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Hey everyone! I'm starting as a school nurse for a middle school and high school next Monday. I am the only nurse in the district. I was told the previous nurse (position has been vacant for a year) would wear scrubs sometimes and sometimes business casual, more like a teacher. Both are acceptable, apparently. What does everyone wear? I don't have set guidelines. Help!
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A school nurse is a licensed healthcare professional who supports student health, safety, and academic success within a school setting. At first glance, the role may seem simple. Many people picture handing out ice packs and calling parents. In reality, school nursing sits at the intersection of healthcare, public health, and education. School nurses often work independently, managing everything from acute injuries to chronic conditions like asthma, diabetes, and severe allergies. The role requires clinical judgment, strong communication, and the ability to make decisions without immediate backup. Key TakeawaysSchool nurses provide both clinical care and public health support Most roles require an RN license and often a BSN Average pay is around $35-$40 per hour in the U.S. The role is more autonomous than hospital nursing Work schedules typically follow school hours -
What is a School Nurse? A school nurse is a licensed LPN, LVN, or RN who works in the K-12 school setting, although regulations vary from state to state. A school nurse usually works a regular school day schedule, which correlates with a teacher's daily schedule. School nurses work with students and staff and must understand triage basics. The school nurse is usually the only medical person in the school building and is the person who is responsible for making medical decisions. What Does the School Nurse Do All Day Long? I have worked in a secondary school, which is grades 8th through 12th, for a combination of nine years. From my experience as a school registered nurse with a BSN, my job was a mystery to almost everyone. Even my school principal was in the dark regarding my medical duties. My initial internship, we'll call it, left me with more questions than answers. The start of the school year was hectic because there were a lot of new enrollees, and I had to make a chart for each new student. The perk was the schedule was the hours. I worked from 7:15 am until 2:45 pm. My job was to ensure that all students either had documentation that they had received all of their state-required immunizations or exemption documentation. If a student had missed an immunization and still managed to attend, we could lose state funding. The day-to-day flow varied. Usually, there would be the same frequent fliers that would grace my door. I would distribute medication, bandages and check temperatures. Contacting parents was a daily activity when students became sick during the school day, or if they came to school sick, they would still have to go home to keep illness away from the student population. Parent calls were tough sometimes. Not all parents were concerned for their children. Some were unwilling to pick up their sick kids. Thankfully, most parents were good and grateful to have someone take care of their kids, but it's essential to know that working in a school is not all positive. Covid-19 challenged nurses regardless of the work environment. I often had to contact parents when there was an exposure, and that phone call was never well received. Happily, those rules and regulations for Covid-19 are in the past. Hopefully, they will remain there too. I did very well on my required observations because my school administrators didn't know what I did all day. A school nurse has a misunderstood job. No one else in the school understands what you do because it is not a traditional educational career. School nursing can be lonely, but that appealed to my introverted nature. What About the Salary? School nursing is not on the higher end of the nursing salary spectrum. According to Salary.com, the current median school nurse salary is $54,264. I did not make anywhere near that range as a school nurse. In contrast, a staff nurse's median salary is $88,815, also found at Salary.com. Working as a school nurse was a good fit for my family and me for years, but it was not without sacrifices. There are conveniences in exchange for a lesser wage, such as a better schedule without required nights or weekends and lengthy breaks. These are individual choices that will have to be weighed by each nurse. Final Thoughts School nursing is something I do not regret because it gave me a family-friendly job. I learned how to work with children and administration, a skill I'm glad to have in my pocket. I'm not too fond of adrenaline-filled days, which was a reprieve from more traditional nursing roles. I encourage other nurses to go into the field because it is rewarding. School nurses should demand wages more in line with that of school teachers. Fair pay is significant, and so is job satisfaction. Of course, all jobs have their sticking points; that was mine. The biggest problem was feeling like an outsider while being a school staff member and being paid on a scale lower than a licensed individual would typically earn. In the county I worked for, nurses were in the same category as staff without specialized licensing, which was discouraging. Dear future school nurses, you are an essential member of the school staff, beloved by many. You matter and make school possible for many of the students you serve. It is your job if you take the assignment to be the best school nurse you can be, and hopefully, you will gain more traction regarding wages and your visibility in the school itself. References/Resources School Nurse Salary in the United States: Salary.com (2023, March 28) Staff Nurse - RN - Occupational Health Salary in the United States: Salary.com (2023, March 28)
