Hello! I just graduated Nursing school in December with my ADN. Started at a small district not far from my home. I am an adult who went back to school to become a school nurse. But now here I am and I am wondering if what I’m experiencing is normal...
Any advice would be appreciated!
I work at an elementary school with 614 kids. There are a lot of adversities at my school, from homelessness to refugees to protection orders and even a self harming 10 year old. It is the DCD school for the district. I work alone. I have 11 kids with meds through out the day, a GJ tube flush twice and a DM1 kid. A new CF kid starts on Tuesday. I feel like the day to day running of the office is just so busy. I see 45-60 kids a day. I’m compensated for 30 minutes kid free time for evaluations and other prep or paperwork. Medications are given late often because the kids are hard to track down and I often have to leave the office to go find the kid. I’m struggling with keeping up with the paperwork side of things without staying late or coming early. I have constant interruptions, there isn’t a time for me to just sit down and do evals or send vision/hearing referral letters out without a kid coming in for a paper cut or another for an inhaler with no audible wheeze or dyspnea. I had the case manager come in asking for SpEd evals for a kid I didn’t even know I was supposed to do an Eval. I was never taught how to actually complete an eval either and I was breifly told about third party billing but haven't done it yet either. How do we balance taking care of the kids with paperwork and IHP writing and calling the parents for injuries treated and so on?
So basically I’m curious if this is pretty typical for a lot of us. I’m also curious how long I should give school nursing before I make up my mind to leave or look for a different school. I started at the schools the day i graduated my ADN program. One of my instructors warned me about going to school jursing right away because it would be difficult to transition out of it if it isn’t a good fit for me. She said it’s easy to go from home care or hospital nursing to school nursing but not the other way around. What are your thoughts on that? I was thinking since I started mid year and took over for a very lasseiz faire nurse who wa spretty disorganized that I should wait until i complete a full school year to decide if I want to move on to something else. But if I do that will I struggle to find another gig because I lost the skills I learned in school? My second choice for a job was homecare nursing, I never really wanted to be in a hospital.
Specializes in Peds, MS, DIDD, Corrections, HH, LTC, School Nurse.
I agree with jess11RN. I use these same guidelines in my clinic. When I started school nursing I had been a nurse for 20 yrs, with most of that time spent in pediatric nursing in the hospital and home health care. School nursing is definitely as different animal and there was a huge learning curve. I am the sole nurse in a middle school (5-8 grades) of about 2,400 students. I have 5 T1Ds, Tube feeding, 12 daily meds, 4 CFs and a student with factor VIII deficiency requiring PRN IV treatment. My daily clinic visits were 80-100 in the beginning ( I thought I would go nuts!) but I have decreased these visits to 30-40 by student, teacher and parent education. I used the 9 B's and When To See The Nurse with my teachers, which helped tremendously! Clinic passes are an absolute MUST!!!! If not you'll have kids wondering into the clinic and no one even know they are there or why. My students know that I will not even look at them without a pass or an escort by a staff member (unless it's an obvious emergency). If a student is seen twice for the same complaint that is deemed invalid to be sent home I will send an email to all of his/her teachers informing them that the student has been seen twice. This has helped because I did find out that some of the teachers do not read my comments on the clinic pass when the student returns to class or the student fails to give it to the teacher. The email is a way for all off us to be on the same page.
I am blessed that I do have another RN who is responsible for records and immunizations. In our district Coordinated School Health is responsible for health assessments, vision and hearing screenings, yet another blessing!
It does take time for your school staff to learn you and for you to learn them. I came into a clinic where there had been no structure and the staff and the students used the clinic like is was a lounge, public bathroom, napping area, snack area and clothes closet, etc. I would have students sent to the clinic because a button fell off their shirt or their back back wouldn't zip! (Seriously, you can't make this stuff up!). I received NO orientation, just walked in one day and was told it's all yours. I spent the most of the first semester reading P&P and trying to organize the clinic just so I could have a place to put a desk, computer and medical supplies needed. I was met with some resistance from my principal, teachers and some parents in the beginning. There was a point when the staff would have luncheons or holiday parties and I wasn't included. I felt very lost and alone. I too wondered if I had made a mistake.
Slowly the staff and I warmed up to one another, the principal recognized I was there for the students and their safety and well-being and wasn't trying to rock the boat unnecessarily. I think the cherry on the ice cream sunday was after a staff member had a seizure and they actually saw me in action, I earned a lot of respect, and they realized that I was actually more than the keeper of the band-aids and ice.
Always discuss any ideas you may have with your principal. The one thing principals dislike is being blind-sided or made to look oblivious to their staff and parents. I also inform my principal of any potential problems that may arise d/t a discussion with a parent or teacher, which is greatly appreciated.
