What school nurses REALLY do

  1. 33

    Many people think the responsibilities of a school nurse are limited to handing out Bandaids and ice packs all day long. While that's certainly a small part of the job, school nurses actually do a lot more than most people realize. From emergency preparedness (and response!), to keeping track of immunization records, managing concussions, fractures, sprains, and strains, caths, tube feedings, blood sugar checks, or just a little TLC during the day, school nurses do it all.

    What school nurses REALLY do

    In response to this comment from a previous thread:
    "Can you tell us what you actually do in detail? That would actually be a more interesting read."

    Give out Bandaids and ice packs, that's it.

    Just kidding! Although that's what the majority of the general public thinks we do. What school nurses do varies from school to school, depending on student populations, state laws or district policies, etc. I'll get the list started with just a few things I personally do at work and my fellow school nurses can chime in!

    1. I personally cover only 1 school and see 30-40 kids a day, and I know I'm one of the lucky few with such great numbers! It's not unusual for school nurses to see 60, 70, even more on a daily basis---from multiple schools or even the entire district. I assess, monitor, treat students for quite a variety of things: wounds minor and severe, sore throats, headaches, stomachaches, N/V, SOB r/t asthma, menstrual cramps, head injuries that may or may not turn out to be concussions, sprains, strains, nosebleeds, chest pain, many more. You name it, a school nurse has probably seen it.

    2. Ensure students with chronic conditions (most commonly asthma, severe allergy, seizure, diabetes---but many school nurses also see students with more specialized needs such as those with cystic fibrosis, spina bifida, etc.) have plans in place that ensure the safety AND success of the student while at school. For example, a diabetic student would have emergency meds/supplies/a plan for hypo- or hyperglycemia. That's in addition to their day to day maintenance plan (e.g., checking in with the nurse before lunch for a blood glucose check and any necessary treatment.)

    3. Administer daily and PRN medications, making sure all necessary forms are on file, calling parents when meds expire or run out, monitoring for any adverse effects, etc.

    4. Educate students on self-care, healthy lifestyle choices, puberty, or more specific info related to their particular condition or situation.

    5. Educate and train staff on common chronic conditions present in our school, s/s to look for, step-by-step response to emergency situations (anaphylaxis, hypoglycemia, etc.) Many school nurses also do CPR training for staff.

    6. Working with administration to develop policies/protocols related to school health that ensure all students are safe and have equal opportunities to thrive and succeed.

    7. Managing the occasional "special cases"---post-op student for example might need to learn how to use crutches/wheelchair to get around school, pain management plan, special accommodations in class (sitting near the door, needing a way to prop a limb up, etc.)

    8. Document thoroughly on EVERY SINGLE STUDENT I see. That alone takes up a chunk of my time.

    9. Annual vision, hearing, height, weight, acanthosis nigricans, scoliosis screenings for certain grades as mandated by state law.

    10. Being the "safe place" for students with anxiety, other mood/behavioral disorders, and all students really. I'm fortunate to have counselors AND social workers but many schools don't so the school nurse plays that role.

    11. Connecting students/families in need with community health resources.

    12. Navigating the tricky world of teachers and education. You're the ONLY "medical person" in the entire building, nobody understands your job (but thinks they could do it since you just sit around handing out ice packs and Bandaids all day), if you're lucky another nurse is nearby or a phone call away but sometimes not, you are SOLELY responsible for your students' health needs and outcomes during school hours. It's tough being a nurse in a "teachers' world."

    Anyway, I could go on but I know the other school nurses have plenty to add. TGIF!!!
    Last edit by Joe V on Dec 17, '14
    Do you like this Article? Click Like?

  2. Visit Kittery profile page

    About Kittery

    Joined May '14; Posts: 155; Likes: 472.

    Read My Articles

    44 Comments

  3. by   Windchaser22
    I'll chime in by adding that we care for every medical condition on the planet depending on the year. Cancer, sickle cell, heart disease,HIV, Guilin beret, transplants, etc. while also trying to do something about obesity and all the regular chronic illnesses. So yea, we're not doing dog crap.
  4. by   Tina, RN
    Good list!

