How Can Admin Help to Retain School Nurses?

LHartnett01

Experienced school nurses, we’ve all had that frightening moment. You have vomiting Vanessa in your office and you need to call THAT parent to pick her up. Her mother had used profanity when you called to ask for the student’s required Kindergarten physical and then posted all over social media how poorly she was treated. You take a deep cleansing breath and dial. Maybe today she might be in a better mood.

School nursing is yet another venue losing staff in droves. It’s not because of poor pay or long hours, because both are really not bad (with the exception of contact tracing when Covid was at its peak). It’s absolutely not the kids, although there are days when they can be mischievous. It’s not the heartbreak of being the witness to neglect or abuse and having to work with authorities. As a certified school nurse, IEP and 504 caseloads can be high in the economically challenged communities where up to 25% of the students may need special education services or accommodations, but this is not the reason. So what is the problem?

FACT: Parents who cannot respect reasonable boundaries are the problem.

I am a parent of three children and have worked as a school nurse since 2013 in seven elementary schools and one high school. I have been the camp nurse for many summers while my children attended. I have been both the girl scout and boy scout leader and worked vacation bible school for several summers; so it is a fair statement that I have spent a fair amount of time working with children. The idea sounds light and fun, and for the most part, it can be. But if there are children to be supervised, there are parents to be managed and this can drastically alter the experience.

All school nurses face being sworn at, being argued with about policies and student pickup, and admittedly, most of my school nurse stories are not as serious as the situation I will now describe. The one that finally broke me in the high school setting occurred during the 20-21 school year when guidance surrounding Covid had its greatest impact on student attendance. I had contacted a father to pick up his son because he was identified as a "close contact" to a positive case. He was unvaccinated and was going to have to be quarantined, as was health department protocol at the time. His father was angry because the student was going to miss a highly anticipated football game. This physically intimidating former military veteran stood in the lobby making physical motions like he was going to hit me because he deemed this my fault. Security was watching and called the principal and the two went into a conference room so that the father could vent and I went back to waiting students. Later that afternoon the father returned and angrily told the security guard, “Tell that nurse to get out here!". The security guard came to tell me about the father’s reappearance at the door and his demands and stated that he had shared this with the principal and then offered to escort me to my car at the end of the school day. The principal never spoke to me about it, even after I requested a meeting to discuss it. There was no administrative follow-up with that parent, nor were any assurances made to me that I would remain safe in the building. Several weeks later, the principal had come to discuss a parent complaint about one of my nurses with me as her supervisor and I brought up the incident that had been occupying my thoughts daily. He shrugged his shoulders and said that was not what he recalled. He did not ask any questions and expressed no interest in addressing the matter. He sat across from me with a flat expression and remained stoic and silent. It was astonishing to me, given the continuous stress from that year including a fire to fights and the nursing team's level of dedication to providing our best care to the 4000 students in that building, that there was no disputing how little I was valued.

So what was I hoping for and what is the answer? The first and most obvious solution is supportive administration. Most school nurses are supervised by non-medical personnel who do not truly understand the role or know what it takes to manage a busy health office. Regular communication between the administrator and the nurse is paramount to growing the relationship and establishing trust. The principal/vice principal/dean should feel confident in standing up and supporting the nurse’s decisions. They can have faith that evidence is weighed carefully and protocol followed as dictated in the district. When an angry parent calls or a teacher complains, the administration should not automatically apologize for nursing staff behavior, but should investigate complaints and respond accordingly. I am not saying that nurses never make errors because we are human and certainly do. I am simply asking for fair treatment and a reasonable level of support. We should not have to stand alone against unnecessary abuse.

Many youth sports programs require the parents to sign a code of conduct that prohibits swearing, yelling at players, and aggressively confronting the referees. The parent handbook and online registration systems have a student code of conduct that must be signed that addresses plagiarism, appropriate use of the school computers, and the dress code. If either the parent handbook or the online registration included a section that also addressed parent conduct we might feel that the school board supported the respectful treatment of all school staff. That is what we seek, after all.

