Advice? Support? I don't know what I need anymore... :(

[KKEGS, MSN, RN]

I am at my wits end and seriously considering throwing my hands up and quitting. I apologize in advance for this long post...

For those who don't know me: I am a District Nurse which means I don't do the hands on care of the kids (usually). The way our district sets up their health services is there are 15 school buildings and each is staffed with an LPN. There are 3 District Nurses who are 4 year RNs with a special license via the State Board of Education. The 3 of us are supposed to work together to supervise the LPNs, provide training and education to the LPNs and school staff as needed, be part of the Special Education assessment teams when necessary to provide accommodations as needed throughout the school day. I also do a fair amount of what I think of as case management for the more medically complex kids in my buildings. I have 5 buildings and 7 programs that I oversee ranging from Early Childhood to the transitional program that SPED kids attend after high school. In all it's well over 1800 students. I am not an administrator so I have all of this responsibility but with no authority to make high level decisions. All of that has to go through the Director of Special Education.

My primary difficulties this school year have been: atrocious staffing levels in my buildings and no subs to cover. Our nurses typically get 2 personal days each school year. One of our nurses has taken 10 (8 of them unpaid but approved by the building principal) and one of my nurses will be taking 5 in the month of March alone. They find their own sub coverage which is great but because we have hardly any subs those subs are now not available for sick calls. Thanks to the horrible flu and strep rates in our district this year we have many sick calls. One Friday last month we had SEVEN nurses out sick. No subs available. Myself and the other two District Nurses covered where we could but 4 buildings were without nurses for at least part of the day.

Turnover also is a huge problem. One of my elementary schools has gone through 3 nurses just this year alone. The third one's last day is on Friday with 49 days left in the school year. I am desperately trying to patch together coverage using my subs but, again, now those subs aren't available for other buildings. There is a type I diabetic student in this elementary school and his father called and yelled at me about the turnover last week. I acknowledged, listened and suggested he talk to my superior, the Director of Special Education. She told me she followed up with the father and basically just listened and acknowledged as well.

Pushback and lack of understanding and support from administration is at an all time high. We are a district severely lacking in funds (I know, welcome to the club). Levies that we attempt to get passed during an election are defeated. Last year there was $1.8 million in staffing cuts. This year it will be $2 million. Offering better pay and benefits (which our LPNs don't get) to attract job candidates to the health offices is not an option. I'd like to hire an agency nurse to cover the elementary school for the 11 weeks remaining in the school year. Nope, too expensive. We have had one applicant for the position. She is not a good candidate. She has interviewed before and has not been offered the positions. We're being pressured to hire her anyway. Administration seems to think that any warm body in the office should be good enough. Never mind the liability of someone who does not know what she is doing being responsible for the day to day management of a 4th grader with diabetes.

One of our District Nurses is leaving after this year. I'm ready to follow her. This job was supposed to be less stressful than the hospital. It's not. I am so tired (literally exhausted) of being in a district where I feel unappreciated and where I don't have the resources to do this job effectively. I am only one person. I ended up with a tightness in my throat and chest and sobbing when I got home on Friday after school. I am not supervisor/management material. I hate it.

I would leave and never give it another thought if it wasn't for my kids. My office is in their building. I eat lunch with my first grader almost every day and she would be heartbroken if I left. I don't know what to do.

[RatherBHiking, BSN, RN]

Do you know why there is such a huge turnover in the buildings? Only 2 personal days a year is ridiculous esp as a school nurse who gets exposed to all the illnesses in the school. However they were probably hired knowing that and the rate of pay so it makes me wonder what else is going on. Start there. Something needs revamped for sure. Is there an option to train unlicensed personnel (and give them extra duty pay) in the event a nurse is out sick and as extra help? I would go to the higher ups and explain they are setting themselves up for major liability and the health of the students needs to be a higher priority. If they aren't willing to make changes then be prepared to leave because it's not worth it. Are you part of a union or able to join one. If so you may be able to get help there. I'm not sure. I know you enjoy lunch with your daughter but it's perfectly fine and good for her to eat lunch with her friends without you if it comes to that. Good luck!

[KKEGS, MSN, RN]

I suspect one of the reasons that turnover is bad is because the pay is so poor and there are no benefits. We have discussed that with the higher ups. It's not an option at this time to offer the nurses better pay and benefits. We also only hire licensed nurses for health offices. The nurses know they can make more money elsewhere. Add in unreasonable, uncooperative, unresponsive parents and it just doesn't seem worth it. I tend to agree! Ugh. It's why I'm considering leaving. School parents rival my nastiest families I worked with in the NICU.

The nurses do have sick time that is separate from their personal days. I also only get 2 personal days. This seems completely understandable to me considering how much time I get off each year. With a 12 week summer vacation and a week each at Christmas and Spring Break there is more than enough time to take a vacation. The nurse I mentioned who took 10 personal days went on a Caribbean cruise. She does this every year. It was mentioned in her performance review last year. Nothing changed. And why should it when the principal just approves it every year?