    Also, keeping track of all immunizations and physicals. Nagging doctors and parents for same...

    Perfecting the art of "mommy-ing" balanced with a little bit of tough love.
  5. by   liberated847
    Quote from Kittery
    In response to this comment from a previous thread:
    "Can you tell us what you actually do in detail? That would actually be a more interesting read."

    Give out Bandaids and ice packs, that's it.

    Just kidding! Although that's what the majority of the general public thinks we do. What school nurses do varies from school to school, depending on student populations, state laws or district policies, etc. I'll get the list started with just a few things I personally do at work and my fellow school nurses can chime in!

    1. I personally cover only 1 school and see 30-40 kids a day, and I know I'm one of the lucky few with such great numbers! It's not unusual for school nurses to see 60, 70, even more on a daily basis---from multiple schools or even the entire district. I assess, monitor, treat students for quite a variety of things: wounds minor and severe, sore throats, headaches, stomachaches, N/V, SOB r/t asthma, menstrual cramps, head injuries that may or may not turn out to be concussions, sprains, strains, nosebleeds, chest pain, many more. You name it, a school nurse has probably seen it.

    2. Ensure students with chronic conditions (most commonly asthma, severe allergy, seizure, diabetes---but many school nurses also see students with more specialized needs such as those with cystic fibrosis, spina bifida, etc.) have plans in place that ensure the safety AND success of the student while at school. For example, a diabetic student would have emergency meds/supplies/a plan for hypo- or hyperglycemia. That's in addition to their day to day maintenance plan (e.g., checking in with the nurse before lunch for a blood glucose check and any necessary treatment.)

    3. Administer daily and PRN medications, making sure all necessary forms are on file, calling parents when meds expire or run out, monitoring for any adverse effects, etc.

    4. Educate students on self-care, healthy lifestyle choices, puberty, or more specific info related to their particular condition or situation.

    5. Educate and train staff on common chronic conditions present in our school, s/s to look for, step-by-step response to emergency situations (anaphylaxis, hypoglycemia, etc.) Many school nurses also do CPR training for staff.

    6. Working with administration to develop policies/protocols related to school health that ensure all students are safe and have equal opportunities to thrive and succeed.

    7. Managing the occasional "special cases"---post-op student for example might need to learn how to use crutches/wheelchair to get around school, pain management plan, special accommodations in class (sitting near the door, needing a way to prop a limb up, etc.)

    8. Document thoroughly on EVERY SINGLE STUDENT I see. That alone takes up a chunk of my time.

    9. Annual vision, hearing, height, weight, acanthosis nigricans, scoliosis screenings for certain grades as mandated by state law.

    10. Being the "safe place" for students with anxiety, other mood/behavioral disorders, and all students really. I'm fortunate to have counselors AND social workers but many schools don't so the school nurse plays that role.

    11. Connecting students/families in need with community health resources.

    12. Navigating the tricky world of teachers and education. You're the ONLY "medical person" in the entire building, nobody understands your job (but thinks they could do it since you just sit around handing out ice packs and Bandaids all day), if you're lucky another nurse is nearby or a phone call away but sometimes not, you are SOLELY responsible for your students' health needs and outcomes during school hours. It's tough being a nurse in a "teachers' world."

    Anyway, I could go on but I know the other school nurses have plenty to add. TGIF!!!
    I was the person that made the comment that the OP quoted. All I have to say about this thread is that School nurses Rock!!!!! I love this thread way better
  6. by   kidzcare
    My day to day consists of:

    First is attendance. When I come in at 7am I listen to the call in messages. Those continue to come in until about 8 or so. All get entered in the computer by 830.

    Students arrive at 725, bell rings at 740. Never sure how many kids will be coming in and for what.

