School Nurse Concerns

OldDude · Mar 19, 2018

Only RN for 3000 students? No others to help?

JenTheSchoolRN, BSN, RN · Mar 19, 2018

Only RN for 3000 students? No others to help?

Yeah, that's a lot! But I'm also not surprised.

My state has some of best RN-to-ratios in the country. Recommendation from the National Association of School Nurses is 1 full time RN to 750 students (none of these students needing 1:1 nursing care, of course).

My school has 700 students and two school buildings about 0.5 miles apart. My load is 500 students in my building. I also teach health class, scattered throughout the year to grades 7-12. The other nurse has a half nursing/half admin position and covers the additional 200 students. It is an urban setting with a lot of need and some days I can't come for air.

I know other nurses on this board have more students than I do.

ABRN2012 · Mar 19, 2018

There is me and one other nurse. We are stationed at the two biggest campuses (elem, MS, HS). The campuses have 1200+ students each. And we have a smaller school with about 300 students that is requiring one of us to be there a few hours a day and "on call" so together we have around 1500 students each. The smaller school is 25 min away from me so it is not like I could get there for a true emergency because EMS would get there first.

As far as your question of the biggest concern for lack of use... Thankfully we do not have very many "skilled" students but we get bogged down doing bandaids and temps, headlice ect. and that doesnt leave a whole lot of time to do the teaching, paperwork, training ect. that we are really supposed to be here to do. Before I came no one had a problem giving meds or checking heads. The school nurse shows up and suddenly no one can give a pill or put on a bandaid for a "invisible boo boo". I love my job, I really do but I stand by that within our school district there should be nothing that "only an RN can do" because there are only two of us. I understand other states have different laws but here if youve been trained you can give it all! We have trained the staff on everything so they know how to do all of it. But when anything is said about epipens or diabetes or whatever it always come up well we dont have to do it we have the school nurse. And I always say "What are you gonna do if I am out or the other nurse is out? And I could not get clear across town in an emergency. I dont stand up and run my mouth in trainings for nothing!"

ruby_jane, BSN, RN · Mar 19, 2018

I have 2300 on one campus and a darned good health aide. Because school nurses don't "fit in" to the education metrics we get left out of funding discussions. Last year there was discussion of replacing RNs with LVNs. The plus side - at least they're still talking nurses and not lay people.

I also don't think I'd take an assignment of 3000 kids spread out over multiple campuses but I know some of us do and do that very well.

WineRN · Mar 19, 2018

I am the odd duck out here. My district is pro nurses. There is a full time BSN minimum RN in each of our 23 schools. All middle and high schools have a part time office aide to handle the increased population. We go through the same PD as teachers, have our own representation in the union and are supported to continue our education/certification.

My best friend is a social worker in a Chicago public high school, and their nurse is only there 1-2 days a week for 2200 students. She doesn't see students while there, just attends meetings, checks meds, and trains any new staff that may have started. She floats between 3 different high schools, all similar populations. While she isn't at the school the office staff handles all medical needs. I can't even wrap my mind around being ok with delegating so much to non medical personal.

OhioBPH · Mar 19, 2018

Our district is staffed by our district RN, an RN at the high school, a couple schools have LPNs, and the rest of us (7) are medical assistants. My opinion of this depends on the competency of everyone. If you have medical assistants who understand their role and are capable of doing the work that needs delegated, it is fine. My district RN is available with a phone call or text, everytime I have asked her to come help assess she does, and I get great feedback from her. I also am able to call on the high school RN for advice in a pinch.

That being said our district is part of the children's hospital school health department, so the hospital oversees the training, policies, and evaluations for all school health employees. There is mandatory training every summer and we have policy reviews mid school year.

I think if I were in a situation where a charter school hired me and I had little guidance, few written policies, and no supprt it would be a totally different story. I'm very competent, but I'm a delegate.

OhioBPH · Mar 19, 2018

I just wanted to add, if you think about this big picture is it better to have a less qualified staff in a school or have no one. We all know of schools that the secretary takes care of the kids during the day. This is far from ideal.

SavyNurse, ADN, EMT-B · Mar 19, 2018

I am the only school nurse between 2 campuses with a total of 1000 students currently. Each year we add a new grade (11th grade next year) as well as adding one 4k class next year. I have asked for a second nurse for the upper school or to work part time but I feel I am a required evil sometimes. Luckily right now we have no serious medical students but who knows what the future holds. At my upper campus the secretary is the non-medical "nurse". She contacts me with any questions or concerns. But again if there is an emergency there is no use of me trying to get to the upper school because it would take at least 15 minutes and ambulance would make it before me probably.

KKEGS, MSN, RN · Mar 19, 2018

I am in Minnesota. Our district has around 6500 students (K through post high school transitional program) plus an ever changing number of preschool children. There are 3 district RNs. We each have 1900, 2200 and 2400 students on our case load. Granted most of these students will never come into contact with the nurse.

We have 15 buildings in the district and each of them is staffed with an LPN. Our buildings range in enrollment from 115 to 2000 (our high school) students. The high school has just the one LPN but the office of one of the district RNs is in that building so she hops in to help with the LPN is swamped. We also employ Special Education LPNs that are based in the classrooms. The high school SpEd LPNs are interested in cross training so they can also help the building LPN during busy times. We have a really good group of nurses in the district who really do try to support and help each other but we definitely feel understaffed most of the time.

lvnforschool · Mar 19, 2018

This topic has been a huge one for me personally. I am LVN working 7th-12th grade school about 600+ kids. I have some special needs kids that I help with daily. The other school in my district is TK-6th grade. The medical assistant has been there 12+ years. She was an EMT prior to that job. So we started out 5 years ago with a RN, but she retired soon after I started. Then last 2 years we had an excellent RN who answered calls, texts and was very hands on. She quit last summer due to she really only wanted part-time work, and we were killing her with full time requests. So we started this year with no RN District nurse. I was getting calls weekly asking me when I was going to be doing trainings for staff- NOT MY JOB! We finally hired a nurse 2 months ago, but Ive seen her really only twice. She works full-time and just doesn't have the time to do anything else.

Avill, BSN, RN · Mar 19, 2018

Where I am located we are fortunate to have a nurse in every school :)