When I first started out in camp nursing, I wanted to read every resource. I was desperate to get a jump on my new job. Even after my first year I was looking for information to help me master some of the finer points of camp nursing. I found a few great resources, that I would like to share with you.
The first book that I read was The Basics of Camp Nursing, by Linda Erceg. This book is the bible of US camp nursing. It walks you through the entire process of setting up and managing a camp health center as a primary nurse. This is an absolute must read, especially if you're just starting out in camp nursing. In my opinion a copy of this should be be in every health center. If you ever attend an ACN conference be sure to take your copy along for Linda to sign.
Another excellent resource is Camp Nursing-Circles of Care by Mary Casey This book is as much about the nuts and bolts of camp nursing as it is about where the nurse fits into the big picture at camp. It really does a good job explaining the nurses role, and explores legal issues and procedures to a slightly better degree than other books. The only issue to be aware of is that it was written with nurses based in Canada in mind, but that is not incredibly noticeable.
An excellent lighter read is Camp Nurse: My Adventures in Summer Camp, by Tilda Shalof . Tilda is a very experienced nurse who chronicles her journey at a few different camps, over several years. All the stories, personalities, and weirdness that she encountered is here in print. I often wish that my time on camps was as exciting as hers. Although I have run into some interesting stories over the years. It's a must read as it is an inside glance into the personal and professional experience in camp, rather than an informational manual.
I hope you are able to take the time to read one or more of these excellent books. If you have any other suggestions about good books for camp nurses please let me know at firstname.lastname@example.org
S'mores and Sanitizer is a blog run by contributor Susan Sultzman. It can be found here This content was created on 6/24/14
It’s 6:30am but I’ve been up for an hour already. The three beautiful windows in my small room in the back corner of the Health Center lets in the early summer light and wakes me up early. The curtains, which clearly date back to the 70’s, are not much help in blocking the light, but they sure make my room look groovy. After three days of greeting the dawn personally, I add “sleep mask” to my list of things to buy when I make my way into town.
I love a short commute to work, so this year I’ve hit the jackpot. Instead of a room at the lodge, I am living in the Health Center due to a change in my job description. I’m now the night nurse 6 nights a week, so it makes no sense to have a room in the Lodge that I will never sleep in. I’m perfectly okay w this; I’m a night owl anyway and the other two nurses are not. I’m on duty 8p-8a and I do get to sleep (albeit lightly) if there are no pressing concerns. Last year I had only one sleepless night with a sick kid in five weeks.
So after all the meds are distributed, boo boos cared for, floors swept, trash put out, the day’s visits entered into the computer, and tomorrow’s meds pulled, I close the HC doors, leave the porch light on, and retire at about midnight.
The memory of my 6-night a week third shift schedule that I worked during the long, cold, extremely snowy winter is effortlessly blocked out from my memory and I sit alone now at the cold fire circle listening to the birds and watching the chipmunks scurry about. Two chipmunks were just dashing around the fire circle, oblivious to my presence, until they both just crashed into my hot pink Croc.
This is day 2 with the campers. My role with the camp is still evolving; during the day I’m doing all sorts of things. Yesterday I did some office work and made some calls to parents who have not yet sent in paperwork. This year I can expect to do a bit of everything, as I’m slated to be a jack-of-all-trades during the day. The first camp bell just rang, almost time for breakfast. I have no idea what today will bring!
When I put up this website my idea was to make a purely informational site, to support camp nurses of all levels of experience. I began to realize that many of the posts that I put up are opinion pieces to one degree or another. It seems unfair to offer my opinion without telling the world a bit about me and my experience. Here is part two of my life experience with camp nursing.
In 2012, I returned to IHC. I felt I wanted a second round with this thing. While 2011 was a pretty good year, I spend half of it not knowing a Comanche from a Chief; I got it all done, but I knew I could do better. This year was my victory lap, my great adventure. I felt confident in the job and myself. After leaving camp in 2011 I started online dating, which was a big jump for me. I had never really dated before “I'm not ready to settle down so why bother”, was my way of thinking. I met my wife, Sara, on the first date I went on. We hit it off immediately, and one of the first things I made clear was that I was going to camp. For us, long distance dating for a few months was kind of fun. We exchanged letters, and she even came up for a visit on my day off where we escaped to a local B&B. She visited around camp and met all the characters that I had been telling her about. The year was amazing. The staff was awesome, we worked together well, there were no major issues in the health center or the camp, it was a year of unusual calm. So calm in fact we all played a lot of cards to pass the time.
2013 was another great camp year. We called it 2012 part two. A lot of returning staff made start-up a breeze. Which was good because there were major issues when the camp tried to switch pharmacy vendors. We didn't get our drugs delivered until the day before the kids arrived. If there had not been so many staff who already know how to set up the meds we would have been in a real bind. A major outbreak of impetigo led to the creation of the scrub club, a tactic that we haven't had to employ again thankfully. Sara and I were married about a month before camp started, and had a short first honeymoon due to a cruise ship mishap. We managed to get a few visits with each other over the summer. My coworkers even threw us a camp wedding in the health center with a heart shaped caked topped with tongue depressor bride and groom. On the home front though my parents were beginning to have issues. In 2006 my father had been diagnosed with cerebral amyloid angiopathy. This had caused him to have a series of strokes, rapidly leading to his full disability. As his health declined my mother became his full-time caregiver, which absolutely didn't help her mental health. They attempted to move in with my brother, who ended up evicting them a week before our wedding. Getting them moved and settled prior to camp was very stressful. Sara and my aunt helped them out while I was away and I called my mother to check in several times a week. It seemed to go fairly well, but being far away when help was needed was a major stress.
2014 was a pretty normal camp year, as far as the business of camp and the health center went. No major conflicts or issues that I can recall. Truthfully my body was on camp but my mind was everyplace else. Sara and I had decided to try for a baby, with great results. She got pregnant the first month we started trying and was about two months along by the time camp rolled around. The thought of being a father was unexpectedly hard for me. I had been depressed on and off for most of the year and the upcoming change in roles was impossible to wrap my head around. I got a lot of good advice from an amazing nurse, Cody, about parenting and fatherhood, as well as from my boss and her husband. Watching them with their kids around camp was the most reassuring thing to me, that they obviously made the whole family thing work, and so could I. My parents had moved into a senior living/disability friendly apartment complex; however the situation surrounding the care of my father was tenuous by the time I left for camp. Things had been fairly good when I signed the contract for 2014, but in the months in-between my mother's mental health was becoming even worse, and although my father was still well cared for, no one was sure how long the situation could last. The plan again was to have Sara and my aunt help out and for me to call frequently. There were issues almost from the start, but they were minor and able to be handled without me. I was constantly worried, and just waiting for the phone call saying that I had to come home right now because of some emergency. In the last week of camp, things became even worse on the home front. Once the campers were on the bus home I was packed and driving within an hour. When I arrived home I ended up moving in with my parents for about a week, and ultimately checking my mother into the hospital for five weeks, and placed my father into a LTC facility. (As of the date of this post my mother is doing much better,living independently and in much better control of her disease process. My father remains in LTC on hospice)
2015 was the first year that I was not able to return to Indian Head Camp for a full 9 week season. My son William was only six months old at the start of camp, so I decided to spend a few weeks at IHC helping them get set up and train the new nurses. After two weeks at IHC, I decided to take a camp position closer to home. I worked at the John Hopkins Center for Talented Youth (CTY) Lancaster location. CTY was a very different organization than IHC. The students were all there to take high-level classes, like Data Structures and Algorithms, Paleobiology, or Number Theory. Every student was extraordinarily intelligent, to an unbelievable level. I was hired as the night nurse five night a week, ten hours a night. I would go to the site, help with bedtime medication, then tend to the inpatients, and any after hours emergencies. I ended up doing quite a bit of overtime helping out on the day and evening shift, as the last three weeks of the season they were very short staffed. I didn't mind because the pay was hourly and overtime! My experience at CTY was mediocre at best. The management was not incredibly supportive, in fact, they were completely hands off. There was no nurse manager or manager of our department at all. This led to a lot of confusion and frankly if all but two of the staff had not been returners we would have been sunk. I met a lot of great kids and some really great nurses. I however decided not to return to CTY for the 2016 season. It just wasn't a great fit for me. Mostly it felt more like a college than a camp, and I didn't enjoy that so much. That isn't to say that CTY and especially the Lancaster site doesn't have a wild culture for the students, a student-run website www.realcty.org provides an inside look.
