DCtoRN

I learned that the “new” aide has been in a supporting role to the previous aide and is just being promoted (no idea what her previous job title was.) I will be working with a good team- superintendent, principals, school office staff. I certainly have my work cut out for me, but just knowing that I have at least one person who has been in the trenches there on my side is a game changer. I will work with the state school nurse consultant, our ESD, you all, and others to assess and make course corrections and enhancements to our school health program.

My sense is that ratios like this are par for the course in my state. We rely on LOTS of teaching and delegation. One good new piece of info I got is that my “new” health room aide has been closely involved in the health aspects of the district for 5 years, including last year and is now being made “official.” She should be a great source of information on how they have operated for all these years with no on-campus nurse and it will be up to me to ensure things are being done properly. This was good news to me. My communications with the Superintendent have shown that he is understanding of the situation that I’m in and he’s ready to support me as within his ability. I will be setting a date soon to go on the campuses and take inventory of supplies, policies and procedures. I just got back from a vacation and will now be focusing on networking within my state and with you all in earnest.

Yeah, it’s better than nothing, I suppose. The state also has a school nurse manual with tons of links. There is no shortage of general and specific information out there on school nursing- but I’ll have to utilize this group and find a mentor nearby to help me navigate my onboarding.

Thank you for reminding me of this. The last time I looked, registration wasn’t live yet and it is now. 2.5 hour orientation and 1 hour 504 plan training. I have Fast Facts for the School Nurse and the new-ish edition of NASN’s School Nursing textbook. My plan is to continue reading those books, these forums, NASN’s resources and state materials. I have also seen the resource page from (Wisconsin?) with lots of info. I think it’s the specific application to my situation I’m stressing. But my superintendent got back to me, letting me know that I can come in early for “inventory and organization.” I will use that opportunity to familiarize myself with previous strategies, documenting, resources, etc….

I believe I’m lucky to have landed a new job as district school nurse, covering an elementary, junior high and high school with 1200-1500 students. The pay and benefits are good, I know and like many of the staff and administrators, and they’ve shown excitement to have me joining their team. I was hired in early June and at my interview, I was lead to believe that I could come in for the last week or two to orient to their current practices and resources. Then I was told that I would start at the beginning of the 2021-22 school year, after the previous health staff (a single health room aid) has moved on to a different position. I offered to come in unpaid to observe and was ignored by my POC in the HR department. Yesterday, the superintendent e-mailed me at my personal account to ask me to connect with the newly hired health room aid and give her direction on the set-up and practices for the school year. He also said that there is room in the budget for me to come in a few days early (before orientation and inservice week) to “set up inventory and organization” for the school year. This district has been operating with a health room aid and occasional contract nurse involvement for thirteen years, so I feel that their expectations are probably more basic than my own personal ambitions, but my plan, beside doing a fair bit of self-driven education this Summer was to show up, observe current practices for a short time, reach out to the ESD, and a nurse at another district who has consulted for the district in the past and formulate a plan. This is the scenario that I feared- total responsibility on day one with no orientation or training. I will express my concern in a constructive manner and I believe the district will work with me to make the handoff as safe and efficient as possible. I have been told that the Elementary School is where the greatest need is, helping the little ones manage the new routines and making sure medications, blood sugar checks, etc. are done appropriately. There has been no mention of my involvement with respect to COVID measures, but I’m sure I should be involved with that at every level, along with start of year IEPs and 504s. What action steps would you recommend? How much unpaid time should I devote to this? I attended the NASN virtual conference this Summer, I’ve pored over this Allnurses page as well as the NASN forums. I’ve read a bit of our state’s (Oregon) return to schools COVID guidance and e-mailed the state School Nurse consultant, who may be in the process of being replaced, so no reply. Sorry for the long post. Thank you for your replies. Sincerely, DC2RN

You’re right- I’m sure I’m overthinking it. I have a talent for that. I am friends with two of the principals I’ll be working for. I will probably connect with them before Summer’s over, to pick their brains. Im grateful to be starting this year and not last year!