If you feel school nursing is for you, give it some time, establish some guidelines and boundaries and develop a relationship with the staff, especially your principal.
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."
This happened to me too, it really shook my confidence! I had a K student come down without a fever but just said her stomach hurt. I had a room full of kids at the time and I sent her back to class twice because she didn't meet requirements to go home. I told her come back if she feels worse or throws up, because there isn't room in the office right now. Well 2 hours later at the after school program, that student spiked a fever of 102.5. Mom called me the following day and yelled at me for 20 minutes over the phone saying it was absolutely impossible that her daughter spiked a fever and how I didn't take care of her and kicked her out of the room. I told her the times I saw her I logged her temp at 99.4 and 99.1 the second time and I don't routinely call home for this. That mom then came to the school and got in my face with others kids in the room and the staff just watched in horror as she screamed at me and I kept repeating myself that the student didn't meet requirements and I can't call every parent of every student that comes in the office. She was mad I didn't tell the after school program that the student was in the office and to keep an eye on her. She couldn't conceive of the fact that I am not aware of what students go to the after school program and have almost no way of knowing which ones do. So after that mom, I really am scared that every kid that comes in is going to have the next parent yell at me. Alternatively I had a mom call and complain that I sent her kid home for puking in school-but didn't throw up again at home. I just feel like I can't win. Every kid with the vague NFW symptoms is a gamble. Is this something that just comes with time? The ability to see that this is the kid that will spike a fever later or this is the kid that is wanting to skip class? That ability is a Super Power, let me say.
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!
I will start these rules right away! I think I just need to get a thicker skin. So many teachers walk their kids down saying So and So just isn't themselves today, but then they don't have a fever or meet other requirements to go home. The teachers just look at me like I'm supposed to just send them home because they aren't themselves. I trust their judgement though, since they see these kiddos way more than I do. So how do I find that middle ground of being a nurse who wants to help but not a push over?
I've had kids sent to me because they have what seems like growing pains, or a painful nose (without any injury), an invisible scratch (yes, for real) etc. I'm sure everyone here has dealt with this kind of thing.
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.
I understand what you mean. My lead nurse who works at a different school keeps telling me to use my Nursing Judgement and I think-I haven't grown my nursing judgement yet. I'm learning how to be a nurse at the same time I'm learning how to run the office and work the logistics of a school. I have been defaulting on my Mom judgement. In just the 3 months I've been doing it, I have learned a lot already though and will continue to everyday.
Being yelled at by a parent is so incredibly unpleasant. It has definitely happened to me from time to time and never gets more fun. I like to think that over the years I have built up "community karma" by going out of my way to help families & students and by being reliable and honest. When word spreads to parents about how helpful or exceptional you are, it makes it harder for a angry parents to get any other parents to support them. I am by no means perfect. I make mistakes. I apologize to parents when I am wrong and I am always trying to do better but sometimes no matter what you do, even if it was not a mistake on your part, there may be someone who yells at you. I just remember that there are 99.8% of appreciative kind & wonderful parents.
Being yelled at by a parent is so incredibly unpleasant. It has definitely happened to me from time to time and never gets more fun. I like to think that over the years I have built up "community karma"
I would agree, there are those that will always appreciate every little thing you do and those who...will not.
I have developed a pretty thick skin over my time here, but somedays it is never going to be thick enough.
Specializes in ICU/community health/school nursing.
11 hours ago, kwhavlik said:
I understand what you mean. My lead nurse who works at a different school keeps telling me to use my Nursing Judgement and I think-I haven't grown my nursing judgement yet. I'm learning how to be a nurse at the same time I'm learning how to run the office and work the logistics of a school. I have been defaulting on my Mom judgement. In just the 3 months I've been doing it, I have learned a lot already though and will continue to everyday.
You are SPOT ON!!! And I begin every year when we do our annual blood borne pathogens training for the teachers by asking for grace. Because it's likely that I will send them back someone who doesn't meet criteria for dismissal right now but will vomit or spike a fever by 1 PM.
It helps that our principal and our Dean of Instruction firmly believe the kids need to be in their seats unless they HAVE to go home.
You're new. You're learning. When you know better, you'll do better. Do you have a mentor nurse - someone you can bounce things off of?
I understand what you mean. My lead nurse who works at a different school keeps telling me to use my Nursing Judgement and I think-I haven't grown my nursing judgement yet. I'm learning how to be a nurse at the same time I'm learning how to run the office and work the logistics of a school. I have been defaulting on my Mom judgement. In just the 3 months I've been doing it, I have learned a lot already though and will continue to everyday.