The 2016 camp season is only a few weeks away. This year I will be returning to Indian Head Camp. My old bosses are still there working to make the place better every year. The management is the same lovely family, who actually know my name when I see them. I really looking forward to returning. I will be staying for the whole nine weeks, and will have my 18-month-old along for the summer. Sara is unable to join us this year, so she will be visiting us and I will be bringing William down for visits with the extended family. It's a big change from previous years where camp was all about me, and my get away. I'm excited to see how this goes, and how the experience changes for me.
Thanks for reading
S'mores and Sanitizer is a blog run by contributor Susan Sultzman. It can be found here This content was created on 6/4/14
I’m home today. I get a day off once a week. Because I’m the night nurse my day off starts at 8am when I’m off duty, and ends at 8pm the following day. Coming home and briefly going back to my “real” life helps me put things in perspective, and helps me reflect about my week. My hubby and I work it out so we both are home at the same time (he is on the road all week in the summer.) So we end up chatting about everything about our week, go out to lunch, do shopping/errands, and then hang out in the evening on the deck or if it’s raining (like last night) we catch some Netflix shows together. Last night there was a break in the rain and we walked down the street to the local bar, which was having an outdoor party with fireworks. It feels exactly like life was before the kids, since they stay up at camp. My day at home is a nice little shot in the arm to energize me and make me feel good about returning for another week of camp.
So the 8p-8a night nurse gig is working out so far for everyone. I love my room in the Health Center and it’s turned out to be quieter than I thought during the day. (Only once was I up late – 2am – with a camper, and although I could have slept in, I just settled for a quick afternoon nap.) When the morning nurse(s) arrive, I grab a quick breakfast, shower, and take some personal time before 10am when I grab a clipboard at the office and do camp and cabin inspections. First, I go to all the camp areas- the shower houses, gathering areas, arts buildings, etc. and determine if the cabin assigned to that area had done a decent job of cleanup. Then I go back up to the cabins and inspect those. Most cabins are extremely competitive and strive to get 10’s. They lose half points if certain things are not done, like if their assigned camp area not adequate, beds not made, trash or clothes on floor, trash not emptied, etc. So that takes me about an hour. I want to get my routine down and cut my time, but so far so good.
After that, my day is potpourri. If you scroll further and read my blog from last year, you’ll see that I had lamented about feeling like a fly on the wall, always on the outside looking in to all the fun and activities from the Health Center porch. My new work schedule this year has granted me my wish while allowing me to still practice nursing. I do a bit of everything, and I never know what they’ll have me do next. Often I drive people into town to the doctor or to pick up stuff at Walmart for various departments. I help out in the office making phone calls, sorting mail, various clerical duties, work the camp store when it’s open, etc. I pitch in down at Arts and Crafts, cover at the Health Center for others’ days off, and pretty much anything that comes up. I usually have down time from 5-8pm,. At 8p I go back to the HC and the rest of the nurses retire. Then, I see and treat a parade of boo-boos, turned ankles, sour tummies, headaches, etc. until 9-9:30 when things finally settle down. Also kids w evening meds come in. There’s usually one or two that forget to come by (ahem… Claudia)… so I call the Rover on duty to retrieve the girl to escort her down. Often a camper who’s feeling poorly will come down with her counselor some time between lights out and midnight. But mostly, after 10pm I pour the next day’s meds, tidy up, sweep, take out trash, enter all visits into the computer, do my own laundry, and I’m in bed (hopefully) around midnight. If a group comes back in late, I need to do lice checks on them.
Sometimes a counselor with the night off will come by for a medical reason and then stay and chat for a while. Or I’ll drive them into town for a doctor visit and engage in some quality talk time on the way. This is one of my favorite things about camp, getting to know these great people. Most of our counselors are from the UK, another European country, Latin America and Australia. (We have some Americans too, they’re just as great!) They are all intelligent, thoughtful, open-minded, and adventurous. Our director really has a knack for choosing quality individuals to work at camp. I really admire anyone who can take such a leap of faith to leave their families and life as they know it to fly far away to to live and work in a foreign country for nearly three months. I love to pick their brains, ask them questions about everything- school systems, uni (college), their healthcare system, tax system, their politics, the EU and their place in it, food, language/accents, culture, current trends, social problems, other countries they’ve visited, families, etc. The way I see it, if I cannot go travelling myself, I can still experience the world through what they tell me. I’ve met several amazing, articulate, interesting ladies so far and look forward to getting to know more of them. I also enjoy fielding questions about America if they ask. When I take people to the doctor, they learn a bit about our healthcare system whether they like it or not. Sometimes they comment on the ubiquitous American flags displayed in public and we talk about the culture of our patriotism. I’ve also described the day of September 11 and how it felt to live in the moment of it, not knowing at the time how the day would play out, the fear we had not knowing what was going on and life in the weeks that followed.
Also, I’ve been able to practice my Spanish with several of the ladies. I’ve been brushing up on my skills for my New Year’s resolution (I quit Candy Crush and replaced that wasted time with Duolingo.com) . I think the thing that’s hampering me the most is my reluctance to sound less than perfect when I speak. I don’t mind having an accent but I’m a Grammar Nazi at heart and I know I’m butchering Spanish when I speak it. (I call it my Tarzan Spanish.) I try to remind myself that as long as I get the point across it’s all good, and they probably welcome a break from the onslaught of English in their ears all day. These ladies earn special admiration from me- they take their rudimentary high school English knowledge, immerse themselves in a foreign land, and muddle their way to fluency over the summer, smiling through it all as they go!
So that’s my camp experience so far. I’ve committed to an extra week now, since they lost a nurse before camp began and they need someone. There’s two more weeks that I’m contemplating, but at this point, Steve and I aren’t sure it’s feasible. I know Natasha and Claudia would love to stay the whole time! More on my girls later!
When I put up this website, my idea was to make a purely informational site, to support camp nurses of all levels of experience. I began to realize that many of the posts that I put up are opinion pieces to one degree or another. It seems unfair to offer my opinion without telling the world a bit about me and my personal experiences.
Through years of observation, I have found that the employees on any given camp fall into one of three categories. The ones who live and breath camp, the ones who are running away from their lives, and the ones who are here for the adventure. I have spent years in all three of these categories over my time at camp. Camp nursing has seen me grow as a person in every way over the 5 plus years I have spent with it. I would like to just spend a bit of time on each year both professionally and personally.
My first taste of the camp experience was at PA Vent Camp in 2009. I had transitioned from long-term care to pediatric home care full time in early 2008. I quickly made my way to trach vent cases as I enjoyed working with the technology. One of the first cases that I picked up was with a client with muscular dystrophy. Muscular dystrophy leads to profound weakness of the muscles but has no effect on cognition. My client was a perfectly age appropriate 13-year-old mentally, but relied on a ventilator and wheelchair. I was asked by my agency if I was interested in going to vent camp with him for a week. I was young and unattached so I agreed. Vent camp lasts five days for the campers, and is hosted by Camp Victory in Millville, PA. The camp is wheelchair accessible and handicap friendly, but vent camp has its own needs above what the camp provides. Half of the bunks become staff bunks, and even then a lot of folks camp out in tents for the week, each camper gets a nurse and a helper or two, depending on needs. These helpers are usually not medically trained and are generally high school or college students. The rest of the volunteers are handling activities and such. The remaining the cabins are completely emptied and hospital beds, generators, and all needed equipment for 8 ventilator dependent kids is packed into the cabin. There are about 30 campers age 7-18. It was an amazing week. Helping my camper to do all the exciting things camp had to offer, activities that are normally not available to him, such as swimming, zip lining, and giant earth ball (see picture). I spent 16 hours a day with my client and my helper, who was an architecture student that had been helping at camp for many years. Camp for these kids is something amazing. It is a week without limits, they can do any activity they wish. They are not excluded in any way, which is a stark contrast to their daily lives outside of camp. I was honored to be able to accompany my client there for two years. I was intrigued after my first year about what other camp settings were like.