I'm new, too! My background is 10 years as a chiropractor (had to quit due to back and wrist issues- ironic, I know), 2.5 years hospital nursing (medsurg and step-down ICU), parent of two teens, much school volunteering. At first, I was so excited to get chosen for the job. I was hired in June, but start in August. I asked if I could come in and get a feel for the current routine (they haven't had a on-site RN for over 13 years), but the school year was coming to a close and I got brushed off. I think the HR people were hesitant to bring me in without pay and/or to start my contract and benefits three months early. Over the past weeks, I attended the virtual NASN conference, reviewed the NASN forums (some, not all) and check in here from time-to-time. I have to admit, my anxiety is building- I just hope that they haven't set early expectations too high. I also have to protect my license and I assume that I am liable for EVERYTHING for 1200 kids in 3 schools from day one. I will be consulting with my state (Oregon) organization as well as our school health officials at the state level. I have and will continue to review the nurse practice act for my state and Covid mandates, 504 and IDEA, FERPA, emergency protocols, etc.

The policy at my most recent hospital job was to not mix insulins, but rather draw up two individual syringes. I can see how the extra cost and poke would pose a problem in the school setting, though.

Amen! Particularly in the hospital setting, nurses seem to unconditionally tolerate extreme working conditions and abuse in the name of sacrifice for the healing of patients. Patient care and stressed out nurses are not compatible! I am so grateful to be venturing outside the hospital and into school nursing. I expect a steep learning curve, having no school nursing experience and being the only nurse in a 1300 student district, but I am great at finding and using resources, asking questions, receiving constructive input, etc. Plus, this district hasn't had an on-location nurse other than an occasional contract nurse for over a decade. They are so happy to have a warm body and they are especially happy to have me joining them (small town- we mostly know each other from my parenting and coaching presence). Be strong nurses!!

Late to the discussion, but I can sure identify. I was severely disciplined for missing a latex sensitivity (non anaphylactic) in a patient and inserted a latex Foley for which he had to return to the ED the next day to have changed due to skin irritation. While the error was mine and won't ever happen again, there were many contributing circumstances. Perhaps because I am active in our union, I was thrown under the bus. I live in a small town with few opportunities outside the hospital and SNFs. Within the hospital, there were few options to move forward (my ED orientation was terminated and I was returned to MedSurg). A new position for school nurse was posted just at the right time and I WAS HIRED!! I gave notice to my manager at the hospital yesterday, the day I signed my contract with the school district. My advice to any nurse going through what you or I went through is to GET OUT!! Hopefully you are in an area with more options than I had and won't need a small miracle like I had, but in my mind, staying at a place that treats nurses like this is putting our own career in jeopardy. Thankfully, my board doesn't post investigations in process. The investigator said my case will be dismissed, but the board is backlogged and it's been 6 months! Hang in there (but don't hang around!) Nurses are in demand- you are valuable.

Good points Natasha. I didn’t even consider the scrape for early retirement option. It seems sad to think that many people think of their job as a means to an end but that may well be the safest bet in today’s rat race. I’m not going to lie- the thought of going per diem in early retirement sounds good to me. But that will be sooner than when I was 32.

I could be way off, but my gut says that if you’ve worked around nurses for years and still aren’t sure it’s what you want to do- keep looking. Society brainwashed us to make choices based on security and consumption. Most people don’t like their jobs, but see the dissatisfaction as a necessary evil. What brings you joy? You’re still young! What do you dream about? Take the time to make connections with people doing things that excite you. Pick their brains. Shadow them. Life is short! Some compromise is necessary. Don’t give too much of yourself away. Your kids will learn an important lesson seeing you work hard to achieve your dream.

