Help Please!

[JLA]

Hello Everyone,

I need some advice from fellow nurses. I have been a nurse for 4 years. I was on a med surg/onc floor for 3.5 years. I just recently transferred within my hospital organization to a med surg tele floor at one of our sister hospitals closer to home. I cut my commute from 45+ minutes to now 10 minutes from home. Since I became a nurse I always wanted to focus on oncology or school nursing. Those are my passions. After almost four years of bedside nursing I'm ready for a change. I don't enjoy my job and don't feel a passion for bedside nursing. I feel anxiety about work, and dread going.

Im at point where I'm going back and fourth on what I should do. School nursing or outpatient oncology/infusion. Both have pros and cons. The school nursing con is I would take a huge pay cut, and would be back to commuting. $30,000 less a year. Yikes. But the perks are more time with my kids, being able to get to my sons games, summers off, holidays and weekends off, working with kids and making a difference. Infusion perks: passionate about oncology, no weekends, no nights or holidays, $6 more an hour than what I currently make. Both of these positions are monday thru friday and both have about 40-60 commute.

I'd love to hear input from school nurses.

1)What do you like/dislike about school nursing?

2) Tell me what is a typical day like?

3) What is something you wish you would have known before becoming a school nurse?

4) Last but not least...what would you do if you were me?

Thank you for taking the time to read this.

[ERschoolRN]

1. I would say the hardest thing is the lack of comraderie. You don't have a "team" and coming from ER I was used to that. I am confident in my own assessments but I miss a sounding board which is why i have started hanging around here. ;-)

2. Some days are crazy and some are slower. I give scheduled meds, i have a diabetic i monitor closely, deal with all the sickness and boo boos of course. Some of it is total nonsense and some is legit. I didn't know how much id deal with head lice or pee pee pants but i'm in elementary and that's just how it goes.am also responsible for keeping up with immunizations, hearing and vision screenings and more that i havent even realized yet...it's my 1st year. I I took a $12,000 pay cut to take this position but i was changing my living situation to where this was doable. Hourly I make more than I did but of course with the time off it works out to smaller salary.

3. I wish i had known how lonely it would be some time but it is totally worth it for the time off with my kids.

4. It's hard to tell you what to do. I was an ER nurse working nights and I LOVED it and loved my coworkers but I got divorced and it just wasn't working for me with my kids. I then took an office job , supposed 9-5, no weekends, no holidays etc. It was an oral surgeon's office and i loved it actually and i loved my work and i was good at it. However, the hours started increasing more and more and more and more responisbility without extra pay. I was working 50+ hours a week and felt like i never saw my kids. This was over the summer and i felt terrible. So enter school nursing. Found a position and took the jump. I enjoyed my other jobs more on a day to day not going to lie about it. BUT I love that my boys come to school with me, i'm home by 4 everyday and can't wait for all the breaks off! I made my decision based on being a single mom and wanting to be there for my kids. I am learning to like this job more and more and learning ways to keep busy. I would say it's been worth it for me but it is a transition being the only medical person in the building.

[NutmeggeRN, BSN]

Also, factor in the cost of benefits and paying into the retirement system, those here are one of the HUGE reasons our district is desirable.

[jnemartin, BSN, RN]

I agree with so much of what others have said. I also have a similar work history to you; I worked bedside (but for much shorter time- only 1 year!), and disliked the work, didn't feel fulfilled, felt stressed and wanted something that challenged me in a way other than just how fast I could pass meds.

1. I love the shorter days, being on the same schedule as my husband, having all weekends/holidays and summers off. I like working independently in my office (no aide), and basically being the manager of my "department," and I like having my own office and being able to set it up and run it to my standards. I like the combination of running an office (ordering, communicating with attendance and teachers), clinical care (actual pt visits), and education/program development (developing a new sex ed program, helping to update policies manual, helping teach health classes occasionally). My bosses (two principals and a superintendent) are totally supportive and allow me to basically run my office and programs as I see fit. I like the emphasis on education rather than just medications, and the time to do it. I feel really fulfilled with my work.

I dislike the "stigma" of school nursing, or the fear that other healthcare professionals will see me as "less" of a nurse than, say, a critical care nurse or even a hospice nurse. I dislike the pay cut, but it's NOT as much as you might originally calculate because of all the time off and the opportunity to p/u work during breaks and summer. I get annoyed with the teachers or the front desk for sending me students for no reason, or making tiny issues into an emergency. I dislike hunting parents down for immunization records - this is literally my only real stress with SNing... that parents are SO bad about turning health records in, and it is a big part of our job to ensure they do. I worry that when I have kids, it will be hard/expensive to keep this job and pay for daycare.