2011 was the year I fled my life; 2010 had been awful. Its a long story, but I felt so bad and angry that I decided I wanted to get away and try something completely different. I was ready to be away from my life as I knew it. I applied at a bunch of camps and found one that paid best, had the longest contract, and seemed more organized than a lot that I had talked to. I accepted a contract at Indian Head Camp (IHC), and a few months later I packed the car and drove upstate. My first year at camp was, in hindsight, as challenging for the camp as it was for me. There were no returning nurses this year except the head nurse. She was busy trying to learn our first computer charting system. Also, this was the last year that we hired only five nurses, what had once been enough staff but was now stretched thin as the camp grew. I think that all the staff that year were fleeing their lives to one degree or another, and it led to enough drama that at times I felt I was in a sitcom. I learned a lot that year. Had a lot of good coworkers, who I would be friends with for years to come. One bad coworker, who was wrestling with his own demons, who taught me the benefit of letting go. I managed to pick up the tasks pretty quick, a med pass is a med pass after all, but the totality of the health center was a challenge to understand. The camp itself was an astonishing organization 600 campers and 200 staff all there for seven straight weeks. The health center operations and management was difficult to wrap my head around, but I enjoyed trying. It had its moments where I loved it, and its moments where I was about to pack up the car and leave. At the end of the season when I sat down and thought about it I decided it had been good.
In hindsight, it was the best thing for me at the time. Camp gave me the reset that I was looking for. It taught me life lessons and gave me the excitement of learning and attempting to master a completely new specialty. In 2011 I was lucky for the most part, the folks who are fleeing their lives don't do so well at camp. Camp is a marathon of long days, short nights, and high emotion, and many who don't approach it with a level head have a very bad time. After that first year, I was hooked. Please check back next week for 2012 to present.
Thanks for reading
S'mores and Sanitizer is a blog run by contributor Susan Sultzman. It can be found here This content was created on 6/13/14
Several weeks before I came to camp, I was here for staff orientation. We had a meeting where the nurses read down a whole list of special needs campers. This was a special opportunity for me to be able to explain to everybody firsthand about selective mutism, what it is, and how it affects my daughter Claudia. I also was able to make suggestions on how to interact with her best. For example: don’t push for answers if she does not respond. Ask yes or no questions when possible. Don’t be too friendly, or make a fuss over her, don’t ask for high-fives or hugs, and if she doesn’t respond verbally, act like you really didn’t notice she was mute.
The positive reaction from the counselors was astounding. Several came up to me throughout the day and told me how excited they were to work with Claudia. They found SM fascinating and saw it as a challenge to be the one to bring her around. (Of course in my mind I was thinking “Oh good luck with that one, get in line!”) Most of the counselors were from other countries, and one girl from England said that she had worked with a little boy with selective mutism. She was very excited to tell me all the techniques she used to bring this little boy out of the shell. I was very encouraged to know that Claudia would be surrounded by caretakers all committed to try their best to make her comfortable. But deep down I felt that it was impractical to get my hopes up too much.
So Camp Day finally arrived. I helped them unpack and settle in, bid them farewell, and then moved my own things into the Lodge. The first day or two, I was getting reports from Claudia’s counselors that she was doing well, but being very, very shy. No surprise there. They told me that they were just ignoring the fact that she wasn’t talking too much, and just asking her basic yes or no questions that she could respond to easily without words. By the second day one of the counselors was saying that she muttered some words very quietly only when it was absolutely necessary. However she was talking just fine with some of the girls and did not seem to mind that she was speaking in front of adults in a normal voice. She did not introduce introduce herself at the campfire, but the counselor did it for her. When I saw a Claudia around camp, she seemed happy and calm. She was really enjoying herself and I was content with that. Several counselors came up to me to tell me that they had introduced themselves to Claudia, And described their exchange using the techniques I had suggested. I was so impressed with their kindness and their consideration.
At about the third day, a counselor from the waterfront told me that Claudia had spoken quietly to her. “I don’t have a swimming buddy.” A whole sentence. To an adult. And to my surprise, I started to cry. In the next day or so, more reports of Claudia speaking started to trickle in. A few days after that, the reports started to pour in! Finally one cabin counselor came to me and said “does this girl have an ‘off’ switch?”
At Camp Netimus, my daughter Claudia does not have selective mutism. Last night at the campfire with the new girls that arrived earlier that day, Claudia introduced herself when it was her turn. There were about 175 people in attendance. And it’s all because the tailored attention and genuine caring that the these lovely mature young women have shown my daughter. People who did not even know us a month ago have been just as excited about Claudia’s emergence from her silence as my family, friends and I have been. I am overwhelmed by the magic that the staff here has created.
My camp is having difficulty finding potential nurse candidates to staff the health center this year, no doubt due to the seasonal nature of the employment, and people need the health insurance that full-time year-round employment provides. This is especially pressing now that we will be tracked and then fined by the government if we do not have it. So this year my role is only that of a resource person as I will be holding on to my full-time job. Basically I'll be helping guide them through the processes of setting up the center and helping with staff orientation. Meanwhile, one of our former camp nurses knows a paramedic who might be interested in working at camp this year. I know what a paramedic can do within an EMS system (a lot!) But legally speaking, what can they do, or not do (independently) in a camp setting? What about an EMT?
If I remember correctly your in PA. All this is the law and camp regulations as understand it.
My understanding of paramedic use in camp is that there are two approaches. The first and most common is to just consider them UAPs (unlicensed assistive personnel). As UAPs any nursing task can be
delegated to them as directed by the nurse practice act. As a general rule, there is some level of supervision required in delegation, and a pretty universal tenet of nurse practice acts is that nursing judgment, and assessment cannot be delegated. In this model, the meds wouldn't be an issue because you would delegate the routine meds to the medic, who has adequate training to safely deliver them. The issue is with PRN meds and sick call. Any PRN med that doesn't have specific parameters requires an assessment to determine need and then another for effectiveness. I think this is where the issue really lies in using medics as primary providers. An RN cannot delegate the assessment portion, so they cannot (to my understanding) independently handle a sick call. Even a sore throat requires assessment and nursing judgment to decide to treat with PRN OTCs or see the MD.
Now some camps have language on their parental permission forms that allows staff to give over the counter medications that the parents authorize, this can be a work around for administering PRN medications, as the parents authorize basically anyone with a pulse, and the directors permission, to give medications. The nuts and bolts of this and the liability ramifications are beyond my knowledge and would require a lawyer and insurance agent to even consider.
The other model is what's called a closed medical system. This is the system that allows medics and athletic trainers to function with extreme autonomy on sports teams and such. Basically, a physician
establishes practice and protocols and delegates authority directly to the provider. This is how a medical assistant with no license can give you injections and other interventions, they are considered an
extension of the physician. The issue here is the doctor who is in charge is assuming all risk and liability for the person they delegate to.
