Help!!!! Going from small to large school


The school I have been a school nurse at for the past 2 years has closed. That school had about 350 students. The new school I will be starting in August has about 900 students. I am so nervous. To those who work in large schools can you please give me some advice. I am nervous about organization, paper work, and reports, tracking all these kiddos and their immunizations, keeping files on the kids. That kind of thing. I will be working in a school that has 8th-12th grade which I was working with 8-12th grades before so that will not be new.

Has 20 years experience.

No one has any organization tips or suggestions?

No one works in a large high school?

Feeling completely overwhelmed maybe I should look for a new job?

Flare, ASN, BSN

5 Articles; 4,431 Posts

Specializes in school nursing, ortho, trauma.

Sorry - the forum is not very lively this time of year - i only peeked in the other day and didn't have time to make a long post.

I ended up going from a very small school to a school 8 times its size with a completely different school population. My best piece of advice it to breathe - and don't let the kids overwhelm you. We have become a society where everyone wants everything NOW. Well, that's fine - well not fine - that's actually a whole 'nuther diatribe. But these kids have to remember that you are one person serving 900 kids.

Prioritize the visits just as you would triage anything else coming into your office. Since these are older kids, they can probably do a lot of the smaller things like bandaids, getting ice packs, and rinsing dust out of their eyes themselves. The most you'd need to do is log their name, complaint and times. And some people establish in the older grades a sign in sheet. Personally, I think it's dicey. Yes, you can do it where you just have the kids write their names, but i'd never remember why who was there for what, and if you have them write reason for visit, then it can be a violation of privacy. Not everyone needs to know that Amanda Cardalucci needed a tampon.

As far as the things that need your assessment- the headaches, stomachaches and general malingerers - let the kids learn how to wait a chicken licken moment. I find that's usually when i get most annoyed and over whelmed is when i am in the middle of something and i get 5 or 6 kids coming in at a time (usually right after lunch and BEFORE they have to resume class) and I often wonder to myself if these kids will use ALL their sick time by the end of January when they get into the real world.

Again, breathe. Take it one student at a time. I usually ask the all what they need, weed out the quick ones or tend to and emergencies first.

Larger school (and older grades) also sometimes come with fun (ha ha) extras like interscholascolastic sports and managing those physicals. That can be a pain in the rump, BUT if there is an athletic director, use him or her as a resource to help you get that job done. Remember- they need your input. No physical, no play. I use my AD to run physical to the school MD, very handy!

coughdrop.2.go, BSN, RN

1 Article; 709 Posts

Specializes in School Nursing, Public Health Nurse. Has 3 years experience.

I have over 3k students in my high school and it's all about time management. When I get backed up, I triage my students whether they like it or not. I also have a supportive staff and if I'm too behind with charting and feeling overwhelmed I can place nurse visits on hold (except for emergencies).

Look for resources in your school and who you can reach out too. Talk to your higher ups as well. Remember to take care of yourself first. Also, look for support within other local nurses.

Good luck!


293 Posts

I have about 750 in my 9-12 high school. My daily med load isn't too heavy. Most of my diabetics are on the pump and very independent. I just keep supplies. I have a good rapport with my PE teachers and pull kids from there for screenings. Remember, you have all year to get them done. My biggest stressor is keeping up with all the 504 plans. I have over 30 plans to maintain, update and make sure teachers are aware. I also have 2 elementary schools to cover. There are RNs there but I am responsible for all screenings and 504 plans. That puts me up to about 1400 students. Keeps me busy!

Has 20 years experience.

Thank you for the responses everyone!! I greatly appreciate it and my stress load has decreased and I do not feel so overwhelmed. My only thing will be getting all those files organized and doing the required report for the state on immunizations but I will be just fine! Just take it one day at a time!!