I may hate my School Nursing job...ADVICE, PLEASE?

[RNPediatric18]

I started a job as a School Nurse on October 1 in a local high school, 30 minute commute each way. The kids are sweet, the teachers (that I've met) are nice, and the job isn't bad at all. I knew I would enjoy the busy parts. However, when I took the position I worried about the slow pace.

The high school I am in is only 480 students and I have 5 scheduled students daily; 2 independent diabetics and 3 ADHD meds at lunch. I have two students with epilepsy and quite a few with food allergies. On an average day I see 7-8 additional students for the usual; sore throat, nausea, HA, emesis, etc... Some days more and other days, like today, nothing. Besides this my days have been filled with trying to find busy work; reorganizing, completing CME's, organizing some more, etc...

Even though I am enjoying this job, I'm not sure if it's going to make me feel fulfilled and/or challenged enough. The schedule is going to be amazing with holidays and summers off, I get that...but I can't help but think what I could be doing or providing to people.

History on my past employment: pediatric office for 4 years as an LPN, telemetry/renal/stroke unit in the hospital for 1 year after completing RN school, and most recently 2 1/2 years at a local community services board working primarily with the Pediatric Psychiatrist.

I loved my job there, coworkers, the children, and the doctor I worked with. However, I wanted to be at home more often with my 8 month old daughter. Therefore, I took this position and a $14K pay cut along with it. Yes, money isn't everything but it has weighed heavily on my mind.

Recently, I've found myself looking at the job postings for the local hospitals. I'm not sure why. Today, I found a listing for a night shift position at one of the hospitals on the pediatric unit and cross training in the mother/baby unit. I am contemplating applying for this job but am afraid I am prematurely wanting to jump ship before giving it more time here at the school. But then I also think, when you know..you know.

Sorry for this long post but I just need some guidance and advice on where to go from here. I feel lost and unsure what to do. I don't know how night shift would be with having a family, plus the hospital the position is at is also a 30 minute commute. However, I don't want to be somewhere just because of the amount of time off and not feel like I have a satisfying career.

Thanks for taking the time to read!

[OldDude]

Me, neither!

Aw...I'm just kidding. But we could have a hearty round of disabusing you of any glamorous notions of acute care these days, if you'd like.

Here's a little bit of my own very humble opinion re: acute care vs. the role you are in right now. I feel like there is a potential for you to be better regarded and respected and treated like a professional in the school setting. I could be wrong, I've never known that side of things. But...acute care is currently having a bit of a hard time demonstrating much regard for the bedside nurse (I'll leave it at that).

This is not to knock acute care (I'm there and I have a hard time imagining myself anywhere else); I mean to say that you probably have a little more going for you right now than you might be able to see/imagine. It kind of sounds like, at least to some extent, you could make your current gig as awesome as you want to make it, using suggestions like those already mentioned in this thread. That's worth a lot. Having a schedule that works well with parenting is also worth a lot - - these are all days you don't get back once they're gone.

Why don't you give it a go for this year, and if, when summer rolls around, you're still not feeling it, look at other options.

Good luck~

This, this, and this! Bam!!

[NutmeggeRN, BSN]

Join NASN and your state school nurses association, and get active with them. Look at educational opportunities you can provide. There is SO much info online. Try to forge an alliance with your guidance department.

Hang in there. it will get better.

Or, just say the "Q" word and the poo will hit the fan!!

[stephrooth]

This sounds like me. I started being a SPED school nurse 10 months ago and It was very slow in the beginning and I hated being work at work... NOW, I've been seeing students back to back and miss being bored in my office.

What state are you in? Do you have a Nurse Leader for your District? Would it be possible for you to call and shadow a nurse in your district and see what she is doing?

When I started this job in September of 2015, not only was I new to school nursing, but my school was brand new. So I had ZERO guidance. To top it off, we are a Charter school, so when I called other schools in my district for guidance, I was met with a lot of resistance and resentment, for the mere fact we were Charter:no: I finally called the school nurse at my own kid's elementary school in a different district and mentioned I was new and had some questions. WOW, was I overwhelmed with stuff after that. I had NO idea that there was a State Mandated Kindergarten immunization survey due in ONE WEEK. I had to call the State to find out how to even access the survey. I started going through every single chart to make sure kids were UTD with immunizations and physical exams (many weren't and it took ALL year to get them UTD). I started going through charts and realized we had kids with documented anaphylaxis but no epi pen and/or no MD orders. Same with asthma meds. It took months of daily phone calls to parents to get this information. I only discovered this forum in my second year, so I likely would have been more overwhelmed, LOL.

If your main issue is that you feel like you are sitting and not doing anything, than the above mentioned things should def keep you busy for a while. If the issue is you are used to being more physically active and only doing direct patient care, and not admin stuff, then you might be in the wrong place. I admit I loathe admin stuff, but the other stuff balances it out for me and the hours it allows me to be with my 13 and 11 year old kids is so worth it. I love my school and my job, but I still take it year by year.

[pedi_nurse]

So you're saying that most school nurses get zero training? I haven't seen one policy or procedure on how I'm even supposed to be doing anything. I understand they may not exist. But Lord only knows if I'm doing anything correctly.

My first district, I got basically zero training. The Health Services Director said she would help and just call if I had any questions, but she was a bit of a mess (I'm convinced it's early onset dementia - it was that bad) and I would get more done figuring it out on my own than if she tried to show me.

My district now is MUCH better with orientation. It's a large district with over 70 schools and a well supported health services department. We had 3 days new nurse orientation (even if you have already been a school nurse before, but were new to the district), and a monthly meeting to review more of our guidelines. This, as well as a mentor assignment, continues for two years. Our mentors were required to meet us at our clinic for at least one day before the start of school. It's not perfect, but I appreciate it. Also, I have a lot more admin work here than I did at my old school. Not because it's admin heavy unnecessarily, but because my old district was so lacking in keeping up with best practices and state laws.