Paramedics generally function on a similar, but better established medical model where they have strict protocols from the state, and to provide ALS skills they need the blessing of a medical command physician (MCP). The MCP is responsible for supervising, QA, and assure the competency of the medics they supervise. In some services,
the MCP will set up additional protocols for their medics to follow in addition to a state protocol thus setting up a closed medical system where the medics under that particular doctor can do skill over and above the state regulations. This is, to my understanding, what's happening with community paramedicine, where medics are visiting chronic system users and assessing them routinely to try and prevent 911 use for what is a non-emergency medical issue, or could be handled in a non-emergency fashion. Admittedly I am not as up on community
paramedicine programs, as they are fairly new, and are not in my part of the state yet. However, they may be a good bridge for camp use eventually as they set the precedent for paramedic use in a none emergency setting, but to my understanding, there are no state protocols for community paramedicine at this time in PA.
As far as who can supervise health services on camp, that is an interesting question. It depends on who you ask. The state of PA is very silent on camps and healthcare, all the regulations that I can find are really related to facilities and sanitation. See PA code chapter 19 on organized camps and campgrounds. This is how boy scouts
and other organizations get away with using EMTs and "health officers" they basically find someone who is willing to do the job, in the case of EMTs they are ignorant of their own practice restrictions, and then set them loose. The state does have extensive regulations on residential care and facilities in state code 3800, but most camps are
exempt from these regulations because they are in operation for less than 90 days.
The Amercian Camp Association, however, is pretty clear they want under the following health standards.
HW.1 Health Care Provider: Resident camp must have a licensed physician or registered nurse on site daily. Day camp may have prearranged phone access.
*HW.2 First Aid and Emergency Care Personnel: A staff member with training in the appropriate level of first aid and CPR must be on duty at all times in camp and on camp trips.
HW.4 Staff Training: Staff must be trained in role/responsibilities in health care.
HW.11 HealthCare Policies: Written policies must include scope and limits of services provided and authority/responsibilities of camp staff, and supplies, emergency health care assistance, etc.
HW.12 Treatment Procedures: Health care staff must follow written treatment procedures for reasonably anticipated injury/illness
Of course, these standards only matter if the camp is accredited.
I hope this helps.
S'mores and Sanitizer is a blog run by contributor Susan Sultzman. It can be found here This content was created on 6/13/14
Although I thoroughly enjoy working as a camp nurse, it’s probably not something I would choose to do on my own. At the very heart of the matter, it’s all for my daughters, Natasha and Claudia, so I can give them an amazing experience for which I could otherwise never manage to pay rack price. For those nurses whose economic situations can endure it (and relationships that can withstand it), working at a summer camp is a unique way to offer their children the experience of a lifetime. According to the American Camping Association’s website, there are approximately 9,500 summer camps of all types in this country, and every one of them needs a handful of medical professionals to staff their health centers. These camps cannot possibly pay the doctors and nurses the same salaries they receive at home, so it’s a common industry standard to reduce or even waive the camp tuition for their children in exchange for professional services provided. It’s a win-win situation.
When I was “shopping” for the perfect camp (both times), all I had to do was surf the web, find the human resources contacts, shoot emails, and watch the offers come in. It was mind-boggling. Last year I searched in late May and thought there would be no jobs left, and I was so wrong! I sent out at least a dozen inquiries the first morning and 8 hours later I had about 5 opportunities to choose from. Most camps emailed, but the director of my camp got back to me via phone. I still remember when I saw her number buzzing my cell phone, and getting this strange feeling that I should pick that up, not let it go to voice mail. Hours earlier, I had already given a “yes” to a fine arts camp and was busy with my “no thank you’s” to the other camps, but I picked that call up anyway. And it’s a good thing I did, because she sold her camp to me just with the enthusiastic love in her voice as she described it. (I shudder to think what my girls and I would have missed out on if I hadn’t taken that call.) I often wonder how many hundreds of camp nursing jobs remain unfilled out there each summer.
So, back to my original point… although we’re not wealthy, Steve and I do okay, but only because we’ve been creative with our finances from the start. We purchased a small townhouse in 1997 with a price tag way below what the bank told us we could borrow. Our mortgage is under $1000 including taxes. Because of this we are not a slave to our finances and largely avoided the woes others have faced in the Great Recession. We endured when I quit teaching and went to nursing school. We endure in the winters when Steve gets laid off.
We have always been able to get by with one of us being a stay-at-home parent for our children (except during times when our schedules overlapped, and we resorted to professional child care only a few months at a time). This is a lifestyle that we chose so one of us would always be with the girls, so we could raise them ourselves and be actively involved in their lives. We don’t give our kids lots of Things. We give our kids a lot of Time. This costs our household a lot of potential income, but it’s worth every penny we never see. And because we live below our means, Steve and I are in the unique position to be able to provide our kids with summer camp. I find it deliciously serendipitous that because we live frugally, it’s something we can afford to do.
When I tell people I'm spending my summer at camp, I feel like they all think that I just magically run away and play in the woods like peter pan. The truth is the amount of thoughts and actions that go into leaving for eight or nine weeks is pretty staggering. I have it pretty easy compared to others. I only choose camps within driving distance, I have never worked more than three hours away. It still takes a bit of doing to pull it off though. God bless you poor bastards who fly across the country to do this job, you're braver than I am.
Every year the task to do first is to start separating from my jobs. I work home health PDN, so I am always considered a PRN employee. I have to carry my own benefits, and have no sick or vacation time to deal with, so there are only a few hurdles to clear. About six months before I plan to be on camp, before the contract is even a thought, I start talking to my schedulers, letting them know that camp is in the plans for next summer. That way they cannot pretend to be surprised by it when things start to get official. Any new cases that I take on, I mention that I leave for the summer every year, so they aren't surprised. It sounds like overkill but people at work and the clients themselves get pretty upset if they feel like you left them high and dry without notice. As soon as the contract with camp is signed I email and call the office to let them know my last day on the schedule. This gives them plenty of time to try and find replacements.
I have a side business teaching CPR so my regular clients are treated the same as my employer, lots of advance notice and reminders. My first year at camp, I scheduled a replacement instructor for the time I was away, but this met with mixed reviews from the clients. It was also a real nightmare when the instructor I scheduled backed out less than an hour before a class. So now I work with the client to schedule classes early in the month that I leave and late classes the month that I return, this means they only miss one class and seems to make everyone happy.
I own a house, and as all homeowners know that is a never ending list of things to do and take care of. This all falls to my wife Sara now. She's amazing by the way! The house ends up being the least of my worries since she came into my life. Previous to her I had some real mixed results with house sitters.
My father lives in a nursing home due to a neurological condition that has afflicted him with several strokes over the past five years. My mother lives independently and is doing well with managing her medical conditions. Besides making sure everyone knows how to get a hold of me on camp, the nursing home included. I'm cautiously optimistic that this may be a low-stress year in relation to my parents. Although past experience tells me that one of them generally has a health crisis at least once a summer while I'm away. I have had to accept that I just have to take those as they come.
The new big worry this year is my son. I took last year off as William was only six months old when camp was starting, and only five months out of the NICU. I did manage to go up for a few weeks to help set up, but a full season was out of the question. This year he will be 18 months old, so more able to be on camp. Sara has to stay home and work, so William will come to camp with me for the summer. My camp is amazing in that they have hired a nanny for him, and I plan to bring him back home to visit about every two weeks on my day off. Packing up and moving a toddler away from his mother is defiantly the x-factor in this year's camp plan. I hope we all have a good summer and can make the arrangements work. Obviously, my future in the camp nurse specialty depends on striking a work-life balance somewhere in these very odd circumstances.
All the preparation in thought and actions all lead to the morning that I drive off to camp. It's amazing looking back on it all, how much I arrange my life around camp. It has been a huge factor in my life, and I hope that it continues to be a positive experience. Five years at camp is a long time, every year is different for camp and for me, I will try and keep notes on how this year goes, and how my family feels about camp. Check back for updates.
