New School Nurse Feeling Overwhelmed...

[StormyRN95]

Hi everyone,

I have been an RN for almost three years. My background is adult med/surg and a little bit of adolescent psych. I recently started as a school nurse for a brand new high school close to where I live.

I know the school year just started and I have to give myself time to learn but I just feel like I'm not doing anything right. I am trying to collect and sort through supplies that have been ordered, even when I'm not really sure what I'll need more of, I am trying to chart correctly on every student that comes into the office, and enter immunizations/health card info.

I just feel like I am not yet confident in my decision making. When I was working in the hospital, a patient could go home once a d/c order was written. It's like I will call the parents to pick up a student with recurrent diarrhea or vomiting or a fever and the parents ask me to get them back to class, but students come in for other issues that I don't think warrant going home and their parents will come get them. ?‍♀️

I had a recent experience when my principal asked me why I was not reporting kids who had gone home after stating they ate food from the school cafeteria (and whose parents are blaming the cafeteria food) but there were no kids who reported to my office saying that. I learned a little later that those kids had not come into my office at all and called their parents on their own to be picked up.

Another thing I have had happen today is that a guidance counselor told me that I need to be developing 504s and IEPs/IHPs for the kids who transferred to our school but I have no idea how to do that. She even went so far as to say that she has 17 years of experience and her previous school nurses know what they're doing. Like okay??? I'm trying my best. If someone could have just given me a crash course in what to do then I would be able to do whatever needs to be done...

A big problem is that I received no training. I had a feeling this was the usual from reading posts on this thread but I just feel like I am failing. I try to do right by the students and I have confidence in my nursing skills but I am starting to find myself surrounded by admin staff who don't take me seriously.

Maybe I'm just being negative because my engagement ended this morning and my feelings are just all over the place but any words of encouragement or advice you could send my way would be greatly appreciated. ?

[peacockblue]

Your job is to keep the kids safe. That is first. All the other things are important too, but that will come in time. You are not qualified to write IEPs and you should have input on 504s but not write. Make sure you are following your medication policy and your teachers are aware of any significant medical problems. Don’t worry about supplies. You will find out what you want to order next year. Are there other nurses in your district you can get advice from? If not, how about networking with nurses in a neighboring district? Don’t change any forms or documents this year. Just use whatever the last nurse used. next year you can start changing things to your liking. I’m sure this group will give you good advice but that is what I can think of for now. Oh, and don’t let the guidance counselor tell you what your job is. You are the nurse, not her.

[CanIcallmymom, BSN, RN]

Breathe, it all will calm down (a little) once you find your groove. Peacock is right, you don't write IEPs or 504's. You can only offer input. You may write IHPs for students who see you for certain medical conditions like asthma, diabetes, epilepsy...but those are usually pretty standard nursing care plans. As far as supplies go, it's an extension of the home environment. I keep gloves, bandaids, gauze, rubbing alcohol, cotton swabs, q-tips, ziplock bags... very basic stuff...and my trusty stethoscope and thermometer.

I completely agree with peacock to not try to change documents yet, just make sure it is your name on there and not the previous nurse. Remind the guidance counselor that your duties are medical.

I'm so sorry to learn of your engagement ending. That is stressful on top of an already stressful beginning of the school year. (Hugs).

[halohg, RN]

It will come in time, the first year is always the worst, by year three it starts to fall into place. You know the teachers, kids, parents, and make best practices. As far as the charting don’t think of it as hospital charting. Real brief, less is more. It’s a serious injury that’s a different story. You don’t know what you don’t know and that’s okay, continue to ask questions. Yes write up the IHPs, the above advice of the other plans are correct.

Is this a private school? Hopefully you have a medical directors orders to help with building your confidence on decision making. Continue doing what as a nurse you have been trained to do and the admins will eventually come around. We are not use to an environment where our medical judgement is questioned however the school environment is different and everyone feels they are an expert and feel they have a right to question yours. Just be you, this comes in time. We practice by evidenced based proof, the rest of your staff give opinions based on feelings.

as far as the rude guidance counselor , I would try an engage them and open up about your lack of training and first time experience as a school nurse. They can become your biggest supporter and a great relationship with this group is vital for the care of your students. They are in the business of also helping others so hopefully that can be turned around. Keep in touch.

[MamaWifeNurse]

First of all, you can do this! Welcome! I just started as a school nurse in March, it gets easier as you come up with your own flow, I promise!

