School Nursing Practicum - how to translate into acute setting?

  1. 1
    Hi all!

    We just received our practicum placements for our final semester in school, and I'm a bit worried about mine. We had little control over our placements, but we could request specialties. I requested pediatrics, thinking that I would be placed in a peds acute care setting, and if not, at least in some other acute care setting. Instead, I was placed at a middle school and will be working with a school nurse.

    I'm concerned. I won't be developing acute care skills in this setting, like managing a patient case load, improving family centered care techniques, or using equipment that is commonly found at a hospital. Unfortunately, there is no possibility of changing my placement. I also did not do a nurse externship. I truly want to work in pediatric acute care after I graduate this May, but I'm scared this practicum is going to put me at a disadvantage.

    Any ideas how I might work this to my advantage? I could definitely use suggestions for how I could translate this experience to acute care.

    Thank you!
    HLR_RN likes this.
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  3. 7 Comments so far...

  4. 3
    trust me, you'll learn a lot about pediatrics. don't stress over what you think are "acute care skills," because if you get a job in acute care you'll learn them there. you'll see lots of family issues, you'll have all sorts of patient care loads. you may see kids with insulin pumps, feeding tubes, trachs, picc lines, seizures, and more drugs than you can count. do not make the mistake of underrating school nursing-- it's not just bandaids and tummy aches and midol for girls with cramps.
    IdrilRN, KelRN215, and mustlovepoodles like this.
  5. 0
    I think you'll get a lot of valuable experience working in a school. A school is a different environment but often in a school, you're it. The parents aren't there and there's no doctor on site.

    Kids with chronic illnesses need to go to school too... you may see kids with G-tubes, kids who need to be straight cath'd, kids with trachs (possibly vents though those children usually have a 1:1 nurse- at least in my state), kids with insulin pumps and you'd be responsible for triaging a lot of common pediatric emergencies- allergic reactions, asthma attacks, seizures. When it comes to diabetes, a school nurse could probably run circles around me. I have never had to touch an insulin pump (when we have kids with diabetes who are on pumps on my floor, the parents or the child- if they're old enough- pretty much manage everything to do with it) and my experience with diabetes is fairly limited since I only see it if a patient admitted to my floor has it as a pre-existing condition.
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    I agree with the above posters. I think you might be surprised at how medically complex some of these kids are today, and yet they are managed primarily outside a hospital setting. Seeing kids like that who do a lot of their own care (e.g. a 7 yr old who suctions his own trach) can teach you a lot about how to provide good care when they are in the hospital environment, but also what they are capable of. If you've already seen a young kid suction his own trach, then maybe when you see a similar kid in the hospital who wants to do the same thing, you'll be more likely to let him. Most kids I care for love to be included in/participate in their own treatment and care. Good luck, and enjoy it, working with kids is incredibly rewarding!
  7. 0
    I agree with the previous posters. I've worked in level III NICUs and I've worked as a school nurse. The school nurse job was far more challenging.

    At the time I took that job, I'd been a nurse for almost 25 years, a mother for almost 15 years and a resident of the school district for over 5 years. I thought I had a pretty good idea of what school nursing entailed as well as the student population of our schools. Boy, was I wrong!

    One of the sickest children I've cared for was a little boy who came to school almost every day. The advanced planning to protect his health and safety and prepare for potential emergencies was the most extensive I've ever done. And we knew about him The surprise full-blown asthma attack in a child not previously known to have asthma took every skill and every nerve I had. Imagine my surprise when I learned two days before the start of school that a family had "forgotten" to mention that their child had begun cancer treatment over the summer and would need central line care in school.

    Then there's the routine, daily stuff: diabetes management with multiple students, all with different levels of skill and independence, known asthmatics, students with seizure disorders, med pass that could rival a lnursing home hall, minor (and sometimes major) first aid and illness, and staff issues, including a stroke in the office, heart disease, injuries, etc.

    Jump in full force and you will learn as much, if not more than you would in a hospital setting, along with a lot of creativity, since you won't have all the supplies you need, or an army of nurses and doctors to back you up.

    In terms of presenting this experience to potential employers, don't worry if you lack some technical skills, although I doubt that you will. Hands-on skills are easy to teach and evaluate. It's the ability to organize, anticipate needs, advocate for the student, plan, work independently, teach, teach, and did I mention teach effectively that you will develop that will put you far ahead of most new grads.
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    I haven't worked acute care pedi (one day during maternal/child health rotation didn't offer too much), but I did complete my community health clinical at a K-5 elementary school, and I found it to be extremely valuable for showing me the baseline... and how varied it really is. Most of the kids who came in to the elementary school nurse had been injured or had an acute illness, so their baseline was "normal" (or at least their underlying issue had nothing to do with why they came in). That is extremely useful just to start with: what is expected at what age, and how do we know when someone deviates from it?

    The kids with chronic medical issues like those mentioned in the above posts are also great to learn from because you see them over time and get familiar with the ebb and flow of their condition and how it affects their everyday lives. You'll also see children with special needs, and you'll learn to ferret out the problem they are having while addressing their communication, behavioral, and developmental issues.

    We had one little guy with special needs who just loved the nurse and came to see us a lot. He was congested much of the time, but one day he was just in worse shape than usual: very cranky (not normal for him), and much less communicative and cooperative. Based on the deviation from his normal, we really checked him out; sure enough, both of his ears were very stopped up. We called mom and advised her to take him to the pediatrician.

    My advice is to jump in with both feet. If the preceptor isn't letting you do stuff, offer. S/he probably has a pattern to how to manage the day, and you will need to fit yourself into it. I observed at first, then took a percentage of the kids or alternated with my nurse, and then finally had a few weeks where I basically ran the show and delegated to my preceptor as needed. Even more importantly, talk to the kids. Middle school kids scare me to death, but my classmates assigned to middle schools loved their middle schoolers and developed a good rapport with them and a greater appreciation for what they are dealing with.

    My experience as a school nurse was awesome, and I think you will learn a lot more than you expect about caring for kids! You can learn skills at the bedside when you work acute care, but this type of experience is extremely important, too.
  9. 0
    Go for it willing to learn! You'd be surprised by how many "tricks" you learn by going to an area that you think you won't learn anything in. I precepted on a floor that was basically "well" patients but I learn more about infection control and safety there than I have anywhere. I also learned certain tricks and techniques that I thought I would only get in someplace such as ER, ICU, CVICU, etc, and I think that's something I use the most...everyday.
  10. 0
    Thank you so much for your comments! I feel much better about the situation now!


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