S'mores and Sanitizer is a blog run by contributor Susan Sultzman. It can be found here This content was created on 6/19/13
From December until May I had a contract with a different camp. It was signed sealed and delivered. Unfortunately, for some reason I did not understand the fine print, but there was a problem w a major detail in the contract that I did not discover until May. It was slipped in so quietly, and not what we had discussed at all. I had to quickly disengage myself from the agreement to work for them. I felt terrible about it and didn’t want to leave them high and dry so close to the season but I truly had no choice.
Desperately, I started googling different camps. I sent in inquiries by email or phone to perhaps close to two dozen camps. I promised kids camp. I wanted to deliver that promise. Within two hours of my initial search I had landed a verbal agreement with a camp way up close to the New York border. It was a lovely fine arts camp. However once I agreed to go to this camp, all of the other offers started rolling in within hours. I got emails and phone calls and I was starting to realize that a camp nurse in late May really has a wide selection of options for their summer experience.
After writing about five no-thank-you emails, and returning phone calls saying no thank you, one number popped up on my iPhone. It rang and rang. I was going to let it go to voicemail and call back later to say no thank you, but I felt a last-minute gut feeling that I should pick that call up.
It was the director of Camp Netimus. She sounded like such a lovely person that she won me over within the first five minutes of our conversation. She was kind, friendly, and just had a way about her that was irresistible not to love. I had to meet this woman. I have spoken to at least 20 different directors of camps in the last several years, and nobody, I mean nobody, exuded the enthusiasm and love for their camp as much as she did.
So I had a difficult decision. The director didn’t want to steal me from the other camp, but she was very enthusiastic about having me and hoped I’d choose Netimus. In the end the kids made the decision for me. In a side to side comparison, a fine arts Camp was no comparison for a camp with zip lining, a rock climbing wall, gaga courts, basketball, and exciting outdoor activities like that. So I sheepishly told the fine arts camp that I really appreciated the offer but my children did not think they would be happy there and I regretted not checking with them first.
Coming to Camp Netimus was one of the best decisions we ever made. I don’t truly believe in magic or miracles, but I have seen and felt things that came close to such in my two weeks here. The real “magic” of this place comes from the people whose love and regard for each other make great things happen. If I didn’t have to report to the health center to work in 15 minutes, I would tell you about them right now. But that will have to wait. Sorry!
I would like to think that I got busy, my life overwhelmed with exciting or tragic events, and that is why I haven't posted in a while. Of course, life is busy, but truthfully I haven't had much to say lately. This is a highly unusual situation for me.
I am happy to announce that I will be returning to Camp Indian Head, in Honesdale PA, for my fifth full season. I will be on camp in early June until late August.
As summer approaches, I plan on taking a more personal tone with the site. Writing more about my feelings and experiences this year, than the informational pieces I generally put up. This will be quite a challenge for me, as writing about myself is not something I have a lot of experience with. Please bear with me.
I will be posting a few selected guest posts from fellow camp nurse Susan Stutzman, and her blog Smores and Sanitizer. Please be sure to visit her site and encourage her to write more about her summers.
If you're interested in contributing in any way to the site please email me at email@example.com I would love to hear from you.
Thanks for visiting Campfire Nursing
“The application of a tourniquet is only ok if you are in a life or limb scenario, loose the limb to save the life” That was the extent of my training ontourniquets in my EMT training in the year 2004. The common knowledge at that time was that tourniquets caused damage, often irreparable damage to the limbs they were applied to, and that generally bleeding could be controlled with direct pressure only. While direct pressure remains the first step to treatment, there has been a rapid evolution in the control of severe hemorrhage, and arterial bleeding in the past several years. Advances that many nurses not involved in emergency care may be unaware of. Tourniquets are back in use, and if nurses in the camp setting are not prepared to apply tourniquets in cases of severe hemorrhage, they are not meeting the standards of care on this topic.
Tourniquets have been a fixture in medicine since the late 1600s especially in battlefield injuries and surgery. By the 1900s problems with prolongedtourniquet use were well known, and the use of them in the field began to loose popularity.(1) Many Harsh criticisms of tourniquet use were voiced after both world wars, mostly due to the devices being applied improperly, or forgotten under blankets, or in the confusion of evacuation. In World War Two the army surgical division established the directive that tourniquets should be used only for active spurting hemorrhage from a major artery and established guidelines on care and time restrictions in tourniquet use. (2) Through the 19th century military use of the tourniquet continued, with the opinion of military surgeons becoming slightly more favorable by the end of the Vietnam War. Civilian use of tourniquets was minimal to nonexistent, being used primarily in vascular surgery, field use was strongly discouraged.
Going into our most recent war the routine use of tourniquets was still generally frowned upon. The implamation of the Joint Theater Trauma System, allowed for real-time evidence-based practice evaluations of both causality treatments and outcomes. This clear and ample data demonstrated very clearly that hemorrhage was a leading cause of death, and that tourniquet application in the field made a huge difference in outcomes. It also demonstrated that the concern over limb loss and nerve damage was overstated, in the present medical system definitive surgical intervention is almost always achieved before any serious side effects of tourniquet application can set in. Over the past decade military training has focused on early hemorrhage control, and has seen a dramatic rise in causality survival. The US armed forced have made the Combat Application Tourniquet (CAT) standard issue to all ground forces, deploying over 400,000 CATs in the field. (3)
As with many other advances in emergency care, the military medical community leeds the civilian community in techniques and science. The tourniquet has returned to civilian EMS, and first aid, in a big way. Most recently with the Department of Homeland Security's “Stop The Bleed” Program. This program provides information to the lay person as well as professional rescuer ontourniquet use. (4)
Tourniquet application in the camp setting is important for a few reasons. Most camps are in rural locations, prompt and complete control of severe arterial hemorrhage is very important, as EMS response and transport times may be prolonged. Camps should also be equipped and trained in tourniquet use due to the low, but present risk of active shooting scenarios. Many nurses are not especially familiar withtourniquet application and may fail to recognize when a tourniquet is necessary.
Direct pressure over absorbent dressings remain the first step in control of most hemorrhage. In cases where bleeding from an extremity is severe, the victim presents with hypovolemic shock, or the injury's are from explosive devices, atourniquet should be applied as close to the site of the would as possible. A secondtourniquet may be applied even closer to the would if bleeding doesn't cease. (5).
Having established that tourniquet use has been added back into the first aid skill set for hemorrhage control, and established the parameters and techniques for application. The next issue to confront is what type of tourniquet to use. There are many commercial options on the market today, however many nurses may be most familiar with basic improvised tourniquet, that uses a triangle bandage folded so the with is about 1-2 inches, and tied tightly around the limb with a square knot. An improvised windless, such as a stick, is slid under the bandage and twisted until arterial occlusion is achieved, the windless is secured and time noted. (6)This style of tourniquet is cheap and effective, the major drawback being that it requires a bit of skill to apply, and there never seems to be a good sturdy enough stick around when you need it.
The most popular commercially available tourniquet is the Combat Application Tourniquet CAT. This easy to apply device has an attached durable windless, that tightens an internal band, that applies circumferential pressure. The windless is easily secured with a hook and Velcro fastener, and a label is prominent on the front to note the time of the application of the device. (6)The CAT has been extensively used by the armed forces, gaining more time in the filed and more real life applications than most other commercially available devices. It will be a familiar device for veterans and most EMS providers, for that reason if you decide to buy a tourniquet, I would recommend the CAT. However there are any number of options for commercial tourniquets, and any can be used with proper preparation and training.
Whatever type of tourniquet your camp employs, all nurses regardless of experience and background should be able to demonstrate its use, and articulate the conditions where a tourniquet will be necessary. Training is important to insure that providers are able to correctly use tourniquets in a correct and timely fashion in an emergency.
