Simply put, I thrive on branching out from what I already know and sharing what I've learned or general thoughts with children, families and communities I work with. I am learning every time I read my time line or interact with a follower or a post that seems interesting. That’s why I’ve remained a “Tweeter”. I want quick snippets of information that I can make note of and go back to later for more in depth info. This is twitter for me. I go down lots of rabbit paths, learn unintentional things, open new doors and bring it all back to what I do as a nurse, parent and community member. How Did Twitter Start At Richmond Middle School? The initial venture into twitter began with then Vice Principal and now Principal @mlepene and then Media Specialist @rickshawlibrary at our middle school (www.richmondmiddleschool.org). Both were enthusiastically supporting twitter as a learning tool and a way to connect with community, professionals and well….The World. I was shocked. This kind of encouragement was progressive. The most I’ve seen about educators and/or health care professionals and social media were policies and employee contracts stating what one may NOT do. Personally I’ve yet to see a guideline or policy on “How to Promote What You Do via Social Media”. I like this positive spin and think that our teaching staff using twitter are well on their way to creating this path. Leaders who promote learning beyond meetings, conferences and encourage staff to explore the networks beyond walls and seats, Thank you. Notes From Two Years of Tweeting As A Nurse I kept a paper notebook for two years and jotted down anything that seemed noteworthy while tweeting. Here are a few highlights in a random readers digest like style.
Twitter Notes………. -Twitter consists of concise, abbreviated thoughts and ideas
-Tweet chats. You might be surprised by who joins in. Patients, students, teachers, families, administrators, anyone, everyone. It gets interesting. My brain spins for days with thoughts after an intriguing chat. Different from conferences where say everyone is a doctor or a nurse. So many perspectives!
-Hash tag (#) makes it easy to follow groups, ideas, and topics. Sometimes I’ll use the search button this way to follow topics I’m curious about.
-Fast Information. Really fast.
-Create lists so that you can quickly scan certain groups. I currently have two lists going. One is RMS Staff and the other is USA school nurses.
-Learn how to block and/or report people. Just like anything, be prepared. It happens.
-Network. Interact. Reflect. Ask Questions
-Follow other disciplines besides your own. Learn from others. Reach outside the comfort zone. To Tweet or Not To Tweet? From a personal and professional experience over a two year period. I can say “Thumbs up”. Tweet with the knowledge and professionalism that you already display at work everyday. The Rabbit Paths of learning await you. Ps. Thank You RMS Staff for extending the learning beyond the walls! @RMSHanover, @mlepene, @RMSYates, @rmsguidance, @pdiddydodds, @anissaVT, @batkinson_PE, @RMSPhysicalEdu, @Joshhall953, @cbalch, @JoDeLora, @JoanneR123, @rmsnurse
What was the hold up? I was feeling impatient as I finished my Saturday morning shopping. I was at the register and the line was not moving. A young man in front of me appeared to be discussing a product with the cashier. Here's how the conversation went. The customer asked the cashier about the e-cigarettes he could see from the register while checking out. Quickly the conversation went in a direction that as a health care provider I hope someday some how will change. The cashier explained how e-cigarettes came with all kinds of accessories, even a car charger. All the bells and whistles or "features" were discussed. Here is the where I imagine uninvited comments from health care providers while shopping probably are not everyones cup of tea. So I held my tongue. I realize that some if not most people do know the facts/risks about certain products they might purchase. But a moment of opportunity right before the purchase remains. A moment to empower the buyer with true evidence based information. And a fair opportunity to make a choice after reviewing known health facts. I wish the following. When customers ask employees about a potentially harmful product, employees would be required to give the customer a handout with known health facts and/or warnings. I'm not sure this will ever happen. So I'm passing along the information here. A quick one-page info sheet on e-cigarettes provided by the Vermont Department of Health. Here's to Saturday morning shopping, conversations and informed choices.
Polio 1916, Iron Lung and Chickenpox. Images via Historyofvaccines.org
I got an invitation I could not refuse last week! The invite involved a room full of 12 & 13 year old students and disease. Two of my favorite subjects! Mr. Schluntz and Mrs. Schaner (7th grade science teachers) recently invited me to their classes to talk about disease. When teachers ask if I will come talk with a class, I don't often think "What am I going to tell them?" I think "I can't wait to learn with them!". Students and I discussed what an outbreak might look like here at Richmond MIddle School, how monitoring immunization records impacts a schools population, herd immunity, vaccines, pathogens and at times we even got a little off track as we were so curious! We watched a video simulation of Herd Immunity. See it here. Reviewed and discussed pictures of vaccine preventable diseases (via historyofvaccines.org and Ms. Schaners own research) Discussed student observations from playing the vaccine preventable disease game Pox. Read about the game here. I also shared my own disease outbreak story about contracting the chickenpox virus as a new nurse and how the hospital I worked for responded. Throughout our discussions, some of the questions students asked: "Do they still vaccinate for small pox?" "Why do you have to have multiple vaccines for one disease?" "Can you get chicken pox more then once?" "Have you taken care of children with vaccine preventable diseases in the hospital?" All great questions that indicate a level of interest, knowledge and desire to learn more. I suspect some of these questions will help fuel a cool assignment that Mr. Schlunz has assigned his class: "Outbreak at RMS". Students will be researching a disease and creating a case study that could happen at school. The very last day of joining the science students, Mrs. Schaner and I had a great conversation about medicine, science and that 'ah ha' moment when students might decide "this is what I'm interested in". We talked about encouraging students to be curious, and to ask "why not?"....which leaves me sharing this great blog post: "The Changing Face Of Medicine" by Minerva Arenas. I hope all students ask "why not" and follow their passions in learning.