Advice for New Grad School Nurse

rbytsdy · Apr 1, 2019

Does your state require any kind of certification to work in schools? In my state we need a bachelors and a post-baccalaureate certification in school nursing which teaches a lot about working in schools.

My first job in school nursing was similar to what you are describing except that I only had 520 kids.

My advice? Run. That is a huge responsibility for 1 nurse, especially without much experience. My biggest concern would be a parent complaining, especially if meds aren’t give on time. I ran into so many similar issues and administrators did absolutely nothing to help me. I was sure school nursing was the wrong area for me until I filled in for a maternity leave position at a school with half as many kids. The job was so pleasant. As it turned out, I was the 7th nurse in 9 years at my first job in school nursing. They were just as awful to the nurses before me. I left almost 3 years ago. They have had 2 nurses since me.

ruby_jane, BSN, RN · Apr 1, 2019

Welcome!! If you will search this board, you'll find many answers to your questions. For maximum impact I'd search "new school nurse" in the search bar to the upper right.

But to answer your main question....we ALL felt like you do at the beginning. You're maybe swimming upstream because you're new to nursing as well as being new to school nursing this but don't give up!

SN43 · Apr 1, 2019

I think starting as a school nurse immediately out of school is challenging because for the most part you are really on your own and it is a lot of responsibility. We do not have all the resources & staff of a hospital or doctor's office. I came to school nursing after about 10 years doing other types of nursing and still it required a huge learning curve for me. I had to learn a lot on my own and had to develop shortcuts and ways to make it easier to get all the paperwork and requirements done. Every year it gets easier, but it is a lot of responsibility. I'm not sure if I personally would have been able to do it right out of school though.

OldDude · Apr 1, 2019

There are others here who became school nurses right out of nursing school, lived through that experience, and are now competent, confident, and all around savvy school nurses. I was as dumb as a sack of door knobs regarding nursing when I graduated from nursing school and there's no way I could have handled school nursing as my first job. So, it's up to you...working conditions where you are will not change significantly so it's up to you to engage, adapt, and overcome if you want to stay. Best of luck! Let us know how it's going.

jess11RN · Apr 1, 2019

Welcome!! Ugh to your situation!!

I think you are having issues with 2 things-1, it is very difficult to come into this position straight out of nursing school, not saying it can't be done, but it makes things more challenging from assessment skills to organizational skills and everything in between. 2-you're taking over for a very disorganized and lasseiz faire nurse.

First thing's first, you are seeing about 10% of your school per day-chances are most of them are for silly reasons. You need to get a handle on the amount of kids that are coming down to your office, especially for those ones that don't need to be down there. Institute a nurse pass, unless it is an emergency or scheduled daily visit, no student is seen without a pass. Equip your teachers with bandaid bags, things like a paper cut or hangnail can be washed in the bathroom and a bandaid can be plopped on in the classroom-older students can do that themselves. Also, give the teachers a list of what they SHOULD be sending students down to you for...I'm not sure if it was here or on the NASN forum that I got these great documents, but feel free to take a look (they are NOT mine). Be honest with your teachers, tell them that you're seeing 45-60 students a day. They probably don't know that you're seeing that volume. A lot of times, they will be more sympathetic. Be firm and be your own self advocate because no one else will do it for you.

Your daily scheduled tasks (meds, diabetic, and gtube flushes) won't seem so huge once you cut down on those silly visits. Set a timer for the medications that need to be given so they're not given late. Communicate to the student's teacher that they need to come straight to you at a certain time, ask that the teacher remind the student (chances are, you'll get compliance with this because they don't want the kid bouncing off the wall in the classroom).

After that settles down, you'll find that you have more time to organize yourself with regards to paperwork and such.

Do you have a neighboring school district with a nurse or is there another school nurse in your district that would be willing to help guide you? Always feel free to post questions (or just vent) on here too!

I had 12 years of nursing experience before I changed to school nursing and I still had a huge learning curve my first year. It was AWFUL. I, too, came in early every day to catch up and every day, I wanted to give up, I cried a lot. But, it got better.

Personally, I would advise to give it another year (or at least through the end of this year) to see if those things you implement make any changes. If you want to stick with school nursing and don't want to stay where you're at, look to see what other districts are hiring, but do your research. If it is in your community, chances are you know someone or you know someone who knows someone that works for the district. If you feel that getting more experience in the hospital would be more beneficial to you, then I don't think you'd have an issue getting a job there either. Keep in mind that most of what you learn is through work experience, not necessarily at school, so I wouldn't be concerned with losing your skills.

Hang in there and please keep us posted and let us know how you're doing!

THE 9 Bs.docx

WHEN TO SEE the NURSE.doc

NutmeggeRN, BSN · Apr 1, 2019

I always recommend joining your state and the national school nurse associations. They are a plethora of information and support!

MrNurse(x2), ADN · Apr 1, 2019

1 hour ago, OldDude said:
There are others here who became school nurses right out of nursing school, lived through that experience, and are now competent, confident, and all around savvy school nurses. I was as dumb as a sack of door knobs regarding nursing when I graduated from nursing school and there's no way I could have handled school nursing as my first job. So, it's up to you...working conditions where you are will not change significantly so it's up to you to engage, adapt, and overcome if you want to stay. Best of luck! Let us know how it's going.