You're number one job is to keep the kiddos safe. As far as parents not picking their children up for vomiting/diarrhea, that is a policy here. Check your schools policy and have it ready. When I call parents, I have learned to say "Your child has vomited, WHO is coming to pick them up? They will also need to be out of school tomorrow and until they are symptom free for 24 hours." "You're child has a suspected eye infection. They will need to have a signed doctor's note before they return to school. Who is coming to pick them up?" I don't give them a choice.

I agree with what others said about the forms, wait until you have your own groove. I started changing/updating mine when I returned from summer break.

Is there another nurse in your district you can reach out to? I have 3 others I call frequently when my nursing instinct tells me I'm doing the right thing, but I need some reassurance.

[SaltineQueen]

Know your critical kiddos first, deal with kids coming into your clinic second, deal with paperwork as time permits.

IHPs are different from IEPs/504s. You are not the one to initiate IEPs/504s, that's a SpEd or principal deal in my district. An asthma action plan is considered an IHP, an anaphylactic reaction plan is considered an IHP. IHPs are created to manage medical concerns, not educational accommodations.

School nursing is SO different from any other kind of nursing. It'll be a while until you feel like you know what you're doing. ? Reach out to other nurses in your district or surrounding districts, find out if your state offers new school nurse training (mine has a lot of good resources through the department of education), and use this board or become a member of NASN.

You will need to learn quickly to be assertive with parents and administrators (but you also need them in your corner). I assume you're young based on how long you've been a nurse, maybe I'm wrong, so maybe they think they can push you around a bit. You're a professional. It's your call if kids need to go home.

I hope you will come to love school nursing! I can't imagine doing anything else.

[Nunya, BSN]

"School Nursing" page on FB. They're great at answering questions, sometimes you'll get too many answers!

[geminiwanderlust]

I was you six months ago. I even wrote a post with a very similar title. I began in March at my current position with almost zero training and juggling four different schools. Prior to this I was an OB nurse--which was helpful with my puberty talks. lol. Last year was a mess--trying to figure out what the old nurse and the sub nurse had done and not done was maddening. This year I feel like I kind of know what I should be doing and am starting to feel much more confident. I wanted to quit every day my first month--and I cried myself to sleep the first time a parent went crazy on me because I didn't send their "obviously" sick child home--he met zero guidelines for exclusion. So hang in there. It will get better. And learn to trust your own judgement without a doctor order to back you up.

[jnemartin, BSN, RN]

Hi there! I read your update post, but could not comment on it since it was closed d/t containing a legal question. In regards to your financial worries, I wanted to suggest that if you can't quit the SN job, you could get an on-call/PRN job at a LTC facility (I also work in the Phoenix Metro area, and work m-f as a school nurse and pick up shifts on the weekend at a skilled/LTC place... it pays much more than regular hospital work), or get a PRN hospital job (also higher paying than regular floor nurse, but not as flexible as skilled/LTC places). You will get paid more than FT hospital nurses and work the days that work with your schedule.

[LadyNurse15]

I'm with Saltine, you do not write IEPs or 504s but you can give your medical input. All my IHPs come from the MD. It almost sounds like the guidance counselor is trying to pass the buck with this one. That or the previous nurse felt the need, for whatever reason, to be more involved in the educational side than he/she needed to be. Paperwork is a little overwhelming at first but I have found that keeping the note short and using your abbreviations helps. These don't have to be full head to toe assessments, just the c/c, your observation, interventions and any phone calls/notes to parents should be enough. Take a deep breath...now let it out, you'll do great!!

[DaisyRN2]

Hello! Yes I am with you. I am a new school nurse and it's very overwhelming. The school has over 900 kids. I had no orientation other than a few minutes with my nursing director and the secretaries that are constantly telling me what I am doing wrong. The teachers send me kids just because they seem to be causing problems in class but maybe not anything physically wrong? I am just doing my best to stay above water. I have confidence in my nursing judgement and you should too! Mostly likely you are the only medical professional in the building and that should be respected. When parents or teachers push back just say "well in my nursing experience..." because they don't have your experience and that's why they are not in your position. If you experience something new don't be afraid or just," that is something new to me. Can you given me some direction about what you would like." It's a new position for you and no one can expect you to know everything.

[SaltineQueen]

On 8/20/2019 at 3:39 PM, DaisyRN2 said:

The teachers send me kids just because they seem to be causing problems in class but maybe not anything physically wrong?

I hope you're getting your admin on board to nip this in the bud! That is a classroom management issue, not a nursing issue. You have enough to deal with.