Severe hemorrhageand arterial bleeding, are low occurrence high acuity events in the camp setting. However preparation for such events is key to good outcomes an patent survival. Camps offer a wide verity of potential for injury's and as nurse we must be prepared to cope with any level of event that occurs at our camps. Tourniquets must be a readily available tool for camp nurses to use in the event of emergency, and modern science supports their use in the civilian realm when necessary.
1.David R Welling MD, A brief history of the tourniquet, Journal of Vascular Surgery, 2012
2.G.A. Cosmas, A.E Cowdry, The Medical Department: Medical service In the European Theater of Operations, 1992, Center of Military History, United States Army
3.Alec C Beekley, Prehospital Tourniquet use in Opperation Iraqi Freedom: Effect on Hemorrhage Control and Outcome, Journal of Trauma, Injury, Infection, and Critical Care, 2/2008
4.Stop The Bleed, www.dhs.gov/stopthebleed, 11/20/2015
5.Bleeding Control Statewide BLS Protocol, PA BLS Protocol 601, 6/1/2015
6.Dan White EMT-P, Return of the Tourniquet, http://www.multibriefs.com/briefs/exclusive/return_of_the_tourniquet.html#.Vuue3_krLIU
Many issues confront camp nurses in our practice specialty. Every nurse worries about massive injuries, disease outbreak, or severe allergic reaction. However, one of the most persistent and annoying issues that I found in my camp practice was the abundance of dermatological complaints that I was asked to evaluate and address. This was a topic that my previous training and background left me feeling unprepared for, so I thought I would give a little information on some of the more common skin issues I come across and how to go about addressing them.
I am not a dermatologist, all advice offered is sourced to the best of my abilities, but should not be viewed as authoritative or take the place of your physician's evaluation or instructions.
Contact Dermatitis is a localized irritation of the skin, a generally flat itchy rash, but sometimes can present a blisters or hives, that is caused by contact with an irritating substance. The substance can be just about anything; but soaps, detergents, cleaning products, latex, kerosene, ethylene oxide, certain foods, and drinks are often the main offenders. The rash can occur instantly, but more often takes hours, and sometimes up to three days to appear after exposure Trying to isolate the source of a contact dermatitis in the camp setting is often an exercise in frustration. After many instances of trying to play medical detective, I personally only spend time and energy trying to isolate an irritating substance if the reaction is severe or persistent. If the reaction is severe or distressing it may be outside the scope of camp practice, it may require evaluation and testing by an allergist.
Treatment of contact dermatitis is generally focused on relieving the itch and irritation. A cool compress and a topical hydrocortisone is generally all that is required. If the reaction is large or particularly annoying. A systemic H1 antagonist such as diphenhydramine (Benadryl), Loratadine (Claritin), or Fexofenadine (Allegra) may be needed. An H1 inverse agonist, such as Cetirizine (Zyrtec) can be used in addition to or in place of an H1 antagonist. If needed an H3 antihistamine, such as Ranitidine (Zantac) may be added. (1). Occasionally perception corticosteroids may be needed.
Impetigo is a common camp malady, that most often affects younger campers. Appears as a weeping blister or sore that has a yellow honey crust. The sores are a dermal infection of generally staphylococcus aureus, but Streptococcus is also a causative organism. The infection is spread by direct contact and is transmitted very easily by scratching.
Treatment of mild impetigo is often done with a topical antibiotic ointment such as mupirocin. In more severe cases a systemic antibiotic is needed. Due to the extremely contiguous nature of impetigo, my camp’s physician usually writes for both systemic antibiotics and a mupirocin applied after gentle cleansing twice a day. Laundering of personal linens and aggressive cleaning of common surfaces is required to control the spread of infection. (2)
Tinea corporis may have a variety of appearances; most easily identifiable are the enlarging raised red rings with a central area of clearing. Other presentations may be a patchy or consolidated rash that has a raised edge with a scaly texture. The rashes are generally found on areas of the body prone to be especially moist. Tinea corporis is commonly called ringworm, but different sites of fungal infection have different common names such as athlete's foot or jock itch.. Tinea corporis is caused by a tiny fungus known as dermatophyte. These organisms normally live on the superficial skin surface, and when the conditions are favorable, they can induce a rash or infection. The disease can also be acquired by person-to-person transfer usually via direct skin contact with an infected individual. Be mindful that a fungal presentation on one part of the body may be spread to other sites. A common saying is “apply socks before jocks” to prevent a case of athlete's foot from becoming jock itch.
Treatment with topical antifungals, such as tolnaftate, is generally applied to the area twice a day for at least 3 weeks. The lesion usually resolves within 2 weeks, but therapy should be continued for another week to ensure the fungus is completely eradicated. Severe cases may require treatment with oral medication, and should be referred to the physician for evaluation. (3)
A solid dermatological reference may be handy to have around camp. Obviously severe skin issues would be referred to the doctor, but a good reference guide such as Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology can be helpful in identifying and initiating treatment of common skin issues. (4) Please feel free to use the comment section to share any common skin issues and their treatments that come up in your camp practice.
All opinions expressed here are my own and do not represent those of my employer. Remember anyone can pretend to be anyone on the internet, so please verify all information presented. NEVER take advice from strangers.
This is not an advertisement. I am not being paid to make this post and am not an employee of any camp organization at this time.
I have spent many great summers at Indian Head Camp in beautiful Honesdale PA, which is about two hours away from New York City in the Pocono mountains. When you think of what a summer camp should look like, that's my camp. Rustic cabins on a shaded path beside a calm lake, a grand lodge, and all the campy activities you can do.
Now, many people envision me sitting on a porch. sipping sweet tea all day at camp, occasionally applying a band-aid to a skinned knee. The truth is that my job is not that relaxed however, I have been known to enjoy a book on the porch in my off times. Camp is an exciting environment to practice nursing because it is a blend of school nursing, primary care clinic, community health, and emergency response.
I cannot stand doing the same thing for any length of time. It took me years to realize this, and once I structured my career around my desire to have constant but well-controlled change, I really found my stride as a nurse. I love the fact that I get to change my job to something completely different for 9 weeks out of the year. I Leave my home and friends and strike out to find new experiences and people. The combination of variety and break is what has allowed me to have a successful career, and avoid job-hopping.
Over the years, IHC has become my second home and second family. It started out as a new challenging job to get me away from a job I had burnt out on, despite being good at it. At first I didn't get the hype, it was an okay gig, and it challenged me professionally and personally, but I didn't “feel the magic”. Looking back on the years, realize, I have made amazing friends, seen relationships, romantic and otherwise grow, and met many amazing kids. I have an amazing boss who has watched me grow as a person over the years. I know the owners of the camp, I see them everyday walking around, they both greet me by name. I realized slowly that I love this camp.
Now that's not to say there are days that I don't so much love my job. It is a job after all. It doesn't pay the best, and I sometimes I get a little overwhelmed and a lot frustrated. Camp Nursing is not for everyone, but I would like you to consider if it may be for you.
Consider making a change, of pace and environment. Try something new. Bring a friend or family, often fun jobs for spouses, and significant others can be provided. Camp programs may be able to be arranged for children. You can even match camps to your particular interests. I encourage you to check out Camp Indian Head at www.indianhead.com. I also can make recommendations on other camps if you're looking for anything in particular.
Many nurses find themselves in the position of giving a presentation to staff regarding health services and overall health care at camp. Ironically, many of the nurses are just coming to grips with camp themselves. At my camp, this is a lecture given in the hockey arena; other camps have entirely online orientation. However your camp does it, here are a few topics that I recommend you cover with your staff if the opportunity presents.
Is this an emergency? Be sure staff understand what is, and what is not an emergency. As a rule, non-emergencies should present at clinic at set times to minimize the disruption to staff activities, and allow for up-staffing during high traffic times. Emergencies can report to clinics at any time. The guru of camp nursing, Linda Erceg, coined the 6 B's of emergencies: Bleeding, Barfing, Bites, Bones, Burns, and Breathing problems. They should report to clinic at once! I add in pink crusty eyes, as suspected conjunctivitis should be quarantined immediately.
