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New school nurse- not sure if I like it. Help!

School   (1,019 Views | 11 Replies)

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I just started school nursing at the elementary level last week, 500 students at the school.  I have been a RN since 2011 with 1 year of adult Med surg experience, 5 years of nursery experience, and did two years in a pediatric day surgery/PACU unit. So Far I’m not sure if I like it. I got a day and a half of training with the previous RN and then I’ve been on my own with the help of an aid. However that is only for the week. My second week on my own I may only have an aid 2-3 days out of the week. 
 

so far, I love seeing and taking care of the kids. What I don’t like is all the other stuff. I had no idea how much falls on the school nurse. All the behind the scenes things. Care plans, keeping up with immunizations, screenings, contacting parents/teachers for various things, taking care of new enrollments. There’s so much paperwork and you are expected to do it with kids coming into your clinic every few minutes. I would be okay with all of this falling on the nurse If there was assistance in the clinic every day. 
 

the other thing that terrifies me is emergencies. I’m so scared of being the only person on the campus if something happens. I’m used to being in the hospital with all the support and equipment. Even then it wasn’t my strength. I am not an adrenaline junkie, I tend to freeze up. And I also tend to let someone else take the lead and I take the role of helping in emergencies. And now it’s me! I’m so scared for the first time something happens.

so I’m beginning to think maybe I don’t have the right personality for this. Has anyone else experienced this ? Any input would be much appreciated 

 

 

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OldDude specializes in Pediatrics.

7 Followers; 1 Article; 4,782 Posts; 30,164 Profile Views

To answer your question...yea you like it!! You've self diagnosed your concerns. One of the reasons a person "hesitates" in a hospital setting emergency is because they can. There are others to collaborate with. Not so in school nursing. So, now that you realize it's just YOU, you'll call on your critical thinking skills, training, and experience and handle it. The administrative stuff will always be there. Hang in there and best of luck!

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GatezRN has 10+ years experience and specializes in ICU, Adventures in school nursing.

108 Posts; 3,581 Profile Views

Give yourself a bit more time.  School nursing is unlike any other area of nursing.  It's overwhelming at first and training for a school nurse position is typically sub par.  Making decisions without having another nurse to confer with is daunting at first, especially in a new setting. 

Work on your planning for emergencies so you'll be ready.  Find out if there are any CPR/AED trained individuals in your building so you know who your resources are if needed.

Once you get to know the kids and staff you'll likely be a lot more comfortable.  Eventually you'll come up with your own system of keeping things organized which is huge.

I was hired as a second nurse for a building, but days before school started I was assigned to my own school.  I walked into a pile of physicals and immunizations that I had no idea what I needed to do with.  Health assessments for potential students?  I had no idea.  EpiPens?  Had never laid eyes on one. Everything eventually fell into place and now I never plan on leaving this job.  I don't miss the hospital one bit.  I even quit my per diem job last year because it gave me too much anxiety.  Bonus... awesome hours that work for my family, no weekends or holidays, and summers off!  I hope you give it some more time and that things work out for you.

Use this forum as a resource.  There are so many experienced, highly skilled school nurses here that are more than willing to provide advice.

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"nursy" has 40 years experience as a RN and specializes in ICU, ER, Home Health, Corrections, School Nurse.

199 Posts; 821 Profile Views

The thing with nursing is you can go from a specific unit in a hospital (med surg, ICU), and go the the same unit in another hospital and it's essentially the same job.  When you switch specialties to something completely different, the learning curve can be unexpectedly huge.  It can be very frustrating  until you've figured out the routine, and developed your rhythm, and that does not happen overnight.  But it will happen.

As far as emergencies, there really is only so much you can do. You're one person, with no equipment, and no code team rushing to your side.  Listen to your gut.  Don't be afraid to call 911, you can always cancel the call if things end up  being non-emergent.  Remember the guideline that adults tend to die of coronary stuff, and kids tend to die from respiratory stuff, so take the respiratory stuff seriously.   If I have a potentially serious respiratory issue and I'm not sure which way it's going, I do the "how bad is it on a scale of one to ten."    The second the numbers go in the wrong direction (they started at 4 and now they're a 6), it's 911 time.

And I'm going to just throw this out there...in the hospital we did not use epi pens.  The first time I had to use one in an emergency, I was clueless.  So maybe you are familiar with them, but if not, train yourself on how to use them.

The worst of the paperwork is in the beginning of the year, and the good thing is, it's not like the hospital where you can't leave your shift, until you've finished documenting.   Screenings and such can be fit in when you are less busy.  

Buy a cheap timer.  When I know there's really nothing wrong with the supposed stomache/headache ache (and believe me you'll get to know your frequent fliers)   I set the timer to 5 minutes and tell the student to go lay down until the timer goes off, then go back to class.  Then I don't have to pay much attention to them, and can concentrate on more important stuff.

I LOVE my job, and would not go back to a hospital for triple the salary.  

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lifelearningrn has 6 years experience as a BSN, RN and specializes in School Nursing.

2,293 Posts; 24,847 Profile Views

The beginning of the year is always crazy.. give yourself time to get used to it.

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129 Posts; 1,830 Profile Views

I agree with nursy.   If it's serious, call 911.    There's a limit to what you can do with your meager clinic capabilities.   We don't even have what comes on a BLS ambulance, let alone advanced.