We do have one unlicensed person on our sub list. She actually was a health office aide before the decision was made by the district to only put licensed nurses in the health offices. I think it's ok to use unlicensed people in the health offices. It's what I had in my last district but in this one she is to be used as a last resort. I even suggested that as an option as a long term sub in the elementary school. I could set up shop in the conference room next door so I can be there to help if she needs it. The other District Nurses don't like that option, not because this person isn't capable but because they are afraid that it just puts a Bandaid over the bigger problem.

I am part of a union but it's the teachers union. I am on the teacher's contract.

[RatherBHiking, BSN, RN]

Even as part of the teacher's union you have the same rights to be represented in grievances but unless they are taking advantage of you somehow then it's not really going to help in this case unless you feel your license is on the line in some way,

Ok so the 2 personal days does not include sick days so that's not unreasonable at all. Also it doesn't seem to even matter if you can get approved to take off more but that really shouldn't be allowed to happen.

No one goes into school nursing for the money. 99% of us could make more money elsewhere. In my district all 30 schools have 4yr degeee RN's and we all could make another $30g a year easily working elsewhere but we stay for the love of our students, working hours, time offf, less stress, etc. We all deal with nasty parents. We live in a high poverty area so we also get a lot of non-educated rough necks just looking for someone to blame for something. We also run out of subs daily and we only have one head district nurse who has to shuffle people around and work herself in the schools to cover. We can't find enough subs either. I don't know what state you live in but each state allows certain things that can and cannot be delegated to non nurses. I think each school LPN should train the secretary, teacher, or an aide how to give meds, emergency meds, etc so if the LPN calls off you don't need to find a sub or coverage for that school. If there is some medical procedure for that school that cannot be delegated then find someone to run over and cover that procedure only. That would help a lot because it doesn't sound like getting more subs is working unless you can somehow contract through the health dept to help out but that will cost more money. Many schools can manage without a nurse for the day. They may not like it but sometimes there's not a choice. You could also make an LPN at a neighboring school on call for that school for emergencies only if someone is out sick. Those are ideas you could pitch. If they say no we want things ran exactly how they've been then you will either have to accept that as part of your duty which you hate or find a new job.

[ruby_jane, BSN, RN]

You're exhausted and burnt out because you have immense responsibility and apparently little authority - and I guess nobody cares if that LPN is taking 8 unpaid days off...

Blue Moon said everything I was thinking. And the district has no motivation or impetus to change. Sadly if something goes horribly wrong, the district won't acknowledge it's the basic structure that cause the thing to happen.

Hang in there. Are there other districts nearby?

[KKEGS, MSN, RN]

Hang in there. Are there other districts nearby?

There are but they never have openings. This is already my second district.

I'm 99.9% sure that I will be leaving at the end of this school year (whether by choice or because I get caught up in the budget cuts) and going back to NICU nursing as an agency per diem nurse (my current side gig anyway). My husband is supportive so that's all that matters to me.

[ruby_jane, BSN, RN]

My husband is supportive so that's all that matters to me.

AWWWW!!! YAY! Again, hang in there. We have 9 days until spring break and 11 weeks left.

[SchoolNurseTXstyle]

I say you are in a toxic environment and the decision to move on is a good one!

[ProperlySeasoned]

Did I read no benefits? I am not a school RN, but I can't imagine this being the norm. To not have access to health insurance and retirement must severly limit your ability to higher good nurses. I am sure the teachers get benefits, can this be negotiated for your LPN staff (pardon the use of the word negotiate, I understand your nurses are not unionized)?

[OldDude]

Break out a legal pad and write the first part of the Serenity prayer on top of the paper.

God grant me the serenity

to accept the things I cannot change;

courage to change the things I can;

and wisdom to know the difference.

Make two columns - list positive things on one side and negative things on the other side. When you're done go through the negative side column, highlight the things that are possible for you to change and obliterate everything else on the list with a black marker.

Now rewrite the list with only the negative things you are capable of changing with the caveat that if you can't change anything it is not allowed to occupy space in your mind and emotional self.

Compare the result and then plug in the "time marches on" factor. Your kids will be there temporarily and will not return to that stage of their life. My #3 is graduating this year. There is a memory of him, on one occasion while here on my campus in 4th grade, that is forever etched in my mind's eye. My kids (all 5) would all come to the clinic after school to wait until we went home. On this occasion #3 asked if he could go out to the playground until we left...I said yes...a few minutes later I walked down the hallway which had a glass door that afforded a view of the playground. I saw him out there, by himself, arms outstretched running as though he was flying, big smile on his face, completely happy and carefree. No words...I have no words.

With God's grace and assistance...best of luck on your decision and what fate may place in your path.

[KKEGS, MSN, RN]

Did I read no benefits? I am not a school RN, but I can't imagine this being the norm. To not have access to health insurance and retirement must severly limit your ability to higher good nurses. I am sure the teachers get benefits, can this be negotiated for your LPN staff (pardon the use of the word negotiate, I understand your nurses are not unionized)?

The LPNs are part of a union along with the paraprofessional staff. Our elementary school nurses only work 6 hours a day and do not get benefits. The teachers and the three district RNs do get benefits but we work 8 hours a day.

[KKEGS, MSN, RN]

Well we're interviewing the only candidate that applied for the open health office position.

And another nurse gave me a heads up that her husband is pressuring her to find another job that pays benefits. Seriously. I have become a one woman staffing office.