    I see usually between 40 and 80 students a day. 20 daily medications and the rest consist mostly of minor first aid. Small cuts, burns (usually from hot glue in art), skinned knees, various bumps/bruises, nosebleeds (especially this time of year), PRN meds for headache/asthma/cramps, stomach aches, cough, allergies, ect.

    Less common but ready for at a moment's notice: head trauma gets a full workup, broken bones, seizures, LOC for any reason, severe allergic reaction.

    Document on every student who comes in my office.

    paperwork including checking over physicals for all of sixth grade (450+), dental forms, yearly health forms, ordering supplies, state reports, quarterly meetings, ect.

    Kids leave at 230 and I spend until 3 cleaning up my office and completing my documenting
  7. by   No Stars In My Eyes
    My gosh! I bow to you folks, no kidding! Even when I was younger I wouldn't have been able to keep up with all that you guys have to deal with!

    NOW I know a bit better why my own elementary school nurse, Miss Nelson, always seemed kind of gruff and harried. She didn't have to deal with special needs kids, but back in those days, it was those "Shot Days" that required a lot of time and effort.
    Imagine the Town Doctor coming to your office, and ALL DAY the line of kids, classroom by classroom, grade by grade, lined up alphabetically, and each classroom's teacher, the nurse, and the doctor; all totally focused giving shot after shot after shot!
    The school held grades 1-8. Each class was between 30-40 kids, everybody getting their required vaccinations. I'm talking several times each school year, because one month it was all polio vaccine, a couple months later, the measles/mumps/hooping-cough trifecta.
    And all those Permission Slips!
    This was long before disposable syringes and needles, so imagine maintaining needles (so they didn't get snags on them, you had to check and smooth and sharpen them before you sterilized them.) I don't know how many glass syringes she had, but I'm pretty sure they only changed the needles for each child and reused the syringes numerous times.
    And there were, in each class the fainters, the cryers, the pee-their-pants-ers........All that anxiety!
    I couldn't stand it, so even though I was at the end of the alphabet, I always raised my hand and said, "Miss Nelson? Can I go first?" I knew the shot was inescapable and all I wanted was to get out of that line full of anxious kids. So, Miss Nelson let me be 'the good example'.
    She had a LOT more on her plate than I ever dreamed!
  8. by   Farawyn
    Don't forget sports clearances and concussion protocol!
  9. by   NurseOnAMotorcycle
    Our school nurse also helps the VERY special student population with g-tube feeding, occasional airway suction. Our wonderful school nurse also does emergency triage for injuries such as adult cardiac emergencies, previously mentioned seizures, syncopal episodes. One notable incident was when my kindergartner cut off her finger at school! That's right: O.F.F. and met me at work via ambulance with a teacher.

    School nurses: don't underestimate them.
  10. by   Bookworm12314
    It is good for us to educate others who visit this page about what we really do everyday. The original thread behind this post also serves to enlighten those same readers about how we are generally perceived and treated by teachers, parents, and other staff. It also served to let off steam that builds and builds over time. We are the only medical person in the building; therefore, everyone "asks" the nurse about every ailment and tells their life story all day long after popping in the health office. I worked with a long time school nurse one day that once said to me, "you know, in 25 years I don't think anyone has ever asked how I was doing." So, perhaps by using this forum to remove some of our isolation we can accomplish several things at once.
  11. by   HazelLPN
    I'm a retired PICU nurse and on rough days, some of us ( me included) would joke that we needed a job as a school nurse. How little we knew about school nursing! In my retirement, I am working as a substitute assistant school nurse for a large urban district taking care of special needs students that the regular school RN simply wouldn't have time to care for. I had no idea how much work that school nurses do. We now have many medically fragile students in our schools. There are days that I work at the handicapped school and I have kiddos who need cathed, who are on vents, have gtubes, on TPN, have seizure disorders, etc. School nurses truly must have excellent assessment and clinical skills. One of the school that I work in had a grandmother collapse and the school nurse and a teacher certified in CPR (trained by the nurse) revived her by performing CPR and using the AED until the first responders arrived. People used to ask me all the time about new grads working in ICU and I would say "sure, if you are willing to ask lots of questions and learn on your own". However, I do not think school nursing is a place for new grads because there isn't an experienced nurse the next bed over, no charge nurse on the unit, no house supervisor, no resident or attending physician. Many of our school nurses are ex critical care of ER nurses. IMHO, acute care experience is very important before becoming a school nurse.
  12. by   Farawyn
    A few of our nurses here have been hired fresh out of nursing school. I give them props. It's intimidating to me and I have 21 years hospital experience.
  13. by   Windchaser22
    Ideally, one could start as a permanent part timer. This way you are mentored and can readily take the reigns when the time arrives.
  14. by   NutmeggeRN
    Quote from Kittery
    In response to this comment from a previous thread:
    "Can you tell us what you actually do in detail? That would actually be a more interesting read."