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2 Followers; 5 Articles; 4,125 Posts; 35,209 Profile Views

School nursing is a very hectic job. It can span from a mundane day to everything that can go wrong, will.   Once you get into a groove and know the student's better, it'll flow.  Knowing who are your frequent fliers and who has the needy parent that WILL call your admin because you didn't call about the kid's stuffy nose (that they've had all week, but suddenly got worse during a math quiz).  The paperwork can be daunting.  But my one piece of advice is to triage what's important and take it in that order.  New enrollment?  Maybe priority level 2 - you need to look at it ASAP to see if their paperwork will permit them to start, while inputting your med orders is priority 1 for you.  

Also, try and see how you can divide work and leave things for the clerk on the days you have them.  Maybe you have a vaccine record that needs to be created.  No reason why your clerk can't do that, as long as you know that kid is complete.  Remember - in a school you begin your school year a month behind in paperwork.  You'll get to everything eventually, it just may take you a bit.  

 You've come to the right place.  Consider us your virtual nursing unit for any questions that you may have.  To get some colleagues closer to you (and available in real time) check to see if there are and state or regional school nurse's associations and join them and don't hesitate to call up a neighboring school nurse to ask a question.  We all know and we all get it.  Now, come and sit with the cool kids, on Wednesdays we wear pink.   

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20 Posts; 343 Profile Views

This is my first year of school nursing. I am at an elementary school with 636 kids, avg about 40 visits per day, and I have no aide. Trust me, the first couple weeks I thought I had made a mistake coming into this field. Eventually though I have found a flow and feel like I have a teeny tiny grasp on things. Don't give up!! 

I have definitely felt the self-doubt and fear of "what if a kid passes out and I have no idea WOW! to do..." or "Her insulin dose calculated to 2.75, do I round up or down?!" Not having another healthcare professional can be nerve wracking, but like the other posts said - you have to learn to trust yourself and your judgment. We also have preceptors that we can call in the district if we aren't sure about something. They are different than our nursing supervisors we can also call when in doubt. If you don't have that available to you I'd suggest reaching out to your feeder pattern nurses and build a relationship there so you at least have a fellow nurse you can call on if need be. 

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7 Posts; 256 Profile Views

I’m leaving school nursing after one month. I do not need to give myself any more time to try to adjust.  Totally the wrong fit for me. I should have subbed in this district.   I think for some nurses it can get better.... not for me and I’m ok with it.    So I totally understand how you feel 

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20 Posts; 1,063 Profile Views

Thank you for your honesty! If I may ask, what do you dislike about it? I’m sure it’s the same things I don’t like so looking for a little validation lol

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Blue_Moon has 18 years experience as a BSN, RN.

1 Article; 478 Posts; 5,217 Profile Views

 The hardest thing is for nurses to come from a hospital setting to a school setting because everything is so different. Remember, you're dealing with a healthy stable population of students for the most part. You also don't need to rush and get all the paperwork done before the end of your "shift" like you're used to. You can take months to get care plans done. Screenings get done when you can because even if they are due by a certain time period what happens if they are late. Well nothing.  New enrollment paperwork is time consuming but the beginning of the year and new student enrollments in the spring are you're busiest times for these. The rest of the year you won't have tons so it's easier to stay on top of. Also, the more you do it, the faster you become. You're lucky you have an aide at all. I've never had an aide to help with anything and I got zero orientation. The only nursing job I've had where they just literally throw you to the wolves but it's because the school system is so laid back. 

I remember feeling that way about the emergencies. However, true emergencies are rare. Very rare. The longer you do this the more comfortable you'll become. Just review your emergency care plans and when/how to use things. You may never need to use an epi pen or whatever. When in doubt call 911. Trust your judgement. 

If you don't mind seeing the kids and taking care of all their little needs then I think you will do just fine with this job. You're just psyching yourself out. You will find things teachers think are emergencies (puke, lice, bloody nose, etc) are not at all a true emergency. The most common serious things I've had are either someone breaking an arm (or other body part) or fainting and these things happen less than a handful of times a year. Well and occasional asthma attacks or low blood sugars. Nothing like you're worrying about.

Educate your teachers of things to let you know about or watch for to prevent problems. I tell mine that any student that has asthma or diabetes may come and see me if they ask to for ANY reason. I've had teachers in the past downplay someone having an asthma attack because they didn't look bad and they thought they were faking (they weren't and you never want an asthmatic to get to the point they look bad!) so I insist they let me figure it out and if there is in fact an issue where they are wanting to cut class then we'll deal with it. I've never had these type of kids ever abuse the power to come and see me whenever they want in 17 years except once and when the parent and I got to the bottom of the issue so it stopped. 

Don't be so hard on yourself. If you enjoy the most important part of the job (taking care of the kids) then you'll be just fine with patience and practice.

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MrNurse(x2) has 28 years experience as a ADN and specializes in IMC, school nursing.

3 Followers; 1 Article; 2,512 Posts; 9,952 Profile Views

School nursing seems to be the perfect fit for so many of us here that it sounds unfathomable that others may not like it. I would encourage anyone questioning their choice to give your employer and yourself six months to see if it may settle down and be something you like. If you still don't feel it is a fit, move on. We don't all wear the same clothes or drive the same car, not everyone will like school nursing.

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