New school nurse! Help!

  1. So I start a new job as a school nurse Jan. 9th in a middle school. I've been trying to read up on some health topics mainly diabetes, asthma, allergies, and head injuries. I have only been a nurse for a year and a half in a hospital med surg unit dealing with adult patients. Honestly I'm a little nervous but excited for the change. I'm in need of tips/questions to ask as it looks like my orientation will be limited. What are some of the most common health concerns for this age group? What can I do now to be better prepared on my first day? I'm starting mid year- will I have a harder or easier time? Thanks for any input!!
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    About RNBSNon12/13/14

    Joined: Dec '16; Posts: 10; Likes: 2


  3. by   Amethya
    Biggest complaint I get is headaches, sore throat and stomachaches.

    Have a visitors log before hand and make sure you document everything on the database as well.

    It depends on if the screenings have been done already and the immunizations were on the system from the last nurse. If that was done then it should be easier.

    Be prepared to see some curious students. Be kind But tough. Its ok to be their friend, but you must be assertive when you have to.

    Good luck!
  4. by   halohg
    Will you be the only nurse?
    Be tough, many will be avoidance or drama issues. The rest are stomachs aches, headaches, sore throat, seasonal allergies, medication appointments, replacement band aids, recess/pe injuries, nose bleeds, use of a private bathroom, or avoidance or avoidance or avoidance. LOL!

    Be aware of process for sports clearances and again be firm. They are old enough that if they want to call home, let them and fight it out with Mom whether they go or stay if no fever. This age group is great as they can be articulate what is wrong. Most diabetics are pretty self reliant and may only need assistance with figuring out insulin bolus or coverage amounts. There is an app you can download that makes it super easy and fast. The asthmatics are pretty good as well, if they come in wanting their inhaler I usually do a quick listen to their lungs and O2 Sat asessment and give them their inhaler. Be friendly with the physical education teachers and know when they do the "pacer" and mile runs and be sure your asthmatics pre treat. The office is always full after the pacer from those that over do it and are feeling dizzy, stomaches or feel faint.

    Be nice but not too nice, they need to start understanding personal responsibility. If you think an injury is suspicious of bullying or fighting ("bumped my head into the wall, the door hit my face", etc.) understand who in administration to get involved quickly, let them figure out if there is more to the story. Make friends with the guidance department as they will know the students who have issues at home or struggling with any of the multiple adolescent issues of today. Your frequent flyers with my first sentence issues may benefit from you having them see the counselor instead of you, you are part of a team I hope and you should have support. Sports physicals can be a harry time as there are typically 4 sport seasons so therefore 4 clearance periods and this age group have a way to wait to the very last moment. Make friends with those coaches and make sure during the student interest meetings it is plainly spelled out when you expect them to come and what they need. Follow up with daily reminders during morning announcements. Somehow they think Math is a great time to be cleared. My system was drop off paperwork in the morning before class started and return during lunch to understand if they were cleared or needed an updated physical. If they forgot, too bad, come again tomorrow during lunch and if they run out of time...not your problem. Then you have the parents, during sports time they can get a bit they scramble last minute even though the child has known for weeks to get done what they needed and didn't...mama bear to the need to be stronger.

    Do a search on this forum as this question as been asked a few times with great information. Try and not become overwhelmed, it can take a full year to implement your practices that work for you. Start with understanding who is on daily Meds, and who has PRN meds in the office, that will give an immediate heads up as to your most medically needy, then hopefully there will be some sort of list of all students with "conditions." Make sure you have orders and medications for all those asthmatics and those with allergies. Understand policy on field trips. Do you have the ability to request a 'float nurse'? If so try and schedule her on the week of sports clearances, when the district doctor comes to do physicals, and when you want to do hearing / vision screenings. Good luck, the community here is wonderful reach out often!
  5. by   halohg
    Find the tread on nurse hacks that one had a lot of great advice.

    use of the bathroom, hydrating with water, temperature check, confirmation we do not have PRN medication in the health office for them specifically and a salt gargle cures most. ice packs cure most of the rest.
  6. by   grammy1
    When they're running the 1/2 mile, lack of hydration is the most frequent thing we see. Oh the avoidance...yes, lots of avoidance and "status dramaticus." The usual headache, stomachache, or sore throat. You'll notice they come in batches, headaches for a few days, stomachaches for a few days, and the same for sore throats. Watch for the frequent fliers, you'll find certain students who always manage to need to see you during math. Got hurt 3 periods ago in PE, but waits till math to come to the clinic. It won't take long to pick up on those things.

