Stressed out, is it just me?

  1. Hi Y'all,

    It is my first week as a school nurse at an elementary school, I am feeling a little bit stressed out. I think it is because I am used to having orientation and training last more than a day. I feel as though there is a million questions with little outside support (my supervisor is new also). I have no clue about immunization compliance and how to to complete this, as well as how to start with health screenings, not even sure how to use the equipment.

    Plus I am in MA and have to get a state DESE license and take a literacy test, and some mandatory training. I know I have a year to do these things but then I feel like I am constantly have new things come up that I have NO CLUE how to do, like new students files (what am I supposed to do with these??), health summarys, etc, and there is both paper and 2 different student computer records that I need to learn. What happens
    when orders expire and the parents wont return my calls/letters?

    I'm sorry for the long vent but anyone who says that school nursing is easy, esp in the beginning, is probably lying the kids are cute but a lot of them are "testing" me, it can get very busy very fast. I could use a few words of encouragement as a new school nurse...Thanks for listening.
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  2. 17 Comments

  3. by   NurseBeans
    I'm not great with the advice, I usually am more handy with the sarcastic comments, but here's a go:

    Hang in there because it does get easier. Focus on getting through the day without letting any kids die. Paperwork and charts are not going anywhere, priority with medications is with the emergency meds that are expired/expiring. With parents, I like to use a multi-faceted approach to communicating. Call, email, send letters, text...try everything until you get what you need from them. Also, there are parents that will never give you what you need, and you can't change them.

    Gently let the children know you are not there for the nonsense. You are there for health matters that require a nurse. There shouldn't be that many of those in a day. Also let the teachers know this; I have found they need more reminding.

    Ice packs and boredom cure lots of ailments. Your office doesn't need to be fun, it just needs to be not scary. You are allowed to tell kids no. There is no cure for a cold and most people can survive a school day with one. Oh, and lice are not an emergency.

    Hope that helps.
  4. by   River Song, RN
    You're not alone! I've only been doing this for 5 weeks and I still think of quitting at least 4 days a week

    In the beginning, I made a list of priorities and goals and it helps me stay sane. A month in, I still feel overwhelmed BUT I feel that I have the most critical things in place.

    Each day my first priority is always treating the sick and injured kids right in front of me. When that was handled I tackled these items:
    1. Get my doctor's orders signed/organized/documented for any meds I'm giving or procedures I'm doing.
    2. Identify any life threatening health issues in my population (severe food allergies, seizures, uncontrolled asthmatics etc.). I used last year's computer records to quickly identify returning students who had major problems flagged and then looked through health histories of my new enrollees for those big red flags. After that, I set my pile aside to go over with a finer tooth comb of ALL records for non-life threatening issues.
    3. Identified due dates of my major projects such as vaccine compliance, state mandated screens, completion of IHPs and then prioritized those projects based on what was due when.
    4. Read through my policies and procedures as time allows.

    As I get things accomplished I cross them off and generally find newer things to add to my list but it does give me a sense of accomplishment. When I had all of my orders updated and scanned, that was my first sigh of relief ... then I dug into the next thing.

    One of my favorite quotes is that the man who moves mountains begins by carrying away small stones and I think that DEFINITELY applies to school nursing. When you look at it as a mountain, it's just overwhelming so break it down into the moveable stones.
  5. by   AllykatRN
    Thanks so much, I had a tough day and needed a little whining over whine. I am used to a team atmosphere in the hospital, and this is all very new to me. I will def take the advice. Thanks again so much and thank god for the long weekend!!
  6. by   SullyRN
    That's a common theme in school nursing, very little orientation, or none. I got two hours at each school while I was a sub so it didn't include any paperwork training.

    With your supervisor being new, that makes it tough. Are there any other nurses in the district? If not, well, that sucks. If so, make them your new best friend. Lean on them and ask them about the immunizations, screenings, and paperwork.

    The first year is always the hardest, you are laying down new ground work and getting into a routine. By year two you will be a pro. We are definitely here for support.