Stitches are not first aid! Make it very clear what first aid can staff provide, and where the line between first aid and health care is. The policy I enjoy is that the first band-aid is first aid, the second one is not. Our cabin staff are allowed to apply triple antibiotic and 1% hydrocortisone cream to minor cuts and bug bites, under the direction of the nurse. Make staff aware of where they can find first aid kits and what they can expect them to contain. Most first aid kits on camp should be of standard design.
Hydrate or die! An issue to stress very strongly is hydration. Staff should make sure that their campers have water bottles at all times, and are filling them at least once between meals. Staff must lead by example in this important activity. I explain to staff that heat stroke and exhaustion, for the most part, are 100% preventable with aggressive hydration. The military has been stomping around the middle east for a decade now, in full gear and pack, and prevents heat emergencies with hydration and rests. There is no reason why campers should suffer.
Smart people do it three times a day. Remind staff to get in the habit of applying sunscreen in the morning and after lunch, and then bug spray for evening activities. There is never a day so cloudy that the cabin staff and campers don't need sunscreen, and bugs do not take a night off. Prevention of sunburn is obviously important, but make sure that staff understand that bug bites are a super highway to skin infections.
In case of emergency. How do staff contact you in an emergency? Make sure that staff know numbers, radio frequency, or the appropriate smoke signals to get you to them in a hurry. If your camp sends out off camp trips, make sure you cover calling 911 and obtaining health care at other camps, as well as numbers to call to get a responsible adult to the situation. Also, cover your camps policy on staff communication with parents, be VERY clear on this topic.
Code Blue. Briefly cover the location of any AED's and EpiPens and instructions for their use. It's easy to spend lots of time on this topic, but remember that cardiac arrest and anaphylaxis are high acuity, but low frequency events. Also, these devices are designed for use by the lay public so a quick review is all that is necessary.
What if they get sick? If your staff is not permitted to use on camp health services, where can they go to see a doctor, or get first aid? If staff are allowed to use on camp health services, where and when can they access it. Where can staff store personal prescriptions and OTC meds?
Strangers in a strange land. If your staff is from overseas, make sure they are aware of local diseases, such as lyme disease. Advise them that healthcare in the USA is a fee for service and that they need to be knowledgeable of their travel insurance limits. Also mention that over the counter drugs are named differently here in the US, so they should be careful of they are buying their own OTC drugs. Foreign staff should also know who is a safe person to contact for help with...sensitive problems, such as buying contraceptives, STD screening, and emergency contraceptives. These services may be accessed differently in their country of origin, and they need to know who if anyone will help them navigate if these situations arise.
Always run your ideas or even your entire presentation past your camp director. Parts of your lecture may be covered in other parts of orientation. They may want to pad or emphasize some language to better fir the message and meaning of the camp organization. Also, ask for ideas on any topics you have missed or on how to make the presentation more engaging. Don t forget to have some fun, make them laugh, or, at least, don't put them to sleep.
Many nurses new to the field of camp nursing are not aware of the competing practice models for nursing service in the field. In fact for both new and experienced nurses entering the camp specialty success is often as much about the camps practice model as the individual nurse’s proficiency, and skill.
In this article I will briefly explain the advantages and drawbacks of the primary, and team models in the camp setting, how they affect nurse without a camp background especially, and what can be done to ease entry into each respective model.
Primary care nursing is practiced in 33% of camps nationwide (1). By primary care, I mean that one nurse is responsible for the totality of the medical or nursing care provided at a location. This has a few distinct advantages. One nurse handles all information and communication, presenting a unified front of practice technique and information management. There is excellent continuity of care, as the same nurse is evaluation the same situation for the duration. The nurse will generally form strong working relationships with camp management as they will be the sole contact point for health issues and questions.
This model has a major challenge for new camp nurses, the lack of clinical assistance or training. A prudent camp director will be aware and concerned with how to address this and should make arrangements. Many camps using this model will have a more experienced nurse who is available for questions via phone, or a comprehensive policy and startup guidebook. These are a big plus to helping a new nurse succeed. However new camp nurses, and even experienced nurses, will have many questions that may not be easily answered by reference materials or an offsite provider. Being the only health resource for a few hundred people can be overwhelming even for experienced nurses, who often have to call on their wits and grit to get through long nights or a disease outbreak. A better solution is if they have an experienced nurse providing onsite training for a week or two of actual in-session camp. It's even better if the more experienced nurse is locally available and can easily be physically present on camp to help if needed, or check in regularly. If proper training and support is provided, the new nurse will easily be more successful in this environment.
There are some issues that may arise that can be major obstacles to new camp nurses. Most concerning is if there is a complete lack of assistance. If previous nurses are not willing to assist, this can be an ominous sign that their experience on the job was not good. Another issue is if the camp director is dismissive or not at all concerned that you’re inexperienced. Some camp directors are completely uninterested in the challenges that face new nurses in the camp setting. A director should adequately address your weaknesses and concerns. If you don't feel this is happening, I recommend you steer clear of that camp. Finally, there should be a plan to make arrangements if you become ill, have a family or personal emergency, or are incapacitated in some way. If no plan exists, this is a red flag that you may become stuck on camp, unable to turn over you patient assignment.
Primary nursing can be a challenging but rewarding practice model. The nurse often feels fully immersed In the camp experience. Being the sole nurse is in immense responsibility, and is a huge amount of work, but many find it profoundly rewarding. Nurses who are not experienced in camp practice, or in a closely related specialty such as school nursing, should be cautious with this model, however if the known issues can be mitigated then a good experience is more likely.
A more common camp practice model is the team approach. Team nursing in the camp setting is generally defined as a single head or charge nurse who delegates tasks to other nurses or, if permitted, unlicensed assistive personnel; to provide all of the health needs of a camp. The major benefit of team nursing to the camp organization is that it allows for larger camps. A single nurse could not provide adequate care to camps that have 500+ campers and staff. A survey conducted by the Association of Camp Nurses shows that 67% of camp nurses indicate they work with another healthcare provider. Another RN was present in 19% of respondents, an LPN was on staff for 68% of respondents (1). The team approach is a newer model, coming into popularity as the complexity of camp health needs, and the size of camps, both increased. This model allows for direct collaboration between nurses. This makes unusual clinical situations or emergencies more easily managed and allow the new nurse to be supported as they learn the ropes. With the team approach, nurses are given a better work life balance as shifts are often assigned. This can prevent excessive fatigue and burnout. It also allows for staff illness and personal emergencies to happen without threatening the delivery of nursing services completely.
There are some drawbacks however; larger camps have larger organizational headaches. More camper information on intake and more nurses being needed to organize it can lead to miscommunication and confusion. There is always some degree of care in-continuity, as each nurse will have subtle differences in their approach to situations, both personal and clinical. Communication both on-camp to staff, and off-camp to parents can become fragmented, as different nurses communicate different information due to having varied levels of understanding in a particular situation. These communication and practice variances can leave new nurses feeling confused and uneasy.
These are a few things that a new nurse should look for that will make their entry into this practice environment easier. Most importantly, in my opinion, is having a good, knowledgeable manager in place. A good manager will delegate without confusion and facilitate communication. Having a good idea of the type of manager you will be working with will offer insight to the culture and work environment of the health center. Whenever possible, speak with the head nurse or health manager when being interviewed. Additionally having a sloid understanding on how communication between nurses, staff, and parent occurs is important to understanding the health services role in camp. I personally favor the team model for nurses new to camp practice, especially for recent graduates, or nurses with little pediatric experience.
