Special Needs "Classroom" Nurse

[momto2lilgirls]

I have been crawling around this forum looking for some answers, but decided to just ask my question outright.

I interviewed recently for a job as a special needs classroom nurse for a K-8 school. During the interview I found out there are 7 children, 3 with trachs, several with g-tubes on gravity feedings, one on continuous feeding, and at least one or two get meds through g-tube. One child has a major seizure disorder with VNS implant. The school wants to hire their own nurse to care for these children in the classroom setting because the contracted nurse currently providing care for a few of the children is way too expensive. I think parents come in and do the care for a few of the other kids. They want to hire an LPN vs. an RN from a cost standpoint, which I guess is understandable.

My name got passed to the special needs coordinator from a friend of mine who works in their HR dept. I just finished my LPN and am waiting for my auth to test for the NCLEX-PN. I have already interviewed for the position so they know I am a "new grad" with no experience. They want to offer me the job if I pass the NCLEX (obviously), but does it seem strange to anyone that they don't want an RN or at least an LPN with med-surg experience? Can an entry-level LPN safely care for these kids? They don't really have a plan to "train" me; their idea is that I would "shadow" the contracted nurse for a few days; however, that is not nearly long enough to learn the ropes, nor is that nurse an employee of the school??? They told me the main school nurse is too busy to deal with this classroom herself, which seems obvious because it sounds like a full-time job.

I would love the experience, but at the same time, I need to protect my license and the safety of the children. I am unfamiliar with school nursing and how caring for medically-involved children works in a non-medical, school setting. I am DYING to talk to a school nurse, or any nurse with experience, about this. Anyone want to chime in?? I sure would appreciate the help.

Regards...

[safarirn]

The fact you are questioning the children's safety being new grad LPN taking this position, instead of just jumping on it for the hours/ schedule makes me believe you are going to be a caring nurse.

I agree with what you. When you are taking care of special needs children with trachs, g-tubes, tube feedings, in a classroom setting- you really do need experience behind you. You can learn how the 'technically' perform all the tasks in 1 week of orientation & you might be okay for a while. But it's so much more than that. A lot of these kids will be non-verbal. They won't be able to tell you if something is wrong. You will have to depend on your assessment skills. Those skills will have to be top-notch.

Remember, you are the only medical person for those kids. You need to know what complications to look for & with limited medical equipment & supplies you have to do this armed with your eyes, your ears, your hands, a stethoscope, & little more. Without experience behind you, this would be tough.

Things can not only go wrong with the student, but equipment can malfunction... again, experience would help in that situation too.

I really encourage you to get some med/surg or pediatric experience behind you before flying solo in a school or classroom.

Good luck to you!

[Purple_Scrubs, BSN, RN]

I started in school nursing with less than a year of RN experience under my belt. That said, I would not have taken a position like the one you describe without considerably more experience. I think that school nursing CAN be done by a relatively new grad, but the situation must be right. When I started out, I had an "easy" school with my only procedure being g-tube meds. I had no trachs, no diabetics, no serious medical conditions. I also had a wonderful support system, which it does not sound like you will have. Even with all of those things, I still struggled at first. Even now I still seek out help from my mentors on a regular basis.

Unless you can get some serious orientation (more than shadowing for a few days), and you can be sure that backup is never more than a phone call away, I would be very leery of this job. Keep in mind that the school does not really understand nursing. They do not realize the difference between a new grad and a nurse with a couple year's experience. They are likely looking only at the financial bottom line of what is the least expensive. Not that they are purposely trying to "get away" with something, they really just don't understand nursing.

I have no doubts that you will be a wonderful nurse. I would just hate for you to end up over your head without having the backup and support that a new nurse needs to succeed in a school setting. Let us know what you decide!

[bergren]

I concur with the other responses. I think that adminstrators and educators assume that since the parents can be taught to care for their own children, that anyone can perform these tasks after being "shown". I don't think they grasp how the lack of clinical experience translates in a school setting. Plus, one of the problems in education overall is it common to not support new teachers right out of school - they start with their own independent classrooms right out of school - sink or swim.

You don't say what state you are in, but in just a few states some of the procedures described are not within an independent LPN scope of practice. You can ask at your LPN program if that is the case in your state. In addition, in all but a very few states, you would need to be "supervised" by another RN in the district. Have you met that person? How far away would they be in an emergency or if you just needed some help?

[blueiwahine]

I just started a life skills nurse position. I have 18 students that I am responsible for...I do g-tube feeding, give meds, catherization and have several who have seizures...my one student that has a trach, has a private nurse with him. I have been a nurse for 3 years, but was in med-surg. This is my first experience dealing with children. I agree with everyone else, you need to have a confidence level in your skills, which only comes with experience, as well as have assistance if needed only a phone call away. The school I am in, also has a regular school nurse. I just finished with 3 weeks of training with the nurse that is leaving the position...which everyone has told me I must be blessed because no one ever gets any training when they start. The school faculty do not understand what all is involved with caring for these children, so do not think they have your best interest at heart...they are only trying to fill the position. I do admit I was uneasy when I first started, but I have been reading alot about chronic illness in children. If you accept the job just remember the important factors ABC's (Airway, Breathing, Circulation). Seizures are usually never life threating, unless they are Status Epiliticus, which you would need to call EMT's if the seizures last too long. PM me if you have more questions

[LovebugLPN]

I am going to just add another possible headache to this situation for you. I worked with a child with a trach for 2 years in a classroom in a room like this and in addition to having to take care of him I had to fight off the teachers' constant questioning of everything I did. Non-medical people can add a whole other spectrum of trouble to the situation.

[mustlovepoodles, RN]

I concur with the other responses. I think that adminstrators and educators assume that since the parents can be taught to care for their own children, that anyone can perform these tasks after being "shown". I don't think they grasp how the lack of clinical experience translates in a school setting. Plus, one of the problems in education overall is it common to not support new teachers right out of school - they start with their own independent classrooms right out of school - sink or swim.

The trouble with admins is that they have no idea just what a nurse does. On the one hand they expect you to work independently and make all the sickies just go away(one way or the other) and on the other hand they want to tell you how to do your job (I had a principal who criticized me because I called 911 several times for students and staff who were having life-threatening problems. Oy)

It is true that parents can be taught to take care of their children. BUt the law doesn't hold them to the same standard that they hold a nurse to. If a parent does something wrong and the child suffers a bad result, they feel guilty and sad. If *you*, a nurse, do something wrong and a child suffers, you can be sued from here to next week.

I would strongly suggest that you take a pass on this particular job. School nursing is a hard job, particularly when you are nursing special needs technology-dependent students. This is not a job for any new graduate. Give yourself a couple years to gain some tech skills.

[spednurse]

in regards to the new lpn wondering about working in a special education classroom: i have been a RN for 21 years, took care of my son who became severly disabled for 16 years and have worked with special ed in the school setting 8 years. with that being said, in my opinion, you need experience in critical care for children and special needs children prior to working in the school. that type of care can become life threatening in seconds. you have 911 but til help arrives your skills are all the child has. you do not have ascess to crash carts etc. in short i would not recommend this type of job for any unseasoned nurse. i hope this helps. special ed nurse

[wearingmanyhats, RN]

I work in this type of situation... BUT I have 25 yrs under my belt. I agree that you should work some med-surg, or even LTC and get some practical experience, and confidence in your abilities first. I do agree that you sound like you will make a good nurse, but you need to know that you can count on your skills when an emergency arises (and trust me, it will happen) If you want to talk, PM me...

Faye