2. Typical day is about 15-20 student visits (in a middle-high school with about 400 students), including about 5 scheduled meds/treatments, and a few "frequent flyers" with mystery symptoms; a lot of anxiety presenting physically and a lot of lingering colds that feel like the end of the world to the students... so basically a lot of education! The rest of my time is emailing, calling parents, making sure meds are complete and everything is UTD, preparing field trip backpacks, monthly AED and fire alarm checks, working on developing my upcoming programs, coordinating with other departments to set up hearing screenings or cross-departmental education (eg I guest teach an anatomy class each semester, give a presentation on drugs, give a PTO presentation on anxiety). I work get in around 7:40, open the office at 7:55 (school starts at 8am), and close up/go home around 3:30-3:45. I don't take a "lunch" but I am alone in my office so I just eat when I want and take breaks as needed. I even have a weight in here so I can do some exercises in my down time - haha! When it's super quiet, I watch educational youtubes or read MedScape articles.

3. I would have really benefited from a one-day orientation that gave the basics of the SN responsibilities, best practices, and common interventions. I basically had to figure it all out on my own. Not horrible, but certainly challenging and could have been a smoother transition.

4. If you can afford it, I would take the SN job.

[pedi_nurse]

1)What do you like/dislike about school nursing? - I feel more like a "nurse" as a school nurse than I have anywhere else I've works (acute care peds, pediatric primary care). Nurses have SO much to offer their patients and community, and it's been a really positive experience for me professionally to come into that role more. I love the kids. I'm at a middle school and they are the best! Just like inpatient, some of my families are amazing and some are really frustrating. Charting wears on me, but that's how it is everywhere. I have a ton of opportunities with middle school age kids to do a lot of patient education - even just teaching them what a cold is and how it progress. But I get the opportunity to do a lot of other education, such as working daily with a new T1D to help them understand the daily ins and outs of management. The admin/school/district really make or break the job though. I did two years at another district and a very unsupportive school and central admin. It was maddening and I was thinking about returning to bedside, which i left because of the stress and anxiety, so that's saying a lot. However, I moved to a different district and it's incredible. Admin is supportive, district has great policies and guidelines in place, we even have a few district aides who help with most of our screenings.

2) Tell me what is a typical day like? I see about 30 kids a day on average plus a handful of meds at lunch. I've got a student with anorexia who eats in the clinic twice a day (she brings a couple friends at lunch, which makes it fun). I have three diabetics, no other complex car kids I have to provide care to (a couple sped kids need assistance with toileting, but sped takes care of that). Often I see less than 30, occasionally I see more. I'll have a rare "emergency" every couple weeks that require a visit to a classroom. Usually it's the gym for a decent injury. The other day a kid fell in the cafeteria and split his knee open pretty good. In addition to this though, I'm keeping track of and following up on immunizations and screening results, I'm calling parents about that kid that keeps coming in with reflux type symptoms, I'm charting/writing a few IHPs, or I'm researching local resources for students and families, etc.

3) What is something you wish you would have known before becoming a school nurse? That it's literally a different world. The people around you don't think like you. And if you aren't in the most supportive environment, they might not even listen to you. It's maddening to try to communicate the importance of sending a trained unlicensed diabetic care assistant on a field trip with you diabetic student, when the principal doesn't care. (Kid went without the assistant and ended up getting too much insulin, of course! ugh). Also, what you consider an emergency (anaphylaxis symptoms) others don't seemed all that worried about it. Blood though - they'll call 911 so fast for bleeding that really just needs a bandage and a trip with a parent to urgent care for stitches.

4) Last but not least...what would you do if you were me? That's a tough call. I'd lean toward the oncology clinic, because I did enjoy working in a clinic environment and the pay is better. However, it is REALLY nice that I can be off with my kid for 2 weeks at Christmas and most of the summer, along with other holildays. I only have to worry about extra child care for those few weeks before school starts back. Also, my admin team at this school is pretty family oriented. If I need to duck out 20 minutes early to do a kid thing, they are totally fine with it. I also could bring my kid up to school for a half day in a pinch, though I certainly wouldn't do that if I had other options. I'm super happy with my choice to move to school nursing (I was only working part time in the pedi office, so it wasn't a pay cut for me). I don't plan to stay here forever, but it's perfect until my kid gets a little older. Also, it gives me time to take more classes and develop professionally outside of work. Whatever you choose will be an improvement, with the no more holidays and such. Good luck!