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Nurses began working in schools in the 1800s to identify and quarantine people with communicable diseases. Now, their main responsibility is to provide nursing care and health counseling to students with increasingly complex medical conditions and chronic illnesses, disabilities, challenges and special needs such as ADHD and autism, to name a few. Some school nurses are devoted to one-on-one care with medically needy students who otherwise would not be able to attend school. According to the National Association of School Nurses (NASN) (2019) report, "only 39 percent of schools employ a full-time school nurse, while 35 percent of schools employ a part-time school nurse. Twenty five percent of schools do not a have a school nurse at all". The National Association of School Nurse’s (NASN) definition of School Nursing: “a specialized practice of nursing, protects and promotes student health, facilitates optimal development, and advances academic success. School nurses, grounded in ethical and evidence-based practice, are the leaders who bridge health care and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that allow individuals and communities to develop their full potential.” (NASN Board of Directors February 2017). Skills/Qualities Must possess a broad knowledge base that covers pediatric, public health and mental health nursing as well as school law and policy. Must have Leadership qualities and the ability to work both independently and collaboratively to manage health programs effectively and advocate for needed change. Should have strong interpersonal skills and enjoy working with children, teens, family members, educators and administrators of diverse backgrounds. Work Environment School nurses spend most of their workday in the school health office in public, private, vocational, alternative and early childhood schools across the United States. They also move around the school assisting students, attending meetings, giving presentations, and observing learning. Some positions require the school nurse to travel between schools. Most school nurses work regular daytime school hours, many of whom enjoy the same Summer and holiday vacations as students. Experienced school nurses may advance to positions of greater responsibility in which they coordinate school health programs at the district or state level. Others go on to work for public health agencies. Nurses who hold a doctorate may conduct research in the field of school nursing or teach classes at the university level. Duties/Responsibilities School nursing has multiple components and the role of the school nurse is a broad one, dependent on many factors, including the school setting (rural, urban, suburban), health needs of the student population and the availability of specialized instructional student support services and programs. Some of the duties include: Develop and implement health plans in accordance with federal laws which require schools to develop individualized education plans for students with disabilities. Dispense medications and show teachers how to administer care. Work with educators to set developmentally appropriate learning standards for physical education programs. Serve as a resource for faculty teaching health-related content. Assess the physical as well as emotional status of students. Provide health assessments of students to determine eye problems, hearing impairment, growth and other health problems that may negatively affect the student's studies. Implement plans for intervention and remedies as well as follow ups for students who are ill. Provide crisis intervention in cases of injuries and acute illnesses or emotional problems. Develop plans for the control of contagious diseases by way of immunizations, timely discovery, and close monitoring. Facilitate normal development and positive student response to interventions. Provide leadership in promoting health and safety, including a healthy environment. Provide quality health care and intervene with actual and potential health problems. Use clinical judgment in providing case management services. Actively collaborate with others to build student and family capacity for adaptation, self-management, self advocacy and learning. Education Some schools employ LPNs. However, the NASN recommends an RN with a BSN. Additional training and background checks may be required in some states. School nurses may pursue voluntary national certification, which is administered jointly by the NASN and the National Board for Certification of School Nurses. Most schools prefer nurses with at least two years experience in an acute care setting. Certification National Board for Certification of School Nurses (NBCSN) The NBCSN offers the Nationally Certified School Nurse (NCSN) certification examination. Eligibility (not all-inclusive) Graduate from accredited RN Nursing program with BSN or higher degree Successfully pass NCLEX-RN Current, unencumbered RN license in U.S. state of practice Minimum 1,000 hours worked within the 3 years prior to taking the test RNs enrolled in MSN programs that do not confer BSN may not apply to take the examination until completion of the graduate program Publications The Journal of School Nursing NASN School Nurse