NURSE’S STATION Are You Working Too Hard? Georgia P. Macdonough, MA, SNP Many school nurses complain, “I work so much overtime, bring things home to finish up, and still always feel I’m far behind.” Experience has shown that busy people can accomplish their jobs more easily if they stop working too hard. Each of us has her own style of working, so the more control you can get over how you approach your job, when you are able to do particular tasks, the better you’ll be able to produce. Record keeping seems to evoke the majority of complaints from school nurses who insist that they are wallowing in paper work. Let us consider, therefore, why record keeping is necessary. Each student must have a cumulative health record established with first enrollment. Information gathered from parental history, physical assessment, developmental evaluation and documents from clinic or physician establish the data base for health services for the remainder of this student’s school career. This record enables the nurse to identify students with particular health problems as well as those at risk for immunizable diseases. The record serves as a method of communication between the school nurse and other faculty members concerned with the student. It also provides a means of educating the student and his parents about his changing health status, his needs and his progression. This record documents the kind of care which has been provided for the student, clearly outlining the types of intervention which proved successful as well as methods which were unacceptable to this student or his family. Records provide statistical information which may be used for official reports or for research projects that the school nurse might be interested in. Records also assist the nurse in long-
and short-term planning. In addition, records can be used to do a nursing audit. By reviewing records, the actual performance of care can be analyzed against a previously agreed upon standard to determine a level of quality. An office management approach allowing for necessary update of information and tracking of referrals for follow-up can be accomplished through the use of a “tickler file” instead of the use of multiple lists of “to do” tasks. The tickler file is organized by date with a subsidiary color code system. A file is set up with primary monthly guides and one or two sets of secondary guides - specifically weeks of the month or days of the month. The color code or subsidiary system designates a particular illness or other concern. A statewide system of identification of unimmunized or underimmunized students is working for Arizona and other areas of the United States. Blue tag, for example, denotes the student at risk for polio. To clarify this system, we will suppose that Nathan Jones has a vision problem. When first screened, Nathan’s visual acuity was 20/40 20170. The nurse plans to recheck him in two weeks in case this was due to an illness of some kind. Nathan’s health record is placed in the tickler file at the appropriate date. An “Out” card is placed in the regular file drawer noting Nathan’s name and the date under which his record can be retrieved. As the school nurse checks the tickler each morning, she will retest Nathan as originally planned. If he fails again, this will be noted on his cumulative record; and his parents will be notified. The record will be moved to the date a week away and notation made on the “Out” card.
When this date arrives, she will check with the parent to determine what action has been taken. With this contact, the nurse finds the family has need for community assistance. Note is made on the cumulative record, proper referral accomplished, and the record is moved to an appropriate date for follow-up. The “Out” card is changed to indicate the new date. This process is repeated until the problem is resolved. This system allows the nurse to keep on top of many concurrent problems with large numbers of students, ensuring they do not get lost in the shuffle. Planned work is almost always more efficient than unplanned. Pacing yourself also helps to make your work more fun as well as productive. Failure to make decisions is another thief of our time and energy. Worrying about the pros and cons of a situation takes up time that can be used more productively. If you’re faced with this situation, make your decision; you won’t be wrong any more often than if you worry about it for a week. By doing your work before a deadline, you can eliminate wasted time and effort. If you know a report is due at the conclusion of school, cumulative figures can be collected during the entire school year for completion during the last week. Don’t forget to seek help when you need it. Volunteers can do routine tasks while you do the critical jobs. Your high standards will not be compromised. You’re working too hard if you feel subdued by your job or if your work saps off the time and energy you would devote to your family, your hobbies and yourself. Resolve to better manage your time and then reward yourself for a job well done.
and short-term planning. In addition, records can be used to do a nursing audit. By reviewing records, the actual performance of care can be analyzed against a previously agreed upon standard to determine a level of quality. An office management approach allowing for necessary update of information and tracking of referrals for follow-up can be accomplished through the use of a “tickler file” instead of the use of multiple lists of “to do” tasks. The tickler file is organized by date with a subsidiary color code system. A file is set up with primary monthly guides and one or two sets of secondary guides - specifically weeks of the month or days of the month. The color code or subsidiary system designates a particular illness or other concern. A statewide system of identification of unimmunized or underimmunized students is working for Arizona and other areas of the United States. Blue tag, for example, denotes the student at risk for polio. To clarify this system, we will suppose that Nathan Jones has a vision problem. When first screened, Nathan’s visual acuity was 20/40 20170. The nurse plans to recheck him in two weeks in case this was due to an illness of some kind. Nathan’s health record is placed in the tickler file at the appropriate date. An “Out” card is placed in the regular file drawer noting Nathan’s name and the date under which his record can be retrieved. As the school nurse checks the tickler each morning, she will retest Nathan as originally planned. If he fails again, this will be noted on his cumulative record; and his parents will be notified. The record will be moved to the date a week away and notation made on the “Out” card.
When this date arrives, she will check with the parent to determine what action has been taken. With this contact, the nurse finds the family has need for community assistance. Note is made on the cumulative record, proper referral accomplished, and the record is moved to an appropriate date for follow-up. The “Out” card is changed to indicate the new date. This process is repeated until the problem is resolved. This system allows the nurse to keep on top of many concurrent problems with large numbers of students, ensuring they do not get lost in the shuffle. Planned work is almost always more efficient than unplanned. Pacing yourself also helps to make your work more fun as well as productive. Failure to make decisions is another thief of our time and energy. Worrying about the pros and cons of a situation takes up time that can be used more productively. If you’re faced with this situation, make your decision; you won’t be wrong any more often than if you worry about it for a week. By doing your work before a deadline, you can eliminate wasted time and effort. If you know a report is due at the conclusion of school, cumulative figures can be collected during the entire school year for completion during the last week. Don’t forget to seek help when you need it. Volunteers can do routine tasks while you do the critical jobs. Your high standards will not be compromised. You’re working too hard if you feel subdued by your job or if your work saps off the time and energy you would devote to your family, your hobbies and yourself. Resolve to better manage your time and then reward yourself for a job well done.