[pedi_nurse]

1)What do you like/dislike about school nursing? - I feel more like a "nurse" as a school nurse than I have anywhere else I've works (acute care peds, pediatric primary care). Nurses have SO much to offer their patients and community, and it's been a really positive experience for me professionally to come into that role more. I love the kids. I'm at a middle school and they are the best! Just like inpatient, some of my families are amazing and some are really frustrating. Charting wears on me, but that's how it is everywhere. I have a ton of opportunities with middle school age kids to do a lot of patient education - even just teaching them what a cold is and how it progress. But I get the opportunity to do a lot of other education, such as working daily with a new T1D to help them understand the daily ins and outs of management. The admin/school/district really make or break the job though. I did two years at another district and a very unsupportive school and central admin. It was maddening and I was thinking about returning to bedside, which i left because of the stress and anxiety, so that's saying a lot. However, I moved to a different district and it's incredible. Admin is supportive, district has great policies and guidelines in place, we even have a few district aides who help with most of our screenings.

2) Tell me what is a typical day like? I see about 30 kids a day on average plus a handful of meds at lunch. I've got a student with anorexia who eats in the clinic twice a day (she brings a couple friends at lunch, which makes it fun). I have three diabetics, no other complex car kids I have to provide care to (a couple sped kids need assistance with toileting, but sped takes care of that). Often I see less than 30, occasionally I see more. I'll have a rare "emergency" every couple weeks that require a visit to a classroom. Usually it's the gym for a decent injury. The other day a kid fell in the cafeteria and split his knee open pretty good. In addition to this though, I'm keeping track of and following up on immunizations and screening results, I'm calling parents about that kid that keeps coming in with reflux type symptoms, I'm charting/writing a few IHPs, or I'm researching local resources for students and families, etc.

3) What is something you wish you would have known before becoming a school nurse? That it's literally a different world. The people around you don't think like you. And if you aren't in the most supportive environment, they might not even listen to you. It's maddening to try to communicate the importance of sending a trained unlicensed diabetic care assistant on a field trip with you diabetic student, when the principal doesn't care. (Kid went without the assistant and ended up getting too much insulin, of course! ugh). Also, what you consider an emergency (anaphylaxis symptoms) others don't seemed all that worried about it. Blood though - they'll call 911 so fast for bleeding that really just needs a bandage and a trip with a parent to urgent care for stitches.

4) Last but not least...what would you do if you were me? That's a tough call. I'd lean toward the oncology clinic, because I did enjoy working in a clinic environment and the pay is better. However, it is REALLY nice that I can be off with my kid for 2 weeks at Christmas and most of the summer, along with other holildays. I only have to worry about extra child care for those few weeks before school starts back. Also, my admin team at this school is pretty family oriented. If I need to duck out 20 minutes early to do a kid thing, they are totally fine with it. I also could bring my kid up to school for a half day in a pinch, though I certainly wouldn't do that if I had other options. I'm super happy with my choice to move to school nursing (I was only working part time in the pedi office, so it wasn't a pay cut for me). I don't plan to stay here forever, but it's perfect until my kid gets a little older. Also, it gives me time to take more classes and develop professionally outside of work. Whatever you choose will be an improvement, with the no more holidays and such. Good luck!

ETA: I want to make it clear that I didn't choose school nursing just for my kid's sake. I like the field and I chose it when my kid was still a toddler. And I continue to choose it because it's fulfilling, less stressful than bedside, and has helped me develop myself professionally. The kid stuff is a huge perk though.

[ruby_jane, BSN, RN]

Yes! My son is a sophomore and daughter is an 8th grader. They'll be in college before I know it. I'm realizing how fast its all going and I know I cant get this time back.

I will tell you now - it's RJ Junior's senior year and I've spent So. Much. Time. at school, at meetings, at events. Going to college visits. Editing essays. Not as much time as being kinder room mom but seniors require as much time as kinders.

[Golden_RN, MSN]

I would suggest going to a district (or 2, or 3) in your area and talk to a nurse there about what they do. I worked as a school nurse for only 1 year, and even as a 0.7 FTE I had 4 schools. I did not have an office at any of my locations. My job mostly consisted of assessments for kids in special ed, care planning for kids with significant health problems, and vision/scoliosis screenings with my colleagues. I didn't have much of a chance to build relationships with staff nor students, and it consisted of a lot of driving around. It wasn't BAD, but we didn't function as the nurses on this forum seem to operate.

I think another commenter mentioned retirement. There may be a pension involved for school nurses, and you may want to consider that. School nurses/teachers in my area (maybe the whole state, I don't know?) do not contribute to social security, so if you are retirement planning that is a consideration. If health insurance is an issue, hospital nurses in my area get that for almost free, while school nurses are paying hundreds/month.