If there are no set policies or procedures (any policies, you could get from the school board or health services director/superintendents), you could always go about researching and establishing your own procedures. Obviously, you have to go through all the right channels in the process, and it's frustrating there isn't anything in place already (love me some license protecting policies!).

[RNPediatric18]

Yes, we do have a head nurse for the county who is over top all of us. That is who trained me for the 3 hours. I reached out to her for further guidance yesterday and didn't receive much feedback other than adding in a weekly visit with the elementary school and middle schools. I sent another email today to her and an email to a fellow high school nurse in the county in hopes that she can give me some further direction as well.

Unfortunately since it is high school and there are no required immunizations for high school in Virginia, that wont help keep me busy much.

My last position was outpatient, Monday-Friday 8-5, and while I did quite a bit of admin work I also was up and down a lot more than here. Additionally, I shared an office with two other nurses and had a lot more interaction with coworkers. I basically am sitting and doing nothing in between the 5 scheduled kids and maybe 4-5 others I am currently seeing a day. I know it will get busier with the changing of seasons and flu right around the corner. I just worry if this position is going to be challenging enough for me on a consistent basis to keep me satisfied.

Right now my daughter is only 8 months and when she does attend school it will be in a different county, 40 minutes away. So maybe I'm just in school nursing at the wrong time?

[RNPediatric18]

Yes, this is exactly what the coordinator did with me too. I got the 3 hours training and then was told to call her or any of the other high school nurses in the county with questions. Which was fine and I did! I can be pretty self sufficient...as I think most nurses are. But past taking care of the students, triage, handing out medications, and documentation, I need a little more guidance.

And YES! I love policies and procedures so that I can protect not only my license but me!

[pedi_nurse]

Right now my daughter is only 8 months and when she does attend school it will be in a different county, 40 minutes away. So maybe I'm just in school nursing at the wrong time?

Maybe. However, I think you mentioned that nursing roles are pretty coveted in your area (as most is in most areas)? Maybe this is an opportunity for you to get some experience so you can more easily find a position closer to your daughter's school?

Obviously, don't stay in a job you are miserable in if there are other options, but also be cautious against leaving mid year. I don't know how it is in VA, but in Texas, it's HIGHLY frowned upon to leave in the middle of your contract. Teachers can even have their license suspended for a year, if they don't have a valid reason to leave (such as moving a great distance, or major health issues). While nurses don't have the same restriction, the district can sue a nurse for breach of contract (doesn't often happen, but I know of at least one). Even those issues aside, if you think you may want to return to school nursing in the future, it may look very bad to have it on your job history that you left mid year.

I'm so sorry you are having a difficult time in this position. I know a lot of us on here love our jobs, and don't want to diminish your experiences/opinions of it. Please know we are here to provide support in any way we can!

[pedi_nurse]

And YES! I love policies and procedures so that I can protect not only my license but me!

It's so telling that as a new nurse I was always thinking, "ugggghhh, aNOTHER policy or best practices guidelines??" Now I'm all, "Give me ALL the policies. PLEASE!" It's maddening and a bit scary not to have those built in protections.

[BluebellRN, BSN, RN]

I'm also in VA! This is only my second year, so I'm still very much learning myself.

I don't know much about high school, I'm in elementary. But, have all the 10th graders had their vision and hearing screening? We hit day 60 today in my district, so all screening is to be finished by today. I know a few nurses in my district are still finishing up re-screens, myself included.

VDOE :: Online Orientation for School Nurses

Here is our DOE health site. There is an online orientation you might find useful. It's also a good go to when you need to find out state specific requirements.

I'll see if I have some more links for VA stuff and post it later. There is a learning curve with school nursing because it's so very different. It was hard last year, but is getting easier.

[RNPediatric18]

I'm also in VA! This is only my second year, so I'm still very much learning myself.

I don't know much about high school, I'm in elementary. But, have all the 10th graders had their vision and hearing screening? We hit day 60 today in my district, so all screening is to be finished by today. I know a few nurses in my district are still finishing up re-screens, myself included.

VDOE :: Online Orientation for School Nurses

Here is our DOE health site. There is an online orientation you might find useful. It's also a good go to when you need to find out state specific requirements.

I'll see if I have some more links for VA stuff and post it later. There is a learning curve with school nursing because it's so very different. It was hard last year, but is getting easier.

They completed the vision and hearing screenings before I came here, although I attended a re-screening at one of the middle schools two weeks ago. I honestly had no idea there was a certain time frame these needed to be complete in and I believe the coordinator has the hearing machine? I feel lost as to what really goes on since I came in two months after the school year started. Thank you for the link and yes, anything else you have would be really helpful!!

[BluebellRN, BSN, RN]

http://www.vdh.virginia.gov/content/uploads/sites/58/2016/12/VDH-Guidelines-for-Healthcare-Procedures-in-Schools_2017.pdf

This behemoth is your P&P manual. Typically, district policies are cut and paste from this.

School-Age Health and Forms – Virginia Department of Health – VDHLiveWell

http://www.vdh.virginia.gov/content/uploads/sites/3/2016/03/Communicable_Disease_Chart-1.pdf

The VDH is great! Have you made contact with the local health dept? That might fall more to your county nurse. Still, they can be a solid resource when you have a kid with a communicable disease or when there isn't a clear policy on exclusion, or like my last call to our epidemiologist to get a Spanish hand out for ringworm.

I'm one of those nurses that is always keeping an eye out for job postings. I almost applied for a health dept position a couple months ago. But, I love my schedule and it works so well for my family, I couldn't do it. I might make a move one day, but it'll be when my kids are older.