New District School Nurse - Help

  1. Yay, I landed a job as a District School Nurse! I have 4 elementary schools and 1 middle school. I really like it and think it will be amazing. My delimma is that I do not have any guidance. I am one of a few new District Nurses who have recently been hired. The former Nurses retired over a year ago and do not wish to Precept/Orient. Thankfully, each school has an AMAZING health assistant who basically takes care of the students during the school day! I do have a handle regarding what is expected regarding immunizations, clinic, supplies, med administration and the basic day to day running of the nurses office.

    REALLY, It is the IEP's I need help with. Since there has not been a District Nurse for quite some time, I do not know what to do with the multitude of requests I am getting for IEP's, and hearing and vision screens. I was hired as a BSN, PHN, but do not have my Audiometrist Certificate. I did apply for my Preliminary School Nurse credential which has not yet been confirmed and, I do not have experience in School Nursing. I did purchase "School Nursing a Comprehensive Text" and have been reading everything I can get my brain around.

    From what I understand when a child is referred for an IEP, the teacher (or I, if I am notified) will send out a health questionairre to the parent. I have received several questionairres from the parent and reviewed their history and cum files. What is next step? From what I understand, I would discuss with parent if there are any concerns from health history, set up and perform hearing and vision screening and write up a report on my findings. My quandary is that I have not been trained to perform vision screen (and am I even qualified to perform this test in my current unconfirmed prelim status without any experience?), not certified in audiometry, and no idea what is expected of me in my report. Do I also do my own head to toe assessment on child?

    Obviously I have met with my supervisor and discussed my concerns and asked about a possible school nurse consultant I would bounce questions off of. The answer I received is they are working on getting me a preceptor, which may start mid October, and to just get to know the schools/students in the mean time. I am not exactly sure what that answer exactly means, and me being OCD about getting things done, it feels like I need to do something because from everything I am reading, the IEP's and screenings are the main focus of this job, since I have Amazing Health Assistants who do day to day student stuff.

    Any ideas? I do have two other nurses I have contacted in districts that are close to mine, but I feel like they really do not want to help. I get answers like, "just write up the report", without any idea what the guidelines are. Of course I have searched for any guidelines or protocols for my position but have yet to find any. Am I totally missing something here?
  2. Visit elprup profile page

    About elprup

    Joined: Jul '06; Posts: 1,065; Likes: 1,123
    Soul searching.; from US
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  3. by   elprup
    Yay, I found some old IEP's and think I can wing it based on cum files and parent questionairre. Obviously, without the hearing and vision screening. But working on it and knowing it has to get better.
  4. by   scistav
    Elprup, I am a school district nurse in the Bay Area and would be happy to answer some questions for you.

    You are qualified to perform the vision screenings. In CA, you are only required to screen for distance vision with a Snellen chart. Passing standards vary by age. You are right that you need an audiometrist cert to do the hearing screening.

    Vision and hearing screenings are required for all new IEPs and then every three years (called triennials or tri's). Perhaps your district was contracting with an outside provider to conduct the screenings before you were hired and that can continue until you have completed your certification.
  5. by   helenaeberg
    I am also a new district nurse in Northern California (Lakeport). I am currently taking an audiometry course through CSU Fresno. It only requires one practicum day in Fresno, all the other work is done online. I recommend taking it the next time it's offered!

    I am still not very sure about the IEP report. I have been performing vision and hearing screenings on some initial and tri IEP students but I've just sent the screening results to the case carrier and that's been it so far. I don't do a whole head to toe assessment, I just ask them some questions and look for any obvious oral health problems, etc.

    I am the only nurse in the district and have little to no guidance. There is only one health clerk who only works at one of the schools so I am constantly going to each school site to manage the five insulin-dependent diabetic students. It is extremely overwhelming! You are lucky to have multiple health aides that manage the first aid clinics!
  6. by   elprup
    Scistav - thank you so much! May I ask where I can find those guidelines regarding only testing distance vision with Snellen? I have been given our eye screen machine and expected to know how to use it before next week. But I cannot imagine using it on EVERY child - it would make sense to use it on those that fail, but even then, it is alot of work!

    Also, the nurse who left did hear & vision screens every year on all IEP students! I did not think that was the normal. But now that all of these IEPS state to do H&V screen every year, I believe I am stuck having to do them??

    Thank you so much for the help. Feel free to message me anytime if I can be of help to you, or you just want to vent.
    Last edit by elprup on Sep 30, '12 : Reason: Spelling, argg stupid Ipad
  7. by   elprup
    Helenaeberg - i am pretty close to you, you'll have to message me sometime. CSU Fresno! Thank you!I realize I am VERY lucky to have my amazing health assistants! And all of them have been there for I am VERY GRATEFUL! we will see how long the budget lasts though. I truly appreciate your responses, and if there is anything I can do to assist you, feel free to message me. It would be great to be able to bounce ideas off of each other.
  8. by   scistav
    Vision Screening for CA Schools Guide:
  9. by   elprup
    Got it thanks! Funny, I got job offer today for county PHN. 10 hours a day 4 days a week but $9 less an hour then my school gig. I would love to learn working with fragile children, but I am sticking it out with the school - better hours, yay holidays and vacations, and more $. Who whould have figured? Just grateful I finally have a JOB
  10. by   cc_RN
    Hello ladies, I recently stumbled across a District School Nurse position in my area (small town in southern california), but am hesitant to apply. I wanted to pm elprup, but I am unable to. Can you please explain to me what a day is like as a DSN? I'm hesitant because I do not see an opportunity for growth. I have been an RN for 3.5 years now. Can you please give me more information about this position?