New School nurse sub - advice??

  1. Hey all, I come from a critical care background but have an opportunity to work as a school nurse sub. I thought it would be a great opportunity to broaden my nursing experience and to pick up a few hours without being unavailable to my kids for a full 12hr shift.

    I signed up as a sub for Thursday through an agency. When I reminded them I had never done this before their brief response was "oh, it's no big deal. A lot of nurses love doing it because it's easy. You just give meds to kids that have it ordered and you're available if they need you." Sounds simple enough... but now I'm getting nervous!

    She told me I just check in to the office 20 minutes early so I have time to review the sub notes and that's all I should need. Oh, and she said there are not tube feeds at this school. (I never realized school nurses DID tube feeding!) This is just so far OUT of my comfort zone it's making me nervous when it probably shouldn't. It's kids and I'm used to being a nurse for big people (often VERY big people), it's during school so they're not hospitalized, and I'll be all alone.

    I think that's what probably scares me the most. I am very comfortable floating just about anywhere in a hospital setting because I know there are other nurses there if I have questions. As a school nurse sub, I have NO orientation so I don't know the school, the people, or even the basic routine. I don't know the policies. What if something bad happened? In the ICU we're prepared because we expect these things - there's a crash cart, a code button, doctors on call, LOTS of great nurses all around, etc.

    I'm a mom, but my kiddos are still pre-elementary (4&2) so I don't even have experience with this age group or in dealing with schools really at all. I'm sure things will be fine and I know you have to step outside your comfort zone to grow and I'm willing to do that - but I DO prefer to be a little prepared!

    So, that's really what I'm asking for - some encouragement and some idea of what I can expect. Any tips for making things go smoothly? Anything I should ask? (I feel silly that I don't even know enough about school nursing to even know what questions I should be asking!) Aside from giving kids their meds (and is there a list I should find somewhere or how will I know who needs what? Do they come to me or do I find them?) what else should I expect? What else do school nurses do as subs? I remember from nursing school years ago that the school nurse implements a lot of education, I've read about how some of you have talked about immunization records, etc, but I don't see how I would do anything with that in one day as a sub.

    Would love any advice you have!!! Thanks in advance
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    About photomom

    Joined: Apr '09; Posts: 22; Likes: 15


  3. by   MassED
    I did sub school nursing and it was easy and often fun. Elementary school kids were needy, middle school kids were a bit more frustrating with their demands/attitude/personalities forming, and high school kids were the most fun.

    It's not the hospital, or critical care, or even urgent care. It's kids at school who get their asthma meds, sometimes need triple antibiotic, and sometimes are throwing up and need to go home. No big deal.

    Although should they need you to use an AED, you'll have that handled. I think having a person with that background is the perfect sub, in my honest opinion. Nothing's an emergency until it IS.
  4. by   photomom
    MassED, thanks! You make it sound so easy and fun and like maybe I'm worried for nothing. I just don't like to be unprepared and since I don't know what to expect, it's hard to prepare. I think I'm probably worrying myself to pieces for nothing!