    Give out Bandaids and ice packs, that's it.

    Just kidding! Although that's what the majority of the general public thinks we do. What school nurses do varies from school to school, depending on student populations, state laws or district policies, etc. I'll get the list started with just a few things I personally do at work and my fellow school nurses can chime in!

    1. I personally cover only 1 school and see 30-40 kids a day, and I know I'm one of the lucky few with such great numbers! It's not unusual for school nurses to see 60, 70, even more on a daily basis---from multiple schools or even the entire district. I assess, monitor, treat students for quite a variety of things: wounds minor and severe, sore throats, headaches, stomachaches, N/V, SOB r/t asthma, menstrual cramps, head injuries that may or may not turn out to be concussions, sprains, strains, nosebleeds, chest pain, many more. You name it, a school nurse has probably seen it.

    2. Ensure students with chronic conditions (most commonly asthma, severe allergy, seizure, diabetes---but many school nurses also see students with more specialized needs such as those with cystic fibrosis, spina bifida, etc.) have plans in place that ensure the safety AND success of the student while at school. For example, a diabetic student would have emergency meds/supplies/a plan for hypo- or hyperglycemia. That's in addition to their day to day maintenance plan (e.g., checking in with the nurse before lunch for a blood glucose check and any necessary treatment.)

    3. Administer daily and PRN medications, making sure all necessary forms are on file, calling parents when meds expire or run out, monitoring for any adverse effects, etc.

    4. Educate students on self-care, healthy lifestyle choices, puberty, or more specific info related to their particular condition or situation.

    5. Educate and train staff on common chronic conditions present in our school, s/s to look for, step-by-step response to emergency situations (anaphylaxis, hypoglycemia, etc.) Many school nurses also do CPR training for staff.

    6. Working with administration to develop policies/protocols related to school health that ensure all students are safe and have equal opportunities to thrive and succeed.

    7. Managing the occasional "special cases"---post-op student for example might need to learn how to use crutches/wheelchair to get around school, pain management plan, special accommodations in class (sitting near the door, needing a way to prop a limb up, etc.)

    8. Document thoroughly on EVERY SINGLE STUDENT I see. That alone takes up a chunk of my time.

    9. Annual vision, hearing, height, weight, acanthosis nigricans, scoliosis screenings for certain grades as mandated by state law.

    10. Being the "safe place" for students with anxiety, other mood/behavioral disorders, and all students really. I'm fortunate to have counselors AND social workers but many schools don't so the school nurse plays that role.

    11. Connecting students/families in need with community health resources.

    12. Navigating the tricky world of teachers and education. You're the ONLY "medical person" in the entire building, nobody understands your job (but thinks they could do it since you just sit around handing out ice packs and Bandaids all day), if you're lucky another nurse is nearby or a phone call away but sometimes not, you are SOLELY responsible for your students' health needs and outcomes during school hours. It's tough being a nurse in a "teachers' world."

    Anyway, I could go on but I know the other school nurses have plenty to add. TGIF!!!
    Nailed it!!!!

close