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

shark_nurse14, BSN, RN · Mar 24, 2020

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!

tining, BSN, RN · Mar 24, 2020

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

tining, BSN, RN · Mar 24, 2020

magnoliablush, BSN, RN · Mar 29, 2020

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.

lissy1214, BSN, RN · Apr 22, 2020

Thank you to everyone who responded ! I read each of your responses and greatly appreciated them. I started my new job as a school nurse this week (virtually of course). It’s got to be the weirdest time/way to start a new job but I’m trying to figure things out as I go. Everyone in my district so far has been so helpful, I’m feeling quite lucky ?

Sriffey1 · Jun 11, 2020

Hey so I am considering School nursing ..I’m following this thread to see how you are liking it!

lissy1214, BSN, RN · Jun 12, 2020

Hi there !

I’ve been working as a school nurse since April but it’s all been “virtual”.
What that has consisted of: working with the local food bank to coordinate getting food to needy families, watching webinars, reading educational articles and literature, collaborating with the other nurses in my district to plan for re-opening (hopefully in September). There’s not a huge role for school nurses remotely (especially since I’m brand new) but the lifestyle change has already been such a breath of fresh air.

The highlights (to be entirely taken with a grain of salt because I have not worked in the actual school yet):

- I love the culture of working at a school ? maybe because I always kinda wanted to be a teacher and really enjoy the school setting. It’s cute and friendly and focused on the kids. At the hospital, you’re constantly bombarded with alarms and pumps beeping and codes being called overhead. That doesn’t exist here. It’s just a totally different environment and I’m loving it. (I’m sure in the future, when I’m actually in my office, I’ll inevitably run into some issues being the only healthcare provider amongst a group of educators.)
- Having an office is an amazing feeling ! I’m so thrilled at not having to scrounge my unit for a functional computer/WOW!.

- The hours are a dream. I’m off the clock by 3pm and I know that I’m off every single weekend and holiday (unless I’m picking up per diem at the hospital). It’s so nice to be able to answer “yes” to plans instead of “ugh, that’s my weekend” or “crap, let me see if I can find a switch”.

The downside:

- Less money . . . but only because this is a 10-month position and not a full-year job. When you do the math, my hourly pay is actually the same as my hospital-based job. It just stinks feeling like I *have* to pick up per diem time over the Summer to compensate for the fact that I won’t be getting paid for July and August.

- The fact that you can’t go on vacation whenever you want (not that anyone is going on vacation right now due to COVID). You are bound to the school calendar. Granted you have off all Summer, a week for Winter break and a week for Spring break. But still, you have to plan entirely around those breaks. With hospital nursing, you could always manipulate your schedule to allow for vacation or just request PTO virtually any week.

If you have any questions, let me know !!

What is your nursing background / what has you considering school nursing ?

Sriffey1 · Jun 12, 2020

Hey ,

my background is Clinic Mostly ;children and adults , home health and primarily wound care / case manager last few years. I recently took position as Utilization review but Not quite sure how I feel about it yet..,have been interested in school nursing for a while for the schedule and I think working with kids would be rewarding . A position has came available and I have an interview soon.