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PICU to Elementary School Nurse - tips, suggestions, insight ?

School   (161 Views | 4 Replies)

lissy1214 has 5 years experience as a BSN, RN and specializes in PICU, General Pediatrics, Pediatric Heme-Onc.

900 Profile Views; 10 Posts

Hi all ☺️

I hope this post finds you well, and staying safe during this trying time. 

I’m posting on here looking for a little insight on school nursing. After working in an inpatient pediatric setting for 5 years, I just accepted a position as an elementary school nurse (grades 1-5). It’s a weird time to be starting a new job but what can you do 🤷‍♀️

 I’m very excited to start this new chapter, whenever that may be ! A few questions:

What are some of the highlights of your job ?

What are some of the challenges of your job ?

Anything you wish you knew before you began working as a school nurse ?

Any insider tips, good resources to have, mantras, tricks, etc. you’d like to share ? 

Additionally, being that I am transitioning from working in a relatively high-stress PICU, I am especially interested in any tips on how to make the mental adjustment from PICU to well children in a school setting.

Thanks guys 😁 

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shark_nurse14 has 5 years experience as a BSN, RN and specializes in school nursing.

1 Follower; 94 Posts; 2,047 Profile Views

What are some of the highlights of your job ?

The kids. You will be with these kids more than most of their parents are. You see them good, bad, and ugly crying. You are able to build a relationship beyond that of a nurse. For a lot of these kids, I'm nurse, counselor, mom, provider. I don't have any children of my own, but I always say I have 500. 

What are some of the challenges of your job ?

Adults; luckily, my immediate supervisor is a nurse and understands the job. As for principals, superintendents, school committees, parents, and teachers...they don't all get it, but you're in their battlefield. You'll find yourself in a lot of disagreements regarding the integrity and importance of your nursing license. "No, I can't give a med without an order" and "No, I'm not calling home because your shoes got muddy, you made a poor choice". In the beginning, I found myself agreeing to a lot of things that aren't nursing related (sewing clothes as one example). I had to learn that I can't be responsible for everything, or else the true nature of my job will suffer. 

Anything you wish you knew before you began working as a school nurse?

You are the sole medical provider for everyone in that building and you have limited resources, and you need to prepare for it. There will be times you think to yourself "Wait, I don't have oxygen, or a suction, or another nurse, or a doctor to call, or...". It's all on you. Make sure you are prepared to do what needs to be done in those situations; I did this by reading through every post I could find on AllNurses, becoming a member of NASN and taking every CEU course I could find, and having a seasoned school nurse I could ask questions to. You don't know what you don't know, and experience in the hospital prepared you for just that, to work in a hospital. You have the underlying skills, but it will take a lot to nail down the nuances.

Any insider tips, good resources to have, mantras, tricks, etc. you’d like to share ? 

Use the people here as a resource...together we have experienced quite a lot. Also, become a member of NASN and your state school nursing organization. There is also a fabulous school nursing facebook page that offers a lot of good insight and tips. I also use the school nursing textbook by Selekman, Shannon, and Yonkaitis. I would also encourage you to find a text resource for writing individualized care plans, IEPs, 504s, and emergency action plans. There are a lot of different options on Amazon

Additionally, being that I am transitioning from working in a relatively high-stress PICU, I am especially interested in any tips on how to make the mental adjustment from PICU to well children in a school setting.

I think there are a few common misconceptions in this statement. You are correct that a good portion of kids in school are well children...but there are also a large amount that are high needs (medically, emotionally, socially). The trick here, is that you treat them all the same; they need to feel that you care just as much about their stomach ache as you do about the student who needs his EpiPen...it's just the nature of the developmental age you'll be working with. Children come to school with all abilities and needs these days and I think you should prepare that not every child in school will be "typical". 

As for the mental adjustment...I don't know how to truly prepare you until you are there. I think the most honest I can be is to be prepared to be amazed at how much your perception of school nursing will change, I know mine did. It will not be the same as having a kiddo on multiple drips, a fresh trach, and a hospital room full of providers. But, you may have 5 kids in your office at once, all talking at the same time, all with different needs (a g-tube feed, audible wheezing, a scratch, a diaper change, a headache and fatigue for a student with diabetes, a teacher demanding to know why you didn't send so-and-so home, your phone ringing and you KNOW it's that social services caseworker you've been playing phone tag with for days). It's a different type of stress and demand, for sure, but taxing all the same.

