Considering Becoming A School Nurse

[kkadi]

I am considering transitioning to a new career as a school nurse. I've always been very interested in community health and would love working with kids. I've worked 18 years in adult critical care so it would be a HUGE move. I'm trying to get an idea of what some of the negatives and positives are to the profession. And where this profession stands in this day and age. I know, in California, that RNs are assigned to a group of schools then supervise aides at each school. That doesn't sound ideal to me but that's the way my school district works. And there are a limited number of credentialing programs in California, too. Which tells me that it may be becoming a less desirable profession with fewer people applying for their credential which is required in all California school districts. Any feedback on where the school nurse profession is headed??

[ihavealltheice]

I think that where the school nurse profession is headed is different in each state. Some states mandate that there is a school nurse in every building where other states are much like California where the nurse supervises multiple buildings/aids. Could you possibly shadow a school nurse near you for a few days? Then you can ask them more specifics regarding school nursing in your specific area. Chances are if you're supervising multiple schools, you won't have much hands on activities with the kids, it'll be much more administrative work. If you are in one health office, there is a lot of mental health, medication administration, treatment for chronic medical conditions (ie diabetes), care management for chronic conditions, student visits for random issues that pop up throughout the day. You will be using a different skillset that you use in the hospital.

For me, the schedule is a HUGE positive for me (I have school aged children so to have their breaks off is amazing). 

Typically school nurses get paid at a far lower rate than nurses in the clinical setting and insurance is much more expensive as well. Although I was working the same amount of hours in a year, I took about a $20K salary cut and my insurance costs tripled when I accepted my first school nurse job. That is probably the biggest negative. 

[Glitternurse, LVN]

I think it depends on the district you are at. I am an LVN in California, I work for a small district. We have 5 elementary and 1 preschool. I work under the district CSN. Between the 2 of us we cover all 6 sites. We are both hands on. What we do is very similar in the day to day stuff (first aid, routine meds, diabetic students, catheterizations, etc...). She, of course, has more meetings, does the 504s, IEPs and care plans. We respond to emergencies depending on who is closer. I also assist with screenings, do the filing and data entry. This year we are both doing contact tracing and surveillance testing. 

[WineRN]

I went from adults to school nursing and it is a BIG adjustment dealing with both your students and their parents. The other big adjustment was being the ONLY medically minded person in the building. You don't realize how different a nurse thinks until you are trying to reason with a teacher who is convinced someone with gas needs to see a doctor.

I can't comment on Cali, but I like the suggestion above of shadowing or see if you can maybe even sub first? I LOVE school nursing, but it really isn't for everyone. People come into this role thinking it will be "easier" compared to other nursing specialties and then are blindsided and burn out when they realize that just because it's not as physically demanding most days, it definitely is a busy field with little to no help. 

[BrisketRN, BSN, RN]

18 hours ago, WineRN said:

You don't realize how different a nurse thinks until you are trying to reason with a teacher who is convinced someone with gas needs to see a doctor.

Don't forget about magic thermometer hands.  I had to make a special note this year that staff isn't allowed to touch children's faces to decide if they have a fever or not ?

[NutmeggeRN, BSN]

I think subbing is  great idea! Gives you a good idea of what it is like with no back up at the ready. What are your strengths and weaknesses? Are you comfortable in a role that takes a lot of autonomy? Good Luck!

[yaRNthrower, BSN, RN]

2 hours ago, BrisketRN said:

Don't forget about magic thermometer hands.  I had to make a special note this year that staff isn't allowed to touch children's faces to decide if they have a fever or not ?

I do not know how many times in my head I have said, "Stop touching the children." ?

[beachynurse, ASN, BSN]

I've been a school nurse for 17 years and can't imagine doing anything else. It's not a job for everyone, the pay isn't any where near what I could be making, but I do have decent insurance and it's not as expensive as some other areas. Coming from adult critical care this may be a bit of a culture shock. School clinics are not set up for major emergencies, just basic first aid. You are the one and only, literally. If there is an emergent situation, there is no medical assistance for you until EMS comes and takes over. It is also difficult sometimes having to reason with non-medical administrators when you make a decision they don't like. Explaining your rationale to them can sometimes be rather shall we say, a challenge. I only work in one school, a high school with about 2,000 students. I do have one assistant. My school division employs an RN in every school, an assistant in every middle and high school, and some elementary schools with high acuities. 

The positives, are working with the kids, love them! The hours, time off. no summers. 

[Wishinonastar, BSN]

Agree with everything said. Nurses all over are pushing and joining together to improve conditions in every area including schools. But as much as we push it has to be legislated. School administrators do not see the value in school nurses and will cut in any way that they can. One school near me has an LPN- this is unheard of generally because an LPN must function under the supervision of an RN. But they have discovered that having an RN in another building is enough to say they met the criteria so it is happening. I look for it to happen more. In my state the ratio is 1 nurse to 1500 students and they will use anything possible to keep to that minimum ratio. Replacing a certified school nurse with an LPN is one step that I see becoming more common moving forward. CSNs in my state have a BSN plus a certificate.

Nurses are pushing to reduce these ratios but money talks and schools are about the money. In some areas the nurse is part of the union, in others they are not. Pay varies widely as a result. I am non-union and my pay is pretty low. After 13 years I am now at $46,000. Doesn't sound terrible but the average teacher is at $67,000. I have more education than many of them. It is depressing how little we are respected or seen as professionals. It can be a discouraging environment. The only thing that makes it worthwhile is the kids. They keep me hanging in and going to work everyday. They are great! And I like being independent so that part works for me!

[k1p1ssk, BSN, RN]

On 4/22/2021 at 10:29 AM, BrisketRN said:

Don't forget about magic thermometer hands.  I had to make a special note this year that staff isn't allowed to touch children's faces to decide if they have a fever or not ?

Don't forget their magic thermometer eyes, too. "But they LOOK warm"... as the child is walking in from recess where it's 75 deg. out and full sun but they kept their sweatshirt on and decided they wanted to play soccer, which means keeping their mask on, too due to the lack of distancing.... OF COURSE THEY'RE WARM.

[2BS Nurse, BSN]

Are there state laws about trached students? Are they required to have 1 to 1 nursing care in school? Would the school nurse be required to care for these students?

[JenTheSchoolRN, BSN, RN]

1 hour ago, 2BS Nurse said:

Are there state laws about trached students? Are they required to have 1 to 1 nursing care in school? Would the school nurse be required to care for these students?

Depends on student's whole health picture. In my state that student likely has a required 1:1 LPN aide - that is NOT the school nurse. This is a nurse specific for that student and that student only, usually provided for by an agency that either the district is covering or likely, insurance is being billed for.