NASN Weekly Digest Job Outlook The enactment of the Affordable Care Act could provide an opportunity to strengthen a nurse program that serves the nation's 52 million school-age children. For many of these students, the school nurse is the sole provider of access to health care. Health care reform's emphasis on wellness is consistent with the goals of school nurses, who provide continuity of care and promote healthy lifestyles for students during their most critical developmental years. They perform early intervention services such as periodic assessments for vision, hearing and dental problems with the goal of removing barriers to learning. Salary (2020) School nurses enjoy competitive salaries. According to ZipRecruiter, the yearly salary for a School Nurse in the U.S. is $60,739. According to salary.com, the average School Nurse salary in the U.S. is $51,074 and ranges between $40,807 and $64,478. A Day In The Life Of A School Nurse Resource/Reference National Association of School Nurses (NASN): Definition of School Nursing
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If you watch the news or TV shows, you might be led to believe that there is a high risk of firearm homicide. Researchers from Northeastern University, University of Washington, and Harvard University conducted a study into the perceptions of gun violence and the leading cause of death in the United States. They found that the presence of a firearm in a home increases the risk for suicide, which is more common than firearm homicide. So, what's behind our misconception about gun violence and how do you educate the community about the real dangers? Looking at the Numbers According to the Brady Campaign, the oldest organization in the gun violence prevention movement, 96 people die every day in the United States from gun violence. Of these 96, 34 are murdered, and 59 die from suicide. That means nearly twice as many people die from firearm suicide compared to firearm homicide. There are also 246 people shot daily who survive - 183 are injured in an attack, 49 are shot unintentionally, 4 are shot in a legal intervention, and 11 survive a suicide attempt. A 2014 study published in the Annals of Internal Medicine reported that access to firearms in the home increases your risk of violent death by suicide, homicide, or unintentional injury. There was a direct correlation to the risk of suicide among people who had access to firearms compared to those without access. The study also reported that the US has one of the highest rates of access to firearms in the world. Could impulsivity and the ease of access to a gun place some people at a higher risk of committing suicide or homicide? The study suggests that it's possible. Yet, there are no hard data to support the claim. States with the highest rates of firearms, also have a higher percentage of firearm violence compared to non-firearm violence. Is it a Public Health Issue? According to the American Public Health Association (APHA), gun violence is an issue that is deeply rooted in our culture and must be addressed through a public health approach. Violence research should be conducted to ensure that guns don't fall into the wrong hands. APHA also believes that access to mental health services must be expanded to those who need it most to decrease the number of suicides by firearms. Do Nurses Have a Role In the Firearms Debate? Every day nurses in Emergency Rooms across the country come face-to-face with the gun violence issue. They might deal with victims of homicide, suicide, and unintentional shootings. Nurses who work in schools have become far too familiar with the issue over the past few years. The National Association of School Nurses released a Position Brief in which they state that school shootings in the US are an urgent public health crisis. The NASN advocates for safe school environments for all children and recognizes the emotional and physical effects that gun violence has on our students. This doesn't account for nurses in the ICU, rehabilitation units, and many other settings that might care for gunshot victims. Unfortunately, healthcare workers can fall victim to gun violence, too. Recent research has highlighted the prevalence of suicide among nurses. And, gun violence in hospitals and other healthcare facilities seems to happen at an alarming rate. In fact, just a few weeks ago, a young doctor was killed in the parking lot of Mercy Hospital in Chicago at the hands of her former fiancee. What Can You Do To Help? Gun violence is a hot political debate these days. No matter which side of the aisle you stand on, as a nurse there are a few things you can do to help keep patients safe: Educate patients about the risks inherent in having a gun in their home. It's particularly important to speak to parents of young children about safe storage of all firearms. Connect patients with mental health concerns to services as quickly as possible. Many patients have mental health needs that if left unattended can quickly lead to violence towards themselves or others. Participate in violence prevention and intervention programs at your hospital or facility. None of us want to discuss or consider that a shooting could happen at our workplace, but unfortunately, the risk is real. Write to your elected officials to make your viewpoints on the issues known. Advocate for more research to be done to increase our understanding of homicide, suicide, and those who commit both. What are your thoughts on the firearm statistics? Do you feel that nurses have a place in the firearm debate? Let us know your thoughts in the comments below.