Be ready to provide first aid, emergency care, case management, counseling, education, advocacy...all the things you provided the hospital setting but in the educational one. Make sure you know FERPA and how your school manages IEPs/504s. 

 

And welcome! School nurses are a true gift to the youth of the world, and we're so excited to have you!

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tining has 26 years experience as a BSN, RN and specializes in School Nurse.

1 Follower; 1,007 Posts; 14,255 Profile Views

There are many threads here for nurses wanting information here are a few:

 

 

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tining has 26 years experience as a BSN, RN and specializes in School Nurse.

1 Follower; 1,007 Posts; 14,255 Profile Views

 

 

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magnoliablush has 2 years experience as a ASN, RN.

67 Posts; 700 Profile Views

On 3/24/2020 at 8:55 AM, shark_nurse14 said:

What are some of the highlights of your job ?

The kids. You will be with these kids more than most of their parents are. You see them good, bad, and ugly crying. You are able to build a relationship beyond that of a nurse. For a lot of these kids, I'm nurse, counselor, mom, provider. I don't have any children of my own, but I always say I have 500. 

What are some of the challenges of your job ?

Adults; luckily, my immediate supervisor is a nurse and understands the job. As for principals, superintendents, school committees, parents, and teachers...they don't all get it, but you're in their battlefield. You'll find yourself in a lot of disagreements regarding the integrity and importance of your nursing license. "No, I can't give a med without an order" and "No, I'm not calling home because your shoes got muddy, you made a poor choice". In the beginning, I found myself agreeing to a lot of things that aren't nursing related (sewing clothes as one example). I had to learn that I can't be responsible for everything, or else the true nature of my job will suffer. 

Anything you wish you knew before you began working as a school nurse?

You are the sole medical provider for everyone in that building and you have limited resources, and you need to prepare for it. There will be times you think to yourself "Wait, I don't have oxygen, or a suction, or another nurse, or a doctor to call, or...". It's all on you. Make sure you are prepared to do what needs to be done in those situations; I did this by reading through every post I could find on AllNurses, becoming a member of NASN and taking every CEU course I could find, and having a seasoned school nurse I could ask questions to. You don't know what you don't know, and experience in the hospital prepared you for just that, to work in a hospital. You have the underlying skills, but it will take a lot to nail down the nuances.

Any insider tips, good resources to have, mantras, tricks, etc. you’d like to share ? 

Use the people here as a resource...together we have experienced quite a lot. Also, become a member of NASN and your state school nursing organization. There is also a fabulous school nursing facebook page that offers a lot of good insight and tips. I also use the school nursing textbook by Selekman, Shannon, and Yonkaitis. I would also encourage you to find a text resource for writing individualized care plans, IEPs, 504s, and emergency action plans. There are a lot of different options on Amazon

Additionally, being that I am transitioning from working in a relatively high-stress PICU, I am especially interested in any tips on how to make the mental adjustment from PICU to well children in a school setting.

I think there are a few common misconceptions in this statement. You are correct that a good portion of kids in school are well children...but there are also a large amount that are high needs (medically, emotionally, socially). The trick here, is that you treat them all the same; they need to feel that you care just as much about their stomach ache as you do about the student who needs his EpiPen...it's just the nature of the developmental age you'll be working with. Children come to school with all abilities and needs these days and I think you should prepare that not every child in school will be "typical". 

As for the mental adjustment...I don't know how to truly prepare you until you are there. I think the most honest I can be is to be prepared to be amazed at how much your perception of school nursing will change, I know mine did. It will not be the same as having a kiddo on multiple drips, a fresh trach, and a hospital room full of providers. But, you may have 5 kids in your office at once, all talking at the same time, all with different needs (a g-tube feed, audible wheezing, a scratch, a diaper change, a headache and fatigue for a student with diabetes, a teacher demanding to know why you didn't send so-and-so home, your phone ringing and you KNOW it's that social services caseworker you've been playing phone tag with for days). It's a different type of stress and demand, for sure, but taxing all the same.

Be ready to provide first aid, emergency care, case management, counseling, education, advocacy...all the things you provided the hospital setting but in the educational one. Make sure you know FERPA and how your school manages IEPs/504s. 

 

And welcome! School nurses are a true gift to the youth of the world, and we're so excited to have you!

ALL THIS!! ^^^^ You are their comfort. It is stressful, and you will worry about "your" kids. Be firm but fair, and know that sometimes they just need to talk to you, not to fix it. You will enjoy it. I love it. 

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