Regardless of practice environment nurses of all experience levels, should set themselves up for success as much as possible. One part of this is the camp practice model and culture however a larger part of success and happiness is being open to the experience and flexible in practice. Truthfully, camp nursing is often not technically difficult; but it is personally challenging. Nurses must start a new job, move residence, and be isolated from personal supports. Keeping an open mind and staying positive will dramatically improve your experience.
Nurses will also benefit from reading up on the profession to gain insight. Two amazing resources are “The Basics of Camp Nursing” by Linda Erceg and Myra Pravda; and “Camp Nursing - Circles if Care” by Mary Casey. The Association of Camp Nurses offers a quarterly Compass Point newsletter with membership. A back catalog of Compass Points is also available.
I hope that this helps you be prepared for entering the expanding and evolving specialty of camp nursing, by increasing understanding of how each practice model benefits and challenges nurses.
(1) ACN Compass Point volume 16, no 1 " roles and responsibilities of seasonal and year round camp nurses survey results part 1"
Hello all! I am presently in transit to the Camp Nurses Association in Atlanta GA. I hope to report back on some of the interesting presentations and people I meet there in a few weeks. In the meantime here are some stories I have found interesting this week.
A camp learns and adapts to transgender campers
Jonah was always different from other boys. Jonah’s parents started seeing a difference in age three that made them think Jonah was gender non-conforming. By age five, Jonah was wearing girls clothes, played with toys typically geared towards girls, and had long hair. When Jonah told her parents she wanted to go by Hannah at eleven – it was hardly a surprise: http://elielcruz.religionnews.com/2015/09/14/this-jewish-summer-camp-welcomed-a-12-year-old-transgender-camper/#sthash.ND01WzZG.dpuf
A mothers reflections on her child's life threatening food allergies
Denial, anger, bargaining, depression and acceptance. Those are the five stages of grief. Who would think that a bite of vegan spinach quiche—crafted with “creamy cashew cheese”—would catapult me into that first stage? http://www.scarymommy.com/food-allergies-mom/
Visiting Day takes an emotional toll on all involved, suggestions to make it easier.
"No more visiting day? Sign me up!" joked Sandy Rubenstein, co-owner of Camp Wingate Kirkland on Cape Cod in Massachusetts. "It's hard for the camper and for the family, and sometimes it's unpredictable who it affects more," explained Sandy's husband, Will. "There are veteran overnight campers who've been here two, three, four even five years. They can be sailing along just fine and then on visiting day, they hit the reset button. http://abcnews.go.com/Health/wireStory/visiting-day-summer-camp-hard-parents-kids-36663336
If you see any stories that you think may be interesting to the camp nurse community, please feel free to send them to me at firstname.lastname@example.org
I have worked at a few camps over the years, and they all had different ways of doing things.. Sometimes in conversations with other camp nurses, I am shocked to find that some items that I find indispensable are not in common use at other camps. So here are a few items that I have used and believe should be in every health office.Read More
Ankle injuries are quite common in camp and other settings. Our staff member, Laura Carney, had the distinction of being the first fracture of 2015. She managed to injure herself before the campers even arrived. I will be reviewing the management of suspected and obvious fractures of the ankle, using Carney's injury as an example. I will review her treatment in the health center using the APIE (assess, plan, intervene, evaluate) nursing process. This article was written with the permission of Carney, who was a good sport about everything even though this injury really ruined her summer.
A knock on my bedroom door woke me up at 10pm. I had turned in early, as I was expecting a long day of setup tomorrow. I knew a knock at this hour meant only one thing, business. I got out of bed and opened the door to find a staff member with a concerned look on his face. The look was different from the “Sorry I woke you for a minor problem” look I usually see. I hate the serious looks at this point in the season; we don't have a doctor on camp and the rest of the support staff are still in orientation, so anything above my pay grade is just that much harder to handle. “Carney hit the tower on the zip line and hurt her leg bad.” I breathed a sigh of relief that only her leg was hurt, "ok where is she?" I asked, while putting on my shoes, as well as my “I'm not panicked so you shouldn't be either face." “They are bringing her down now” he replied in a hurried voice. We walked to the front room as the door flew open, and in came Carney being carried by two of our adventure staff. Her ankle already visibly swollen.
Assessment: Carney was seated on a chair and the injured foot was elevated using another chair with a pillow on the seat. Her shoe was removed very gently. I then began to assess her injury site. When assessing an extremity injury, I evaluate for deformity, open wounds, bruising, swelling, pulses and distal perfusion, ability to move fingers or toes, and sensation in the injured extremity.
The ankle was not grossly deformed, but was already noticeably swollen. She had good capillary refill, and skin was warm to touch. Upon palpation she had extreme pain in the malleolar area. I also felt crepitus, which is the grinding feeling when two bone ends rub together. I evaluated Carney using the Ottawa ankle rules, an easy to use tool useful in guiding nurses in identifying ankle injuries at high risk for fracture.
Using the ankle rules, Carney was absolutely a high suspicion of fracture based on the malleolar pain and inability to walk. Feeling the crepitus removed all doubt that she had some form of fracture and need immediate evaluation.
Plan: Carney's ankle injury was absolutely in need of a higher level of care. Her plan of care was elevation, ice, PO OTC pain medication, and splinting/stabilization of the injury prior to transport to the local general hospital.
Intervention: Elevation, ice, and ibuprofen were provided. The next step in her treatment plan is to apply a splint. Splinting is a first aid skill used for the treatment of fractures or suspected fractures. The goal of splinting is to immobilize potentially broken bones and prevent further pain and injury from unnecessary movement. Splinting an injury is also often the most effective form of pain control available to nurses in the camp setting, as pharmacological interventions are very limited in the camp setting.
For injuries of the ankle I prefer a pillow splint, this is simply wrapping a pillow around the ankle with gentle pressure that will support the injury, and securing with cravats or tape.
Care should be taken leave toes exposed so circulation can be assessed. Other types of splints that can be easily used on an ankle such as Carney's are a padded board, or preferably a molded SAM splint.
Splinting is often as much of an art as a science, any combination of materials that accomplishes the goals of immobilization and support of the injury are acceptable. The rule in first aid has long been to splint fractures in the position in which they're found, especially if the injury involves a joint. However, current textbooks recommend that, except for joint injuries, extremities should be splinted in their correct anatomical position unless resistance is met while repositioning the injury. Carney's ankle was not deformed, however if it had been, I would have gently returned it to its anatomical position. Most orthopedic specialists feel that the anatomical position occurs when the body naturally rests to alleviate stress, exertion and pain and argue that repositioning protects against further injury and makes the patient more comfortable. This is even done in cases of compound fractures involving exposed bone. If bone ends re-enter the body, note this and cover the wound with a dressing prior to transport.
In Carney's situation a splint was obviously necessary, in other less easily distinguished injuries splinting is always a safe treatment choice if there is any suspicion of fracture.
Evaluation: after all interventions Carney's pain remained uncontrolled but was slightly improved from her arrival. The injury was splinted and her foot continued to have good capillary refill, sensation, and motor ability. All interventions were as successful as could be expected in the camp setting. She was loaded into a camp vehicle to be transported to the hospital.
Carney's fracture was severe, she required surgery with pin and plate placement. She was casted for the duration of camp and non weight bearing for a few weeks. Unfortunately her injuries made her unable to serve in her original role, she was reassigned to the health center as an assistant, where she served admirably for the summer using a leg scooter and crutches. My attempts to nickname her Scoots were not successful, much to my disappointment. She returned home to Australia and was discharged from physical therapy in late December 2015.
I hope this detailed explanation of the assessment and treatment of Carney's ankle injury helps guide you in planning your nursing process for similar injuries. Ankle injuries are very common in camp settings, and camp nurses of all experience levels should be comfortable in assessing and treating these injuries.
All opinions expressed here are my own and do not represent those of my employer. Remember anyone can pretend to be anyone on the internet, so please verify all information presented. NEVER take advice from strangers.