    Is there usually something that tells you the routine? I'll be at an elementary school. Anything I should ask when I check in? Reading some of the posts by FT school nurses, it seems there's a lot of chain of command and you should have reported such and such to whomever. Do I need to worry about that? Who would I typically talk to if there's a problem or if I have questions? Would it just be the secretary that i check in with in the office?
  5. by   supervisorhatchet
    Don't worry too much. It is no different than any other nursing job....Your job is to follow the MDs order. No order no med, tx, etc. And in case of are never alone! There is internet every where! You'll make it, and ace it to. !
  6. by   rdsxfnrn
    You'll be fine, promise! I went from nursing school to school nursing. I am the only nurse in my district. I have learned by trial and error. Most of it is common sense. Follow doctor's orders, if you did not see them throw up then they didnt, do not hesitate to call 911.
  7. by   mycsm
    c/o being sick, check temp, fever=send home
    vomiting (in your office/class) send home. I never believe the old "I just threw up in the bathroom"
    possible broken ankle arm wrist= call parent for pick to get checked
    severe emergency= 911
    menses= rest x 15 min and return to class, I don't leave work for my period, you don't leave school
    sore throat=check temp, cough drop (with permission form parent) back to class. Nopermiss for cough drop..cup of water
    bad stomach ache= use my bathroom, check temp=return to class
    injury over the weekend and you need ice=I dont give it with out a doctors order. I know "it's only ice", but if the knucklehad keep the icepack on too long and burns his own skin=yup, I'm responsible
    headache= check temp, rest x 15 min..inquire why they didnt come in during THEIR lunch hour and how many tests do they have scheduled rest of afternoon?
    Stomachache begiining of school=why didnt you eat bkfst? oh you didnt have time..well, I have three kids to get ready, bkfst and lunches to do and I ate bkfst. heres two crackers go back to class
    You want to be excused from gym why?? no note from parents, no excuse. (some kids just hate to sweat)
    Diabetics= follow the orders
    Epi allergies= follow the orders
  8. by   mycsm
    P.S.: Have fun!! Part os the fun part of subbing as a school nurse, you don't have all the paperwork to do that comes along with a fulltime position. You can actually spend time getting to know the kids and finding your own groove.
  9. by   luv-of-kids
    Donnacee- that was a great list you gave her and IMO, just about covers a typical day. If you are really concerned about knowing where things are, ask your agency if you can go to the school for a couple of hours of orientation when the full time nurse is there so she can show you around a little bit and you don't have to walk in blind. I'm not a school nurse but went to school for a year with a special needs child and saw a lot of what she does. This particular schools nurse also had a closet full of different size clothes and underwear (underwear was always brand new in packages, but clothes were used donations) for "accidents".
  10. by   photomom
    Thanks Donnacee! That makes me feel a LOT better! I know, I know. It's just a basic nursing job, but my brain isn't usually in minor complaints mode when I'm in scrubs so it's sometimes hard to step back and remind myself I'm not at a hospital and they're just kids.

    How are docs orders usually organized? Should I look for charts on invidual kids? What else should I look around and find when I get there to make sure I have everything I need available when/if I should need it?
  11. by   photomom
    Oh, and maybe a silly question, but how high of a fever = send home criteria?
  12. by   danceluver
    You are so lucky @photomom! I hope I am able to find a school nursing job when i graduate. I would love working in the schools Any tips on how you got your job right out of school? Did you have any extra certifications?
    Good luck!
  13. by   photomom
    Hey danceluver, I actually got an ICU job right out of school and have been doing that for the past 5 years. I am only starting as a school nurse sub now through an agency and apparently it depends on your state and even disctricts in some cases as to what qualifies you as a school nurse. For me, it's being an RN and passing the tests, etc through my agency that qualify me for ANY agency job through them.

    In my opinion (and maybe those of you with school nurse experience will disagree and that's fine), unless you went to nursing school for the sole purpose of being a school nurse (and maybe other community nursing positions, I'm not sure), then you should probably start your career somewhere you can get the greatest amount of experience in the least amount of time. That will open you up to a world of possibilities later, including school nursing, but then you will have real world experience to draw on if there's a real emergency and not struggle to remember what you learned years ago in nursing school. But, if it is what you've always wanted to do, then by all means, do it! You just don't want to be pigeon-holed into it down the road if you decide it's not really for you. As an experienced ICU nurse, I can basically pick and choose where I want to work and what I want to make.

    Good luck with the rest of school!

    Quote from danceluver
    You are so lucky @photomom! I hope I am able to find a school nursing job when i graduate. I would love working in the schools Any tips on how you got your job right out of school? Did you have any extra certifications?
    Good luck!
  14. by   Flare
    Photomom's got that right! Not saying that there aren't school nurses that go into that job right out of nursing school, but they will have a harder time with the job. Student and staff come in to your office with questions about everything. And I mean everything. Medically fragile students that wouldn't have been in mainstream schools and now fully integrated. It isn;t uncommon for a nurse to do a tube feeding, straight cath, trach care, etc. You really need to be secure in your skills before you step into that office - remember - you'll be on your own. There usually isn't another nurse to precept you.

    Every nursing student rolls their eyes when they are advised to work a year of med surg after gradution - that advice has stood the test of time for a reason - it's sound advice. It opens the doors for a lot of specialties.