As a reformed chiropractor, I agree with some of the above statements and find others ignorant. Traditional chiropractic focused on spinal alignment and the term for the misalignment is subluxation (not to be confused with medical subluxation). The standard was to take xrays, point out minor misalignments, correlate with objective and subjective findings, and manipulate. Like most passive musculoskeletal treatments, this has a fairly poor outcomes record in studies, but charm and persuasion and the body’s natural regression to non-pain create the appearance of effectiveness. This goes for PT, chiro, massage and acupuncture as well as many others. I see a current trend of young chiropractors dismissing the old school and learning very sound diagnostic skills and employing more rehab therapy and patient education, with a goal of empowering patients to participate in recovery and minimize dependence in the chiro. You may ask how this differs from PT. In practice, not a lot. The chiropractic license provides some latitude in scope and they are primary care, so no referrals are needed. There are many chiros that would jump on a short DC to PT degree program just to work at outpatient PT clinics and leave the billing, coding and practice operations to someone else. The DOD, VA, Kaiser, and other systems are hiring evidence-based chiropractors with increased frequency because enough honest, ethical, intelligent DCs are moving away from the pseudoscience. As far as vertebral artery dissection, the risk is minuscule. There are legion chiropractors twisting and cracking necks every day (along with massage therapists, PTs, frat brothers, etc.) and VAD is extremely rare. Look up the studies. Cervical manipulation does offer at least temporary relief to a portion of those who receive it, so the VAD risk doesn’t come near the modest benefit. Long story short- if you’re in pain and haven’t found non-opioid and non-surgical relief, consider a chiropractor. Pre-screen by asking a) do they treat subluxations? If yes, move on. b) how long are the first and subsequent visits? First should be at least an hour. Follow-ups, at least 30 minutes. This leads to c) does the chiro prescribe and supervise exercises at every visit? The answer needs to be “yes”. d) are xrays required for all or most patients? Most xrays are useless and only serve as marketing tools for “scare care”. Finally- a good chiro will not be cheap. They won’t likely charge the hundreds per visit that MDs and PTs do, but chiros are physicians, chiro school is very thorough (as are the 5-part national board exams), and chiros tend to carry the entire overhead of a private practice on their shoulders. In the end, most back pain resolved on its own. Getting and staying active seems to help. Cognitive behavioral therapy seems to help. Core and balance (but not necessarily yoga) integrity seems to help. Stress reduction, hydration, inflammation control seem to help. Drugs and therapies may often do more to create dependence and catastrophizing the pain/diagnosis. Excellent resources: Back Mechanic by Stuart McGill, PhD. fixyourownback.com mckenzie institute international

I, too, was a chiro in private practice in a small rural town. I’m great with people, pretty solid clinically, but stress over potential Medicare audits (practice was 50-60% Medicare) kept me on edge and I didn’t dare grow my practice because that would mean more Medicare patients to stress about! I also had back, shoulder and wrist problems that limited my volume. I enrolled in an Associates in Nursing program at my local community college. While not expensive, it was time intensive. I think it would be almost impossible to be the primary provider for your family and go to nursing school, whether accelerated or traditional. My learning curve was primarily that of working in a hospital, with endless policies and varied equipment, supplies and support personnel. There’s a right way to do just about anything and we are expected to follow procedural steps pretty closely. Nurses also play a huge role in assessing patients, making recommendations to the doctors, bringing new or changed elements to the doctor’s attention and carrying out or overseeing most interventions. I put in 8 months in general nursing, followed by 15 months in our progressive care unit and am now applying to the ED. I’m 46 and on the slow path to finishing up raising my kids, putting in my 10 years for Public Service Loan Forgiveness and getting my BSN (I went to chiro school without a Bachelor’s degree). Im not settled into whether I will pursue a nurse practitioner license, continue hospital nursing, travel nursing, or returning to a concierge style, part-time chiro practice (least likely). Nursing is fast-paced, often stressful, and full of potential pitfalls. But I like leaving my work at work (no billing, marketing, bookkeeping, etc.), working with a team, learning and getting paid to learn, and the latitude to switch specialties and environments relatively easily. Hope this helps.

We have supply personnel who regularly travel through the ICU, PACU, MEDSURG, and ED in our small hospital who refuse to wear their masks properly. Initially, when mandatory masking was implemented, they affixed their masks to their shirts with a safety pin! Multiple complaints were made to management, infection control, and the ethics hotline. After a few weeks, they began to wear the masks, but cut the bottom strings so the mask just floats out off their nose. Their practice continues. The complaints have likely ended due to lack of action by management. Absurd!