Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation!
I have been a school nurse for 40 years with the last 21 in a high school. There have been times when a nurse was absent with no substitute available, and I had been asked to run over to that school in order to cath a student, or start and end a tube feeding. Our job function is to ensure the well being, safety, and health of the students. What would happen to that student if no one agreed to go to that other school to cath them? Even though the nurse was absent, the treatments still have to be done, so I don't mind running over to a nearby school to help out. I may need the same help at my school one day, and would hate for another nurse to refuse to help my students.
There is a great school nurse forum here on allnurses, I hope you'll reach out to your colleagues here for helpful insight.
Not being a school nurse, my questions for you are:
Here are a couple of key resources that include position statements and guidelines regarding school nursing roles and staffing:
National Association of School Nurses (NASN)
If you are a NASN member, you can access their peer-reviewed journal for articles on safe staffing and school nurse access. If you are not a member, joining your professional organization provides valuable resources and enhances your credibility.
NASN has a position statement on School Nurse Workload: Staffing for Safe Care, but it is not prescriptive as to floating. That said, NASN guidelines recommend the following ratios:
American School Health Association (ASHA)
ASHA provides essential resources regarding school health policies and practices. Although it does not have specific position statements on floating, it addresses school nurse practice standards.
New York State Department of Health
The New York State Department of Health's School Health Services (NYS School Health Services) position on school nurse staffing is that school boards ensure appropriate and adequate licensed nursing personnel to meet student health needs. While this focuses more on guidelines than position statements, it can provide local regulations that back up your position.
These documents can provide additional support for your argument, especially around the need for school nurse staffing, the safety of students, and the limitations of floating when special health needs are involved.
You are not likely to find black-and-white, enforceable regulations covering schools other than your assigned school. Guidelines and position statements often tend to be just that—high-level guidance.
Actually, this is an exciting opportunity to address a problem. You could be part of the solution.
Consider proposing a solution that shows your flexibility while maintaining your professional responsibilities and commitment to your students.
Here are a few suggestions that could balance the need for staffing flexibility with the obligation to provide proper care for students:
Designated Floater Role
Set Priorities for Care
Rotating Nurse Coverage Between Schools
Clear Floating Protocol and Limitations
Delegation of Routine Tasks
Advanced Notice for Floating
Compensation for Floating
Document Health Risks & Safety Concerns
Presenting the Proposal
When presenting these solutions to your supervisor or the board, frame them regarding student safety, quality of care, reduced risk, and practical staffing solutions. Emphasize that while you're willing to be flexible, the unique health needs of the students in your assigned school require continuity of care, and that these proposed solutions allow you to continue to provide the best possible care while ensuring that other schools are adequately staffed.
You could say something like:
"I am committed to ensuring all our students receive the best care possible. However, as we all know, some students have very specific and ongoing health needs, such as diabetes and other chronic conditions, that require consistent, skilled nursing intervention. My experience and training make me the best fit to provide that care at my assigned school. I understand the need for coverage at other schools, and I am open to discussing potential solutions that ensure all students are cared for while maintaining the high-quality care for those with critical health conditions. I've outlined several options that could help us achieve this balance and look forward to working together to find the best solution."
This approach is constructive, solution-oriented, and demonstrates your commitment to your students and your role.
Best wishes,
Nurse Beth
Thanks for the information- If I didn't have a student with multiple needs throughout the day (Pre K) for diabetes and fairly new to a pump, and a student with a fractured femur of one week, I would have floated to the other school. I am assigned to my school and felt that their needs were my responsibility. If I left to cover another school who would adjust the insulin dose for the student at my school? For beachynujrse response.
NASN has a position statement on School Nurse Workload: Staffing for Safe Care, but it is not prescriptive as to floating. That said, NASN guidelines recommend the following ratios:
1:750 — For schools where students generally have good health and few complex health needs.
1:225 — For schools with students who need daily or frequent professional school nursing services, such as those with chronic health conditions.
1:125 — For schools with students with more complex health care needs, including multiple medical conditions requiring individualized care or interventions.
1:1 — In situations where a student has complex, ongoing medical needs, such as a severe disability or medical condition, a dedicated nurse may be required.
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The updated school nurse staffing position statement is coming to the BOD this month for approval. Keep an eye on the NASN website for the current version.
Published
I am a school nurse in NYS- I have an assigned school with students who have existing health issues, diabetes, etc. I have been asked to float from my school recently to cover schools with no nurse. My contract states I have an assigned school. Last week I refused to float due to two significant health concerns in my assigned school that needed a nurse's intervention. The NYS nurse practice act makes recommendations, though no mandates about floating; I showed this to my supervisor- a non-nurse, and it was not really taken seriously. I wanted to see if there was anything with stronger wording about this type of thing. I have been a nurse for 42 years and do not want to have an issue with something like this.
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