Beyond Bandages, the Nuts and Bolts of School Nursing

• #School Nurse

The two-way radio in the health office suddenly erupts with a report from a classroom. A student has developed hives and is having difficulty breathing. The school nurse grabs the stock epinephrine injection and responds. Upon assessing the student, the nurse determines the student is experiencing anaphylaxis. Immediately, the nurse administers epinephrine while a school clerk calls 911 and the student's parents. The parents are en route to school, and the nurse monitors the student. Emergency medical services(EMS) arrive at the school. The student's symptoms improve, yet, EMS recommends that the student be evaluated in the emergency department. Emergencies like this are stressful and luckily don't occur every day. The best news of all is that the student had a good outcome.

School nursing is a specialized nursing practice that bridges health care and education. School nurses promote student health and wellbeing to allow access to education and facilitate academic success. In addition, they provide care coordination and collaborate with individuals and the community to support students and their families.

Different Delivery Models

School nursing varies significantly from state to state. Factors that influence school nursing coverage are state law, the nurse practice act, and school district funding. Several states have one RN/BSN per school and follow a ratio of 1 nurse per 750 students. However, if students have significant health needs, that ratio can drop to 1 nurse per 225 students. In addition, there is one RN per county in some states, and in other states, LPN/LVNs provide school health services. However, the objectives remain the same. The goal is to remove barriers, so each student has access to a free appropriate public education(FAPE).

A Day in the Life

What does a typical day for a school nurse look like? Truthfully, no two days are the same, but specific responsibilities include:

Medication Administration: School nurses can perform this or delegate it to an unlicensed individual in some states. Staff can administer medications including anti-seizure, stimulants for ADHD, chronic health issues, and other required daily medications.

Procedure Administration: This may include diabetes care, insulin administration, gastrostomy tube feedings, nebulizer treatments, clean intermittent catheterization, tracheostomy, and ventilator care. A school nurse completes many procedures. However, a nurse may delegate based on state law and the state nurse practice act.

Emergency Medication Administration: Many schools have stock emergency medications such as naloxone, epinephrine, and albuterol.

AED Response: Many schools have AEDs(automatic external defibrillators). Nurses train staff and respond during critical events.

Immunization Compliance: The nurse facilitates state-required immunization compliance.

Assessments: Health assessments include vision, hearing, oral, vital sign measurement, gross/fine motor, developmental, and cranial nerve screenings. These assessments may be required for the special education evaluation process.

Vision, Hearing, and Scoliosis Screening: States mandate screenings per law.

Health Education: School nurses teach students about health promotion and individual health needs. Nurses teach how to manage diabetes, asthma, and other chronic medical conditions in the school setting.

Mental Health Support: School nurses support mental health needs and are often part of crisis response teams.

Illness and Injury Support: School nurses assist in managing students’ daily health and wellness needs on their campuses. Injuries can range from a paper cut to a compound fracture or head trauma.

Communicable Disease Management: Since the pandemic, school nurses have been critical in supporting students and schools in managing the ever-changing requirements of Covid-19 management in schools.

School Nursing During the Pandemic

The pandemic has significantly affected all areas of nursing, including school nursing. As students returned to in-person learning, school nurses had to have a mitigation plan. Many school districts work with their state, county, or regional health departments to develop a program that allows students to return to school. These plans include COVID-19 mitigation measures, contact tracing, and treatment areas for well and sick students. School campus locations indicate where AGPs(aerosolized generating procedures) can be completed, such as oral/tracheal suctioning and nebulizer treatments. Also, school districts rely on school nurses to educate students, staff, and parents on communicable disease prevention. Often, the school nurse is the only medically trained school professional on a school campus, district, or county.

Life Balance

School nurses are the backbone of school health and wellness. You're a vital part of the school community as a school nurse. You have significant responsibilities, but there's also a life balance. Typically, school nurses have weekends, extended holidays, and summers off. In addition, school nurses typically support each other in teams or throughout school districts, sharing procedure coverage and other duties. This camaraderie and support, paired with helping children make school nursing a gratifying role.

School nurses are independent, organized, self-motivated, and critical thinkers. They positively influence the lives of children. The school nurse supports students, families, and their school communities in health promotion. School nurses are critical in establishing access to education and facilitating lifelong learners.

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References

National Association of School Nurses

U. S. Department of Education