Trudy did an excellent job of describing a typical day of a substitute nurse, where you need to hold down the fort and safely respond to staff and students with emergencies and episodic needs, administer medications, and carry out skilled nursing procedures such as trach suctioning, tube feedings and catheterizations. However, when a full time registered nurse is employed in a student health setting, just a few of the other areas the nurse is responsible for:
1. assisting with authoring policies and procedures
2. data driven practice - ie information management
3. emergency plans and health care plans for acute and chronically ill children
4. meeting federal requirements for Section 504 and Special Education
5. Preventative care, health promotion and health education
6. Partnering with stakeholders in the school and community
7. Training and Delegating to unlicensed personnel
8. Implementing evidence based interventions for individuals, groups and the school population - for instance, in response to a needs assessment following an observation of the breakfast issue, the prudent thing to do would be to review the literature which would provide rationale for school breakfast as a evidence based intervention for both decreasing time out of class for health complaints, but also for increasing student achievement. The federal government provides grant money to the states for school breakfast (Here is Illinois:
http://www.isbe.net/nutrition/htmls/breakfast_qa.htm) . The school nurse can partner with adminsitration and food services to acquire these grant dollars to provide a school breakfast program = increased health and achievement.
School Nursing Scope and Standards of Practice is available from the National Association of School Nurses.
www.nasn.org
I liken school nursing to running a small business. You are usually the only person responsible for all aspects of the management of the office. As the only health care provider in the school and the only one cognizant of the laws that affect health care practice in any setting, you have to be pretty assertive and confident of your own knowledge base.
A recent survey showed that very few nurses are coaches or sponsors for clubs. When discussing this with others, the thought was that school nurses cannot usually be released from school early to travel to away games, that home visits were most often made after the end of the school day and that many of the special education IEP meetings were held after school hours. Sponsoring an after school program is possible, but those who had done this mentioned that they and their students were frequently interrupted by those sponsoring other activities wanting a nurse to step in with a child who had a minor injury, even though the school nurse was off the "school nurse clock".
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