A question I’ve seen asked by a few CSN’s recently is “How do I know when a student should be sent home versus sent back to class?” Is there a specific formula to make that decision? The short answer is no. Every situation is individual and every kid has different needs so what might send one kid home might not send another kid home.
Before I get into specific guidelines to consider, I want to point out two things: 1. Listen to your teachers. They are with these students most of the day and they know when they are not themselves. Often the students trust the teachers and confide in them if something needs addressing. Don’t just assume that the teachers are “trying to do your job” because most of the time they are just trying to do theirs. It’s a team effort. And 2. You’re the boss of your health room. Don’t feel pressured into sending students home or keeping them at school. You do your assessment, you make the medical decisions.
Sending a student home should be considered when the health issue is impacting their ability to learn in class.
So here are some basic guidelines that can be used to decide if they should stay or if they should go. This is not an exhaustive list as it is dependent on the student at the time.
Fever: If the student has a fever over 100.4 they should go home (in some places the rule is still 100.0 because of Covid). In most schools they should not return until they are fever free for 24 hours with no fever reducing medications. They should not be given fever reducing medications and sent to school, or be given medication and sent back to class. Also consider Covid testing.
Excessive coughing: cough unrelated to known asthma or allergies that is disruptive and causes inability to focus on class. If they are coughing up a lung and miserable then send them home. Check a temp and consider Covid testing.
Vomiting or diarrhea: If a student is vomiting due to sickness they should go home. Often you will find little ones that saw something gross that made them throw up, or they gagged on their food and have a low threshold for vomiting – in cases like that they can get themselves together and return to class. Consider how they look (pale, clammy, feverish, in pain, etc), how they report that they feel (tummy hurts? Gonna throw up again?). Check a temp and consider Covid testing. If the student is having diarrhea they should be sent home.
Needs emergency care: Injuries that require sutures should be picked up as soon as possible and have that addressed immediately. Broken bones or suspected broken bones should be picked up as soon as possible for emergency evaluation. Anything that requires the activation of EMS for the problem obviously should not be in school ie: anaphylaxis, use of Epinephrine, asthma attack that is difficult to control,
communicable disease (diagnosed or suspected): Obviously we can’t diagnose but there are a few things that we can send home for suspected concern such as suspected pinkeye, suspected scabies, suspected strep throat, lice – per your district policy as many districts are not excluding immediately for lice, and obviously Covid if they are tested at school and test positive.
Pinkeye: while we can’t diagnose pinkeye we can assess for the obvious signs for it such as eye redness, swelling, copious discharge, intense itching, and pull down the lower eyelid to look for increased redness or swelling inside the lower eyelid. Pinkeye can be viral or bacterial but we won’t know until they see a doctor. Due to it’s highly contagious nature, the student should be sent home to be evaluated.
Seizure: While not all seizures require the student to be sent home, some can. In general, absence seizures are fairly benign and the student can continue their day. Some grand mal seizures can cause the student to urinate or defecate on themselves, or require emergency medications or EMS calls in which cases they should obviously be sent home. Some students who have a seizure may be postictal but be allowed to remain at school. That is an individual issue that should be addressed with the parent and student as part of their action plan.
Asthma: most of the time a student with an asthma flare can be treated and return to class. On occasion the measures at school are not enough to treat the flare and the student may need to be picked up to be closely monitored by their guardian and possibly seek medical care or use their nebulizer at home.
Diabetic Emergencies: high and low blood sugars can generally be treated at school and the student can return to class when stable but if they are having a difficult day with managing or they are very out of control and symptomatic then the parent can be called to pick them up to closely monitor at home and/or seek medical care (or EMS if appropriate)
Certain head injuries: obviously minor head bumps do not need to be sent home but a more severe head injury with other symptoms such as change in consciousness, needs sutures, severe pain, or dizziness would need to either be sent home with parent for medical evaluation or sent to hospital.
Sickle Cell crisis: Often sickle cell issues can be managed at school with a little bit of rest, hydration and Tylenol but if the symptoms are more severe or not settling with the usual measures then the student should be sent home. If a Sickle Cell student develops a fever the parent should be notified immediately as per their action plan.
Covid: Districts all have varying rules regarding Covid protocols but in general if a student tests negative at school but is symptomatic then they should be sent home to see the doctor and have a PCR test or an alternative diagnosis.
CSN’s clinical judgement: The CSN is here to make these decisions. If the nurse examines the student and feels that they are sick and need to be sent home then there you have it. Sometimes the nurse (and teacher) knows that the student is not a complainer or that they don’t look right or seem like themselves.
Again, this is not an exhaustive list of when to send a student home. Most of the time it’s a judgement call but your safest bet is to call the parent and let them decide what they want to do if you are unsure if they should stay or go. Districts all have varying guidelines as to certain protocols like lice and covid so look into the specific protocol for your district or state to be sure.
Would you add anything to this list? Message me and let me know what you think!