    I'm also at a jr. high, good luck to you, I hope you like it. I could never go back to the "littles."
  7. by   Dimple58
    You probably could use a Emergency Guidelines Manual that we use. It is A-Z so everyone is on the same page with about 40 pages that have diagrams of what to do if the answer is yes or no.
    Frequent complaint is headache. Temp check, ask if they ate food or had water. Maybe rest 15 min.
    Second frequent complaint is stomach or throwing up. Middle kids can lie, so I ask who saw them throw up. Did you eat spicy chips? No fever, back to class.
    Third is a mixture of adolescent silly stuff like, putting on tight knuckle rings, girl cramps, cutters, peer pressure issues (get counselor involved).
    Fourth is some legitimate stuff like asthma, adhd, seizures, diabetes, bathroom issues.
    Last edit by Dimple58 on Jan 4, '17
  8. by   JustRNingAlong
    Hi and welcome! This thread has been super helpful! You will find tons of great advice and help! I think you are definitely on the right track with reviewing. May I ask, what state you will be in?
  9. by   RNBSNon12/13/14
    Thank you!! I'm in Illinois.
  10. by   RNBSNon12/13/14
    This is great advice! Thanks so much! I will be the only nurse. Although we have an adjacent elementary school with a nurse in that building. That makes me feel a little better.
  11. by   RNBSNon12/13/14
    Thank you all so much for all the tips/advice. I've already learned so much just looking through these posts. I learned I will have 1 day with the health services coordinator! Yikes! Nervous about that but she's also just a call away and I'll have lots of resources from what I hear. So far I do know I have 2 kids on insulin pumps. I've been reading a little about that but if anyone can provide any input on this I'd appreciate it! Thanks again.
  12. by   Duncan6
    I am new to school nursing as well, but my certification is in diabetes ed. Pumps are great! For most middle and high school students they should be able to calculate carbs pretty well and give their own boluses. When I would sub at our high school one of my Type 1 students had a pump and he would just come in to check his bg and give me his numbers for documentation purposes- he did everything on his own. With a pump they are getting a constant amount of fast acting insulin instead of a long acting like Lantus. They bolus through the pump for bg correction and for carb coverage. The pumps are pre-programmed with insulin to carb ratios and correction factors ,so they should be able to just put in their blood sugar, how many carbs if they have eaten, and the pump will calculate the insulin to be given. Some even are programmed to deduct insulin if the bg is low, for instance my 8 year old type 1 student came in with a bg of 67 before lunch. He ate ~60 carbs. Normally he would probably get 2.5 units or so, but the pump subtracted insulin off d/t the low bg and so he received less than a unit. It's also more usual for kids to check a bg before lunch then give the insulin after since kids' appetites are erratic. Carbs can be a bit of a guessing game- my kiddo tends to drop half his lunch on the floor so I estimate as best I can. As far as working the pump, once you find out the manufacturer you can usually go to the website for a lot of info. Often they will have instructional videos of how to use it. It would be helpful to have back up insets at the school in case one is dislodged or develops an occlusion. The older kids usually change them on their own. It's really important to get the pump back up and running asap due to the fact they have no long acting insulin on board. Medtronic and Omnipod are two common brands of pumps. Hope this helps!
  13. by   Running Cat Lady
    +1 to everything above.

    If you're willing to spend the cash pick up a (used) copy of School Nursing: A Comprehensive Text by Janice Selekman off Amazon. It's a giant book but the portion with common illnesses listed by body system really helped me wrap my ICU trained brain around school nursing and what I should be doing or looking for. Maybe it was just me but after a decade trying to keep complex, (often very old) people who were suffering from major medical issues alive it was hard to switch gears to public health/pediatrics