    Are there any MA school nurses that can help her with screening/immunization requirements? Also, if you let us know what kind of charting system you use, it's likely someone here uses the same and can fill you in on tips and shortcuts.

    Welcome, and good luck!
  7. by   Jen-Elizabeth
    Quote from SullyRN

    Are there any MA school nurses that can help her with screening/immunization requirements? Also, if you let us know what kind of charting system you use, it's likely someone here uses the same and can fill you in on tips and shortcuts.

    Welcome, and good luck!
    MA nurse here! I'm well versed at MA immunization requirements (though this year submitting them is much different than the past and requires access to our state-wide immunization database) and just finally finished up my DESE certification last spring (I waited forever to sit down and take the MTEL test, which was actually pretty easy!).

    Not sure if you are able to PM, OP, but if so, feel free to PM me. MA has a ton of resources for school nurses, but like everywhere else you just get thrown in to start. The trainings you have to complete for your DESE license are awesome.

    MA also has a comprehensive School Health Manual here:
    Comprehensive School Health Manual - Summary of Chapters
  8. by   OldDude
    Welcome to the farm...although vague, I recall my first day as a school nurse. As with most, I was shown where the clinic was, handed the key, and so it began. Only school nurses know how school nursing is - you know - putting bandaids on skinned knees and wiping runny noses, so don't hesitate to sound off with us here.

    All excellent advise above...student health and safety is top priority and everything else gets arranged afterward. I promise, when you're off this summer while the rest of the world is going to work you'll be smiling and waving.

    So, like River Song said above, start moving those stones!
  9. by   Jacquipals
    Hang in there, it will get better! I'm new to school nursing, and also in MA. My first month was awful. I was so overwhelmed. Like the posters above said I concentrated on making sure no one died and getting my medications straightened away. Yesterday I finished care plans, and today I'm entering all the immunizations in. Do you have SNAP or something similar? It's tedious but fool proof.
    Don't wait to sign up for the trainings. They do get full. The MTELs were not that bad. Maybe if you could wait to take until the summer so you have some down time to study? Feel free to PM me with any questions. Good luck!
  10. by   ruby_jane
    Quote from Jacquipals
    Like the posters above said I concentrated on making sure no one died and getting my medications straightened away.
    THAT!! Yes. Breathing, airway, circulation, then band aids and saltines.

    Find a system (either your EHR or some kind of spreadsheet) to know who is not vaccine compliant (and who is coming up). Good luck!!
  11. by   Amethya
    My first day, I had a 8th grader break her ankle from the stairs.
  12. by   AllykatRN
    I really appreciate all the kind words!! I am putting one foot in front of the other. Thankfully there are other nurses in the district and I hope to make friends We use health office anywhere (not my fave) and Aspen for student info. I am so glad to have this community of supportive nurses! XOXO happy friyay
  13. by   Jen-Elizabeth
    Quote from AllykatRN
    I really appreciate all the kind words!! I am putting one foot in front of the other. Thankfully there are other nurses in the district and I hope to make friends We use health office anywhere (not my fave) and Aspen for student info. I am so glad to have this community of supportive nurses! XOXO happy friyay
    Health Office is meh. My first district also used that and I wasn't a huge fan. The MA community of school nurses is good one, though! And you can make more friends at the trainings.
  14. by   MHDNURSE
    Here at my school we use Power School which I am nor a fan of. My district where my kids go to school uses Aspen- also not a fan...I mentioned in your other thread you posted back in September all the info pertinent to MA nurses- hope it was helpful. MTEL is not hard, just annoying. There are practice tests online which are the exact format of the real thing so worth checking out : Practice Tests
    Select whichever ones you want in the pull-down menu.

    I feel like there are several of us on this forum in MA- this forum has been really helpful. I have completed everything for my DESE except my 2 day training that I am unable to go to until Summer of 2018 probably, sigh. They have everything else I need on file. It is a long process but like another poster mentioned, the trainings are actually helpful.

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