School Nurse Advice

[Jollysox]

I am hoping to get some advice from veteran school nurses. I was offered a job as  a school nurse, at a high school of about 1,650 students. It's a public school, with some "medically fragile" children, as the hiring manager described them, and then your diabetics, afternoon adderall passes, and what not. I was told that the clinic sees about 50 kids a day, and that I will have an MA working with me. I'm wondering if this ratio is insane?

I have been a nurse for 20 years, and I have ER/critical care experience. I looked into being a school nurse as a way to slow down, but 50 kids a day sounds like I will need to work at the same frantic pace I do at the hospital, but for much less money. I don't know if this is just anxiety over trying something new, or it will likely be as bad as I'm imagining? 

[Cattz, ADN]

With that much experience. I have no doubt that you can handle it. The shock to your nurse brain is that you will be the only medical person, with no one to problem solve/give you an extra hand, etc. But, I don't think this would let you slow down, except for holidays and Summer break- which is a great perk to the job.

Good luck in your decision! 

[k1p1ssk, BSN, RN]

I also think that that volume of kids may have to do with the culture of the health office, but I honestly don't think that ratio seems insane at all. I used to sub at a technical/trade high school that had less than 700 kids (I don't recall the exact numbers, but I know there were less than 200 per grade), none of whom were medically complex, and every time I subbed, I saw, by myself, over 70 students per day. The nurse at the time let the kids walk all over her and she became a glorified pill dispenser and cold shower (I found two kids who came in separately for "naps", hooking up behind the curtain less than 5 minutes later). 

My last building-based assignment was at an elementary school with just over 200 kids. I usually saw about 15-20 visits per day. 30 during peak illness season. The other elementary school in the district had the same enrollment and routinely saw 30-50 per day, simply because of how different I ran my office compared to the nurse in the other building, as well as how teachers handle injury/illness. At my school, they used more common sense judgement and would try to redirect kids they thought might be avoiding work whereas the other building, the staff take no responsibility (or very little anyway) and want the nurse to be the bad guy, which of course also means the kids are running things over there.

The high school in my current district has less than 300 kids. The past several years, the main nurse made the health office a cozy hang out space, complete with infused water, bean bag chairs, and puzzles, zen sand garden, and other sensory "toys" and the volume of visits ballooned because the office became a destination in the school. The current nurse has removed many of those creature comforts and is not as willing to let kids hang out and so the visits are less frequent. 

I'd ask about what the visit acuity is like - is it 50 kids with actual illness or is it a lot of "I want to get out of class and so I'll feign illness to take a nap" kind of stuff? If its the latter, you should feel like you can take control and let the kids know what you are there for and what to expect from you. You may see the volume of visits go down quickly if they know they can't pull the wool over your eyes.

Good luck!

 

[seedanurse]

That staff to student ration seems good actually.

The high schools in our district have that many students, medically fragile rooms and the nurse does not have an MA. They fly solo.

I'm at a middle school with 750 students. I am only allocated 2/3 time so 5.75 hours per day, and this year average about 40 sick/injured visits, along with 8 daily medications, and 2 students with daily diabetic care. During URI season, the visit numbers tend to go up quite a bit. 

It's manageable. You are going to have great triage skills, with your background, which will make the job a lot easier. ?

[k1p1ssk, BSN, RN]

Also, don't forget, you are not spending 15minutes with each kid. These are "what is your immediate need" assessments and treatments for the vast majority of visits.

For example: A sore throat with no other symptoms? Should be 2-3 minutes tops, as would be most illnesses. Temp check, visual inspection, palpate for lymph nodes.. If WNL or not concerning for strep or peritonsillar abcsess, you get a cough drop or 3, maybe a salt water gargle, encouraged to drink more water, and instructions to return or see your doctor if it gets significantly worse. 

And at the MS/HS level, you often can set kids up to treat themselves. They don't need the bandaid put on for them like a little often does. 

[beachynurse, ASN, BSN]

I'm at a high school with almost 2,000 students and I have an assistant that is an LPN. Just the 2 of us...