0Jan 8, '14 by ChaRNbsnI just started a position at a k-12 school as the Health Services Nurse (school nurse). I would like to hear from school nurses, any tips/ strategies or pointers will be greatly appreciated. Here's a little background:
Today was my 1st day, the nurse before me was very unorganized and when it comes to what she charted on the students it is very illegible and files were not all in a central location. I find out that I have a 29 student caseload + the rest of the k-12 school and a certifies school nurse is only in once a week. They told me that they will supply me with whatever supplies I require. I honestly feel a bit overwhelmed being a new grad (this is my 1st nursing career since passing NCLEX). I am waiting on my laptop to come sometime within the week and one of the things that bothered me about the student charting system is that there is no "triage" charting I should say.
For example when a student comes in I have no set piece of paper that I can use to chart, when they came in, what their complain was, what I did to address the complaint and so on. I was told that "I can come up with a template for it and we can discuss it" but I am drawing a blank. Also on my caseload of 29 students I don't have a system to chart what we discuss.. basically the "care plan" I don't have a set piece of charting for that either.
Would any school nurses happen to have any templates or pointers? Also, My office is bare bones. Would anyone have any sites that has basic school nurse posters on hand hygiene, asthma, healthy eating and what not.
The help/ advice would be MAJORLY appreciate by this new nurse starting out with a big load.
3Jan 9, '14 by JDuffHi there. You are going to love being a school nurse. It may seem kind of daunting at the beginning, but once you get organized and establish your own way of doing things it becomes much easier. The first thing I did after starting was going through and organizing everything the nurse before me left. Sometimes I discovered things that were useful to have later.
I then made a place for everything I needed to have on hand; a place for student meds, emergency meds like epi pens, benadryl, glucose for diabetics etc. (in an easily accessible place). Also having the most used things in an easily accessible place is good too - like bandaids. I gave out a lot of ice packs wrapped in paper towel for recess "injuries," it was a healthy kind of placebo and it usually made the kids feel much better. I would made little bags during times kids weren't in the office and so when they all rushed in at recess I could have them at hand.
The triage charting can be really simple. We had a simple form like this:
Name Assessment, care given
All I did was write their name and what the assessment/story was, and then the care given. This was not the actual charting, but more of a reminder to me of each child so I could chart it into the computer later. So, for example, I would write: Jane Doe, scraped left knee falling on gravel, gave ice/bandaid. This way kids could come in a rush during recess or other high flow times and I could write little notes down to myself for a reminder later. Then during low flow times I would take the sheet in with me and chart it all into the computer, a little more in-depth, and cross off on the sheet all the things I've already charted. Something I've had to learn the hard way is to always write down their names and the issue; in the moment you think you can remember it but then unexpected things happen and you forget.
Something that's really comforting to remember is that the parent is always the number 1 resource. Calling them and just making them aware promotes trust with the nurse, and often the parent will make the decision. If you are concerned about sending them home for something call the parent and tell them your assessment and what you are thinking, then ask them their opinion and desires about what to do. They also know their kids really well, and can tell you if extreme stomach pain is a normal thing for their child due to anxiety, or that their child is depressed because of a recent family death, etc. Sometimes everything just clicks into place when you get the parent involved.
Some supplies that would be helpful to have are:
1) extra clothes, especially socks, underwear, and pants in various sizes. I was surprised how many kiddos needed extras because they had peed their pants, fell in a puddle during recess, etc.
2) Books: whenever a child complained of a stomach issue they always went for the books. These were also great tools for talking with kids and allowing them to open up to you.
3) Little plastic bags for ice and lots of little water cups
4) Sterile saline and eye wash cups if they get sand or something in their eyes; Benadryl (even if you cannot give this without Dr.s orders, you can always call the parent and do what they tell you to do); vaseline for chapped lips; little bags or containers for lost teeth (one nurse I know had a little poster on her door that the kids could sign their name if they lost a tooth).
5) A large filing system (whether cabinet or drawer or something) where you can have all paper forms for all the students. I also had a separate little file system that I kept on a table that had the most critical kids (diabetics, etc.) and their individual care plans. That way I had easy access to the really important, and most often used, documents. Personally, I think the careplans should differ based on the condition. So a diabetic could have a different looking careplan than a child with severe allergies to peanuts. The careplans
6) Hand sanitizer
Here is a really good website for diabetic care plans; there is a download link at the bottom of the webpage: Diabetes Medical Management Plan - American Diabetes Association®
Anyways, I hope I haven't overloaded you with information! Enjoy your time as a school nurse, it is really a wonderful place to start out and will give you such confidence in working independently as a nurse. I have always enjoyed it, and the kids will keep you laughing.
0Jan 9, '14 by Jen-Elizabeth, BSN, RNOP, send me a private message and I can email you a paper form that may help until your computer system is up and running. (Things I attach here seem to never attach right).
I went from passing the NCLEX until school nursing last year as well . In my office, I sent home a basic health card (front/back); when I got it returned, that went into a binder as it included the best phone numbers to reach a parent/guardian; for my asthma or diabetic kids, the asthma action plan or insulin orders were stapled to this card. For those taking prescription meds in school, medication was also stapled to this card. Easy access, two steps from my desk.
1Jan 9, '14 by NutmeggeRNWelcome! Familiarize yourself with your office and equipment, talk to guidance-they are great resource, talk to your administrator, start to read through files, maybe by YOG (year of graduation), look for emergency lists and familiarize your self with those kids, check in with your school nurse association and get on their list serve, check your supplies ( check for expired meds-happens to the best of us)....that is a start!
What is the 29 student caseload? Special Ed, 504, medically fragile?
I have a binder for Emergency treatment forms that also covers OTC meds (allowable in NH)
I find binders with labels get lost less often than manilla folders I also use colored folders as well!
I keep student records by YOG (Year of Graduation)
I keep med orders and med administration records in a separate binder (that way when given med the order and parent perm form is right there. At the end of the year, it goes into their permanenet file.
1Jan 9, '14 by FlareI do everything on computer using healthmaster and i adore my software. I tell my boss over and over that it's key to keeping my office running like the well oiled machine that it is. If you can, push to get some sort of EMR like healthmaster or SNAP (a lot of districts use electronic programs for grades and attendance that have a health component - it may be better than nothing but a program that is built for nurses and designed by nurses is best - it will feature things like overwrite protection which is important in case your charting is ever called into question and it's asked whether or not you changed it after the fact) anyhow - i'll step off that soapbox now.
One thing that I do maintain is a paper med log for subs - it's simply too difficult to assign log-ons to subs should I be out - i've attached the form I use. I make a double sided copy with the order on the other side (or staple the copies if there is multiple medications).
I'll continue to peruse my files for useful things but in the meantime, I found this site very helpful when I was getting myself started in developing my own paperwork.
1Jan 20, '14 by ChaRNbsnOMG thank you everyone for all the advice and information. it has been 8 days so far in all and I am still slowly chugging a long, Also I have to do 504s my boss is going over them for me but I am just trying to keep my head on straight from all the information. I have another questions to anyone willing to answer it. On friday I have to do a presentation what what teachers should send down to my office and what they shouldn't send down. Honestly I don't even know what should be sent down or not LOL. Oh and strategies that teachers can use to address minor things in the classroom instead of sending even little bleeding finger down to me.
How do I handle a kid with a sprained ankle? I got a lot of those last week and I just gave the kid an ice pack. LOL I notice that they tend to think that it fixes everything.