[cowboysandangels, BSN]

I left bedside 5 years ago for school nursing and I love it. I feel as though I make a difference in my community and I get to have a relationship with the families I serve daily. There are no "typical" days. Some days are belly aches and chapped lips while others are seizures and G tubes becoming dislodged. The children in our care are a much higher acuity level than in the past. Catheters, tube feedings, baclofen pumps, etc. are a part of the care we give. If you have a heart for children and being a part of a community, school nursing is the key.

[drvncrazy, BSN]

My 1st job out of Nursing school I worked a hem/onc unit at a Childrens hospital (7yrs). I then worked 15 years at a Pediatrician and now am currently in my 8th year as an elementary school nurse.

1) LOVE the hours (I have kids in select sports and school athletics and this has allowed me to go to basically everything.) My district pays for your years as a Nurse- so I did NOT take a paycut and got the added bonus of great hours. What I do not like is sometimes its boring and sometimes I feel isolated.

2) I see anywhere from 15-35 kids daily. stomachaches/headaches, injuries etc. daily meds, inhalers, I do vision/hearing/scoliosis screens as well as the "Puberty films"

3) MY ADVICE to anyone who wants to do school nursing is to be VERY comfortable and confident with your assessment skills and I always think having pediatric experience is best.

4) You are on your own for this one.

[jess11RN]

This is my 4th year as a school nurse after spending 10 years in outpatient oncology. I initially took a cut in pay. I'm certified and on the teacher's scale now, so I make almost what I made working part time in the hospital, but our insurance now costs significantly more as well.

I miss using my venous access skills and chemo knowledge and I miss working side by side with other nurses and health care professionals. I miss having the solid relationships with the doctors where I could just tell them what to write-lol! But, on the flip side, I cherish having more time with my kids (they're still elementary age), I get home in time to get them off of the bus. I don't have to work weekends, summers, spring break, winter break, and I don't have to fight with coworkers to get this coveted time off.

You'll develop the same (yet different) types of relationships with your students vs patients and their families. School nursing is definitely more of a leadership role than you would take in an outpt onc setting, you are the only medical professional in the building and everyone relies on you and only you for the medical answers (and then sometimes people still don't want to believe you).

To me, both choices would be great, but I think it's all a matter of where you are in your life.

[T-ROD, LPN]

When I started here at the school I took a 40,000 a year pay cut. I was driving 60 min and working 10-12 hour days.

No weekends. I never saw my family!!!

Now I drive 5 minutes and have off every time my children do.

Money is great!! But it doesn't compare to the time I have with my family now!! This decision was a no brainier for me.

Good luck in your decision making!!

[Glitternurse, LVN]

A quick background for me first. I am an LVN and have been for 25 years. I completely left nursing a few years ago and became an instructional aid for my children's district so I could spend more time with them. I made that decision because I was becoming very depressed getting texted pictures of my kids having fun with other people while I worked weekends and holidays. When my daughter broke her arm at school and I couldn't go to the ED with her it was heart wrenching (my husband was there and I trust him, but it's not the same.). I had not intended to go into school nursing, because as an LVN I didn't think it was an option. Anyway, long story less long, The district RN had been trying to get someone to assist her (our district is 5 elementary schools and 1 preschool) for several years and after learning I am an LVN she had leverage to get the job created because I was already a district employee.

1)What do you like/dislike about school nursing?

I love having lunch with each of my daughters one day a week. I love having so much time with my kids. I like that I can help the students here feel

better, stay healthy and teach them how to take care of themselves., I like that my presence makes a difference (some of these kids need to know

someone to cares). Irresponsible, lazy, unresponsive parents are the worst and are my biggest frustration.

I must also mention i love being on this board with these awesome men and women. I learn and laugh a lot

2) Tell me what is a typical day like?

Everyday's an adventure, there is no such thing as a typical day. one day your office if full of vomitters and the next it's full of kids with severe cases of

I-don't-want-to-be-here-itis and the next day you might be wandering the halls looking for somebody to come to the health office (although that is actually

very rare) and then there are state mandated screenings, checking immunization records to review and the ever exciting Lice outbreaks.

3) What is something you wish you would have known before becoming a school nurse?

I wish I had known how many parents really don't think they are responsible for their own children once they are at school.

4) Last but not least...what would you do if you were me?

Your kids will grow and be gone before you know it. Holidays and summer breaks are a great time to connect with your kids and watch them grow. They will

never be this age again. For me I don't want to look back on my life and regret not spending as much time as I could with my children. We all have our own

financial obligations and individual family dynamic, but if I were in your shoes I would go with the school nursing job.