FACT: We want to be treated with common courtesy and moderate respect.

marsbar37 · 2022-06-22T13:35:35Z

It never ceases to amaze me how as nurses we are expected to be abused and just accept it. We get grief from admin who number crunch and teachers who thought that every sneeze or cough was Covid and not anything else like allergies or common colds, to parents who blatently lie and suffer no repercussions.

masscane, BSN, RN · 2022-06-22T13:42:39Z

I don't work in school nursing, but I work with adolescents in psych. I'm lucky to work in a program where if the parents are verbally abusive then their kid can be removed from our program. I can feel for you because I haven't always had the kind of support that I get now. It is shameful when administrators allow for that kind of bullying and abuse to go on. It shows just how little we are valued. With those kinds of organizations, sometimes the best we can do is vote with our feet. Staff abuse by parents should be taken much more seriously and have consequences attached. We matter!!

EdieBrous, BSN, MSN · 2022-06-22T14:29:42Z

Why would anyone leave a cushy school nurse job? Put "cushy" in quotes. School nursing is extremely stressful. As much as the public doesn't understand what nurses do, even the nursing community doesn't understand what school nurses do or how difficult their job is. The idea that is is just band aids and immunizations is very outdated. Deepest respect for them - they change and save lives.

Athabascan, BSN, MSN · 2022-06-22T18:18:31Z

I feel it depends on where you are at in your nursing career. School nursing is more political now with BOE putting their political agendas before best practice. School nursing is not difficult work. Yes, you don't get the same respect when working for educators, they do not appreciate our skill set. I certainly love the hours/vacation and flexibility. My day is not anywhere near as stressful as working in the hospital. Also, you have time to work on your graduate studies or other certifications when there is down time. I would not suggest a brand new graduate nurse work in school nursing as you will not get the clinical experience as you would in a hospital setting. I find that older generation nurses transfer to school nursing before they retire if they are fortunate enough to find a school position willing to pay a decent salary - good luck with that! I work PRN in addition to make some extra spending money. So I have the best of both worlds. I am working on a school nurse grant and when that expires I will more than likely just work PRN. It depends on where you are at in your career!

HiddenAngels · 2022-06-23T13:21:58Z

I def feel for you. I’ve never done school nursing nor do I want to now. I’ve def encountered my share of abuse from pts/fam but I had no idea you guys were getting it at the same level as us inpt nurses. Another thing we share in common is the lack of support. We are not supported or appreciated at all. The only time we hear from administration is if, I’m sorry, NEVER!

That guy should have been arrested, not sorry! How dare he use his military bravado to intimidate a nurse and of all places at a school! With the youth! What freaking kind of example is that!

I don’t have an answer on how to retain nurses but a start would be for us to have rights! Things we are not and should not have to tolerate. Facilities that help with some of the problems disguised as medical problems! Zero tolerance for Pat/fam abuse. I’ll stop here. Going out for a 🏃‍♀️

Gratefulbutnotstupid, ASN, LPN, RN · 2022-06-23T23:13:25Z

Nurse abuse is no different than other forms of abuse and should be dealt with appropriately. An administrator who does not stand behind a nurse who is unjustly being abused needs to hand in his/her resignation. Personally I am not a fan of non- medical personnel supervising nurses. They do not have the knowledge necessary to do so. There should be a physician affiliated with the school supervising. Expensive, maybe, but the correct way to do things. Perhaps several schools could affiliate with the same physician. Nurses take orders from physicians, PAs, NPs, podiatrists and dentists, not administrators. That’s the way I see it, unless some nurse law is in place for school nurses which I am unaware of (it’s possible). Regardless of the supervision, the administrator should have stood up for the nurse. There will come a time when nurses will just call the police ( they have the right to do so) which most likely will make their employer mad. Oh well, nurses have the right to call the police if they feel threatened in any way, it’s about time everyone is aware of that.

Brittanydub · 2022-06-23T23:35:56Z

I was a school nurse who got terminated for having a small amount of residue in a pill crusher

How Can Admin Help to Retain School Nurses?

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