LPN new grad as a classroom nurse

JustBeachyNurse, LPN · Jul 29, 2015

I just graduated nursing school and passed the nclex. Had my first job interview at a special needs school as a classroom nurse. The responsibilities seem to involve giving meds, monitoring, prn assessments if the child appears ill, etc. There are also teaching responsibilities as well. Does anyone here have a similar job? Any recommended books/ reading on school nursing at the LPN level?

This sounds like private duty 1:1 care of a specific student or are you responsible for all students in the class? What is the primary population of the school? Cerebral palsy? Medically complex? Autism? Multiple disabilities? Are you employed by the school or an agency? What state? Is there an RN on site?

Jp381209 · Jul 29, 2015

I would be an LPN/TA for all the students in the classroom (4-5 students I believe). The kids in this class have physical and medical disabilities. There is an RN offsite but on call and available during the day. I am in Ma and would be employed by the school.

JustBeachyNurse, LPN · Jul 29, 2015

I would be an LPN/TA for all the students in the classroom (4-5 students I believe). The kids in this class have physical and medical disabilities. There is an RN offsite but on call and available during the day. I am in Ma and would be employed by the school.

Check the NPA. You need to have physician orders for most interventions. You would need access to the students individual health care plans and medical orders. Honestly this does not sound like an appropriate job, especially without on site support, for a new grad LPN.

Are you experienced in GT/JT feeding and medication administration? Are LPNs in MA permitted to reinsert GTubes? (Some states it's RN only or LPN with onsite RN supervision) Do you know how to troubleshoot GT malfunction and what is a nursing intervention vs what needs MD specific orders? Are you doing nursing or paraprofessional work? Some schools try to save money by having one person in a dual role, regardless if it's best practice.

Would you have a title of nurse? I'm not certain but I believe only RNs can be school nurses in MA.

Are you familiar with common emergency seizure protocols? (Not every student needs Diastat/rectal diazepam some use SL/cheek clonazepan or other ODT benzo) Would you be responsible for toileting, diapering, and/or bladder catheterization (if ordered)? Would you be responsible for oral feeding of dysphagic children or would it be the (more appropriate) responsibility of the speech pathologist.

Many of these schools have students with various forms of cerebral palsy or chromosomal abnormalities. You would need to be familiar with common coexisting medical conditions (gastroeparesis, failure to thrive, bronchopulmonary dysplasia/chronic lung disease of prematurity, various orthopedic impairments, hypo or hypertonic muscles, scoliosis, epilepsy, asthma, cortical vision impairment, dysphagia, high risk for aspiration, and more). Students may have seizure action plans or asthma action plans. If receiving feeding therapy may have very specific feeding protocols to reduce aspiration risk.

BuckyBadgerRN, ASN, RN · Jul 29, 2015

Does your state allow LPN's to do assessments?

JustBeachyNurse, LPN · Jul 29, 2015

Does your state allow LPN's to do assessments?

Most restrict assessments to RN only and LPN can do "data collection" (vital signs, signs/symptoms, observations) in consultation with or indirect supervision of an RN

I still think this is not the best choice for an inexperienced new grad

JustBeachyNurse, LPN · Jul 29, 2015

To practice as a school nurse in MA, one must be a registered nurse, not a licensed practical nurse.

School Nursing

I suspect this may be a private school hiring an educational paraprofessional that happens to be an LPN with the hope of delegating skilled nursing tasks to the paraprofessional/LPN. I've seen this before and I've seen new grads eager to work hard and do their best not understand the responsibility they have accepted...and ultimately put a medically complex child or their nursing license at risk.

I work 1:1 with complex students in school with a written plan of care, there are one to four certified school RN's on site. I have a RN clinical supervisor that creates the plan of care and if available for phone consultation if needed (or comes to me if needed). I know if I have an emergency with a student the school nurses on site are there (change in LOC, increase in seizures, issues with GT, accidental trach dislodgement)

Jp381209 · Jul 29, 2015

Thank you so much for all the input, I really appreciate it. I will have some questions now for the 2nd interview. Justbeachynurse you are right this is an LPN/ teachers aid combined position.

Adele_Michal7, ASN, RN · Jul 29, 2015

I would think that this would be a poor fit for a new graduate; especially given that it would be for 4-5 children.

BuckyBadgerRN, ASN, RN · Jul 29, 2015

Exactly. I know my state does not allow LPN's to do "assessments".

Most restrict assessments to RN only and LPN can do "data collection" (vital signs, signs/symptoms, observations) in consultation with or indirect supervision of an RN
I still think this is not the best choice for an inexperienced new grad

Jp381209 · Jul 29, 2015

Yes here in Ma we can't do the initial assessment but we can assist the RN and do data collection, vs, etc.

JustBeachyNurse, LPN · Jul 29, 2015

Yes here in Ma we can't do the initial assessment but we can assist the RN and do data collection, vs, etc.

You may be out of your scope in this role if they want you to assess/evaluate a change in student status without an RN on site. I'd be less concerned (but still concerned) if there was an RN on site. The board of education is not there to protect your nursing license. You can always consult with the MA BoN or even the school nurses association of Massachusetts.

I suspect your title will be educational assistant, educational paraprofessional and skilled nursing tasks that cannot be delegated to a non parent UAP such as tube feeding or the administration of rectal diazepam will be assigned to you. They won't tell you this though.