Agree. Sometimes timing is off, but when you look back you realize it is a blessing. Experience can't be rushed and critical thinking takes experience, you can't learn it from a book.

RatherBHiking, BSN, RN · Apr 1, 2019

I agree with what the others have said. I second the fact you're seeing way too many kids a day. That's ridiculous and they are taking advantage of you. Take all the advice of Jen on how to cut that down because it does work and you have to stand your ground. Send kids back without passes before assessing them. Do not send kids home for vague not feeling well symptoms. Don't give kids too much TLC. One nurse in our county gave kids saltines, juice and let them watch cartoons while resting when they complained of stomach aches. You can imagine how many kids she saw a day! Here the rule is no fever, no witnessed vomiting, no signs of some type infection, you stay at school. If I get a kid who I've never seen before all year or last even, looking super pale, never missed a day of school or maybe one or two all year, it's in the height of flu season, etc and wants to go home then I give them a little more leeway. But the ones I see every week/month, you better have concrete symptoms.

Also, if you can, start calling teachers, cafeteria, etc when you're looking for kids that need meds. There's no need to run all over the building. That's a legitimate reason to call teachers and if they don't like you calling their room then maybe they'll start remembering to send them. Set yourself a timer and have a check off sheet. If they are more than 15 min late start calling.

Also, most of us don't get 30 min kid free time so you're very lucky you have that.

The more organized you can get things for yourself and the more you learn to do things your own way the easier it gets.

Don't let the kids and teachers make you think every issue their kid has is an emergency and most of the time it's something that can wait a few min or an hour!

The first year is HARD for everyone. It's a lot to learn at once. It just takes time. Good luck!

rbytsdy · Apr 1, 2019

1 hour ago, jess11RN said:
Hang in there and please keep us posted and let us know how you're doing!
THE 9 Bs.docx
WHEN TO SEE the NURSE.doc

Those are good documents!! I used the “when to see the school nurse” document and it did help.

I should clarify- I was in my first school nurse job for 2.5 years. My first principal was very nice and tried to be supportive. He found that “when to see the school nurse document” and suggested we present it to the teachers. We had 72 teachers in the school. If they all just sent 1 kid a day, I would still be overwhelmed.

The 2nd year, a new principal came in and she was completely overwhelmed so she her own defense was to throw me under the bus if parents complained. I had a dad come in and threaten me because I kept calling for his son’s Epipen (parents felt they had a right not to sent it in if they didn’t want to). I tried to hang in there because I’m a nurse and I wanted to care for these students, many of whom were in a tough position. In the end, it didn’t matter. I was just one of the many nurses who came through.

I’d still tell you to run. But run from that school. I love school nursing and I think it’s a great speciality. But this speciality is like any other. If you don’t feel safe (license, etc), then you need to get out. They are a lot of great schools out there.

The recommended ratio for nurse to students is 1:750. I’ve been subbing in high schools where that ratio is still tight. I think that is way too much at the elementary school level. If you had even a part time nurse, I’d think you’d be a lot better off.

Can you check with your state school nurse association? My state requires screenings every year. I had to beg and plead for a sub to come in and help me. There was no way I’d get screenings done otherwise.

geminiwanderlust · Apr 1, 2019

I too am new at this. My only experience was subbing for a large district school--that had tons of guidelines and organization aid in place for one day a week for the start of this school year to getting hired full time by my local district, juggling four schools. I have been here one month--and I should've realized a nurse leaving in the middle of the school year is never a good sign. I am trying to hang in there--but nothing prepared me for parents complaining to the principal about me already. I didn't send their son home after two visits to the clinic--no fever, just a stomach ache. I also talked to dad twice and kept him abreast of the situation. Dad complained that "I gave too much reassurance that johnny was fine." So trust that you are not alone. I can't imagine being a new grad on top of this. I had 8 years prior experience in ob/gyn and L&D. This is tough job and I am cringing at the coworker nurse who told me "what a cupcake job" when I first told them I was going to take a full time school nursing position.

Amethya · Apr 2, 2019

Welcome!

I was in the same spot as you 3 years ago. They just plopped me on my chair and said, here's the computer, here's the key. And from there it's been a trip.

The only thing I can tell you is you need to establish ground rules. If you don't you will always have 40-50 kids in a day.

I used to have SO many kids like that in the beginning, and my school was a 500+ school from K-8. Now this year, I get only 10-20 kids in a day, not including my medications.

Now, I'm not a RN or a LVN, I'm a Medical Assistant, but I have 5 years of working my career under my belt. It could be you are also having a hard time because this your first job out of school, and that the last nurse was very unorganized. Try your best! I believe in you! If you decide to come back next year, I highly suggest you assert your dominance, establish rules, make sure the staff and students know the rules and give out small first aid kits.

Another option is ask your head nurse for help. She will be a good asset to you!

If you have any questions, don't hesitate to ask us! Just keep in mind that each of us come from different states, so if you have a question that pertains to your state, make sure to tell us.

Good luck!