New School nurse sub - advice??

[photomom]

Hey all, I come from a critical care background but have an opportunity to work as a school nurse sub. I thought it would be a great opportunity to broaden my nursing experience and to pick up a few hours without being unavailable to my kids for a full 12hr shift.

I signed up as a sub for Thursday through an agency. When I reminded them I had never done this before their brief response was "oh, it's no big deal. A lot of nurses love doing it because it's easy. You just give meds to kids that have it ordered and you're available if they need you." Sounds simple enough... but now I'm getting nervous!

She told me I just check in to the office 20 minutes early so I have time to review the sub notes and that's all I should need. Oh, and she said there are not tube feeds at this school. (I never realized school nurses DID tube feeding!) This is just so far OUT of my comfort zone it's making me nervous when it probably shouldn't. It's kids and I'm used to being a nurse for big people (often VERY big people), it's during school so they're not hospitalized, and I'll be all alone.

I think that's what probably scares me the most. I am very comfortable floating just about anywhere in a hospital setting because I know there are other nurses there if I have questions. As a school nurse sub, I have NO orientation so I don't know the school, the people, or even the basic routine. I don't know the policies. What if something bad happened? In the ICU we're prepared because we expect these things - there's a crash cart, a code button, doctors on call, LOTS of great nurses all around, etc.

I'm a mom, but my kiddos are still pre-elementary (4&2) so I don't even have experience with this age group or in dealing with schools really at all. I'm sure things will be fine and I know you have to step outside your comfort zone to grow and I'm willing to do that - but I DO prefer to be a little prepared!

So, that's really what I'm asking for - some encouragement and some idea of what I can expect. Any tips for making things go smoothly? Anything I should ask? (I feel silly that I don't even know enough about school nursing to even know what questions I should be asking!) Aside from giving kids their meds (and is there a list I should find somewhere or how will I know who needs what? Do they come to me or do I find them?) what else should I expect? What else do school nurses do as subs? I remember from nursing school years ago that the school nurse implements a lot of education, I've read about how some of you have talked about immunization records, etc, but I don't see how I would do anything with that in one day as a sub.

Would love any advice you have!!! Thanks in advance :)

[Flare, ASN, BSN]

Photomom's got that right! Not saying that there aren't school nurses that go into that job right out of nursing school, but they will have a harder time with the job. Student and staff come in to your office with questions about everything. And I mean everything. Medically fragile students that wouldn't have been in mainstream schools and now fully integrated. It isn;t uncommon for a nurse to do a tube feeding, straight cath, trach care, etc. You really need to be secure in your skills before you step into that office - remember - you'll be on your own. There usually isn't another nurse to precept you.

Every nursing student rolls their eyes when they are advised to work a year of med surg after gradution - that advice has stood the test of time for a reason - it's sound advice. It opens the doors for a lot of specialties.

[NutmeggeRN, BSN]

flare makes great points. i would also add that not everything is always as it seems....school nurses keep a ton of information filed away in their head and they may respond to a child/family/situation differently than you will based on the limitations of your knowledge and their familiarity with the child and family social system. that is not to say what you do will be wrong, but it may just be different, and you may or may not have the opportunity to discuss how each of you would handle a certain situation. soak up as much as you can from any orientation you may get and don’t be afraid to ask questions!

[mycsm]

how are docs orders usually organized? should i look for charts on invidual kids? what else should i look around and find when i get there to make sure i have everything i need available when/if i should need it?

usually the orders are kept in a binder. you will see daily meds, prn meds. simple to follow

jun 12 by photomom a member since apr '09. posts: 12 likes: 2

age: 32

oh, and maybe a silly question, but how high of a fever = send home criteria?

i send home with 100 and higher. honestly, if a kid comes in with 99.6ish and looks icky, i will send home because the fever will only go up.

[HazelLPN, LPN]

I'm also a former critical care nurse (retired) working as a substitute school nurse, although I am an assistant and work almost exclusively with special needs students, but occasionally assist the regular school RN as needed. Many school nurses are former critical care nurses it seems. Yes, the job is easier than working in critical care for ME, but the actual school RN has many responsibilities. In someways, she/he is in a primary care role as many of our kids who live in poverty do not have regular pediatricians and the school nurse is the only healthcare provided that they see on a regular basis. As a sub, however, they will just be thankful that there is a nurse there.

Yes, I too was amazed to learn that school nurses gave G tube feeds, give meds, have kiddos on vents, have kids who get cathed and I've even have some on TPN if you can believe that. There are many more medically fragile children in schools these days than years ago. We have a special school for medically fragile children, some of which live in LTC facilities but can still come to school and learn. I am pretty busy sometimes, and its probably like working on a skilled LTC unit, although with many less patients and they don't send them to school if they suspect their are the slightest bit sick.

At first I felt naked. No drug box? No Os? No intubation box? What if a kid gets sick...I mean really really SICK? It can happen.....

Well, you've got juice boxes and cake frosting for the diabetics, inhalers for the asthmatics, epi pins for the kids with allgeries...and an AED, first aid kit and above all... 911 for emergencies.

Best to you.....you'll do great!

Mrs H.

[paulaclark29]

Hi i just got a postion to be a school nurse sub, i went to school for medical assistant, and theres no training so i was wondering is there any advice you nurses can give me?

[crssy24]

Hi i just got a postion to be a school nurse sub, i went to school for medical assistant, and theres no training so i was wondering is there any advice you nurses can give me?

I am a LVN/LPN and currently working as a school nurse. My best advice is to get a good county contact to give you some guidelines and protocols . My Contact told me to reference " The green book". Good luck!

[squidbilly]

I became an RN last year and ended up getting hired as a "school nurse specialist" after having no luck finding employment in a hospital setting. I had a rough start, to say the least. Even though I obtained a permanent, 25 hr/wk position at the elementary school, I received very little orientation or guidance. As a new grad with limited clinical experience, and having little experience with children and the school system, I felt like a fish out of water. Five months later and I am happy as can be! I have never had job satisfaction like this before. I don't think you have much to worry about. You have extensive critical care experience, and amazing nursing judgment, I am sure, not to mention experience with children of your own. You got this!

[roser13, ASN, RN]

I think you got some good answers on your other thread. You need to be very careful as to how you present yourself and in the work that you're willing to do without a license.

Hi i just got a postion to be a school nurse sub, i went to school for medical assistant, and theres no training so i was wondering is there any advice you nurses can give me?

[KANTO]

Thank you so much for this thorough post and helpful responses! I'm new grad, and recently moved to Japan to be with my husband. School nurse sub seems like my only option for employment on a military base.