Please take my statement in the context of student safety. Your statement should cause deafening alarms in your head. You are in a position where you have no other nurse to bounce things off, a HUGE element necessary to learning. You are isolated without a safety net, something this nurse with 25 years experience as well as parent experience, felt acutely aware of when I first started school nursing. I really think you are in a 200 ft deep quarry with no swimming experience and your floaties are around your wrists. School nursing is a great position, but not for new nurses. It isn't fair to the students for the next three years while you get your experience. I'm not saying never, just not right now. Once again, sorry to be so severe, but this is something I am truly passionate about and I would not feel comfortable with my boys at a school with a newly graduated nurse in the position.
I trust their judgement though, since they see these kiddos way more than I do. So how do I find that middle ground of being a nurse who wants to help but not a push over?
I typically don't trust their judgement unless it's something that I see as well, especially the kindergarten teachers and the new grad teachers. You're working in a poverty stricken area. The best thing for these kids (unless they truly are ill) is for them to stay at school.
Also, keep in mind, that sometimes it's not a nursing/health issue. It may be a social work issue-your social worker should be your best friend. Maybe they're not acting like themselves because they didn't have anything to eat, maybe their parents didn't make them go to bed at a decent hour, maybe their parents aren't around much. Maybe the kid has been acting up and the teacher needs a break. Maybe they chose to stay up late the night before playing on their tablet or phone and they just need to learn a "life lesson."
Recognizing all of that, plus finding your middle ground is something that comes with experience. I learned my first year of school nursing not to be very lenient. If you don't have a real medical reason to be in my office, you're in class.
The thick skin part also comes with experience. I'll be honest though, the best experience for comes from the hospital-nothing thickens your skin faster than having a doctor screaming at you in the middle of the nurses station
Feral.Cat.Herder, RN
194 Posts
I agree with jess11RN. I use these same guidelines in my clinic. When I started school nursing I had been a nurse for 20 yrs, with most of that time spent in pediatric nursing in the hospital and home health care. School nursing is definitely as different animal and there was a huge learning curve. I am the sole nurse in a middle school (5-8 grades) of about 2,400 students. I have 5 T1Ds, Tube feeding, 12 daily meds, 4 CFs and a student with factor VIII deficiency requiring PRN IV treatment. My daily clinic visits were 80-100 in the beginning ( I thought I would go nuts!) but I have decreased these visits to 30-40 by student, teacher and parent education. I used the 9 B's and When To See The Nurse with my teachers, which helped tremendously! Clinic passes are an absolute MUST!!!! If not you'll have kids wondering into the clinic and no one even know they are there or why. My students know that I will not even look at them without a pass or an escort by a staff member (unless it's an obvious emergency). If a student is seen twice for the same complaint that is deemed invalid to be sent home I will send an email to all of his/her teachers informing them that the student has been seen twice. This has helped because I did find out that some of the teachers do not read my comments on the clinic pass when the student returns to class or the student fails to give it to the teacher. The email is a way for all off us to be on the same page.
I am blessed that I do have another RN who is responsible for records and immunizations. In our district Coordinated School Health is responsible for health assessments, vision and hearing screenings, yet another blessing!
It does take time for your school staff to learn you and for you to learn them. I came into a clinic where there had been no structure and the staff and the students used the clinic like is was a lounge, public bathroom, napping area, snack area and clothes closet, etc. I would have students sent to the clinic because a button fell off their shirt or their back back wouldn't zip! (Seriously, you can't make this stuff up!). I received NO orientation, just walked in one day and was told it's all yours. I spent the most of the first semester reading P&P and trying to organize the clinic just so I could have a place to put a desk, computer and medical supplies needed. I was met with some resistance from my principal, teachers and some parents in the beginning. There was a point when the staff would have luncheons or holiday parties and I wasn't included. I felt very lost and alone. I too wondered if I had made a mistake.
Slowly the staff and I warmed up to one another, the principal recognized I was there for the students and their safety and well-being and wasn't trying to rock the boat unnecessarily. I think the cherry on the ice cream sunday was after a staff member had a seizure and they actually saw me in action, I earned a lot of respect, and they realized that I was actually more than the keeper of the band-aids and ice.
Always discuss any ideas you may have with your principal. The one thing principals dislike is being blind-sided or made to look oblivious to their staff and parents. I also inform my principal of any potential problems that may arise d/t a discussion with a parent or teacher, which is greatly appreciated.
If you feel school nursing is for you, give it some time, establish some guidelines and boundaries and develop a relationship with the staff, especially your principal.
Best of Luck!