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Did you know that only 39% of schools in the US employ full-time school nurses? Did you know that in a recent study it was reported that "nearly half of 5- to 17-year-olds have experienced trauma in the form of at-school victimization. Exposure to trauma increases students’ risk for mental health disorders and school failure." This was in a published article in the Journal of School Nursing. This is just one issue that school nurses encounter. In-school bullying is known to cause trauma that lasts much longer than the school year. School nurses are on the front lines of education from pre-school age thru college-aged students. Some of the issues that school nurses deal with include: Asthma which can be a chronic issue with episodic flare-ups requiring Falls Other acute medical complaints Chronic illness Communication with parents, staff and others in the community Assessment of social issues Administer medications Coordinating screening of hearing, eyesight, weight Provide healthcare education Many other duties So, what skills should a school nurse possess? Ability to listen and also to be inquisitive Very familiar with developmental milestones The ability to explore sensitive issues with tact, understanding and patience. Ability to stay calm in an emergency. Record-keeping and organizational skills. School nurses wear many hats during a day. They must have great communication skills and the ability to get along with many types of people in sometimes very stressful situations. These nurses face many challenges doing their job including: Students that come from non-English speaking homes Students that have grave social situations I.e., poverty and food-insecurity Homeless students Parental discord Mental illness in students Students with severe physical disabilities The school nurse supports the students in an environment where they spend many hours of their day. As parents, our children are our greatest asset and some of our most vulnerable citizens. The school is often the only supportive place where these children go. The National Association of School Nurses (NASN) is the organization who provides school nurses with continuing education, conferences, jobs and “is the leading worldwide expert in providing opportunities and programs for school nurses.” The NASN also tasks school nurses to be advocates. Only school nurses have the insight to educate stakeholders so they know the role of the school nurse role and the different school nurses make in the lives of children. Stakeholders need to know why school nurses are important. School nurses serve students and families and should proactively engage their school community. They encourage school nurses to attend PTO/PTA meetings and engage in the community via their local elected officials. It takes some very special people to be school nurses. allnurses.com has a very active School Nurse Forum - come and share some of the reasons you are a school nurse. Some of our recent threads have discussed nosebleeds, diabetics in the school, questions about time off/PTO, and essential oil diffusers. Current news is also a hot topic. Happy School Nurses Day! References: Study Reviews At-school Victimization In Middle And High School Students National Association of School Nurses
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Hello, I am pretty sure I posted something on this sometime last year, however I cannot seem to find it. Does your school have a manual or program for your new school nurse hires? If so, I would love to see the content. I am putting together a program specific to our district for new hires. Our nurses all have "substitute binders" with all the information about the specifics of the school, students to look out for, etc. And Massachusetts has a mandatory program for all school nurses to attend as part of their licensing, but nothing is in place for them when they arrive on their first day on the job. I would love to hear ideas and if you have something in place I would love to see it. Thanks everyone! Edited to add that I have found some online manuals, but would like to hear from you what is helpful to know as you begin, specifically ?
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Alright y'all, let's get to the nitty gritty. What Sx are you excluding? Direction from our local Health Dept (OH) is to exclude for ANY symptoms, and then goes on to list eeeeverything under the sun. I mean, EVERYTHING. Congestion, runny nose, headache, nausea, fatigue... So I brought this up to our Health Commissioner during a county wide SN conference call and he didn't even touch base on it. I'm in a PK-1 building that is starting out at 100% 5d/wk, so that applies to pretty much my entire student body on any given day. Between little people's anxiety, allergies, adjusting to waking up early ? I wouldn't have anyone in my building!... but that's a discussion no one is ready for ?
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Where are We Now? Here we are rounding the bend of October 2021. About 20 months into a global pandemic, healthcare has been in a strange place. While many in healthcare have worked tirelessly caring for COVID-19 patients, those with other health issues other than COVID have been put on the back burner. Although some practices have been open to all or most patients for a while, there are still some areas where finding a physician who will see you in person has been a feat. From my own personal experience, I have not been able to see my PCP for almost two years, as he is still concerned about the number of COVID-19 patients he has been treating and how many have died. He has been seeing me remotely only. When an issue arose last year with my blood pressure, which I had never had an issue with before, I was told to go to the Emergency Room at my local hospital. I was much more concerned entering an ER full of sick people than I was seeing my primary care physician in his office fully masked, seeing the risk of getting infected much lower than sitting amongst a room full of sick people. Needless to say after over two hours I called my PCP and asked him to “just call me in a prescription for something” because I could not handle another minute in this ER where no one was leaving, yet more people kept coming in. That’s typical of course in any Emergency Room, but the idea of being less than six feet from sick people in an indoor space during a second wave of the pandemic, well, that was just unnerving, to say the least. People have put off getting the medical attention that they really have needed in the past two years because of fear of contracting COVID-19. It’s a tragedy that cancers have gone undetected, heart attacks and strokes ignored, and life-saving surgeries put on the back burner. Preventative care has been just about thrown out the window. School Children and COVID-19 I am a school nurse in the city of Boston. When our students were able to return to school at least a few days a week in cohorts last year, some medical practices were still seeing pediatric patients only remotely, so a physical exam consisted of not much more than subjective data. There were no vital signs performed and vaccines were given out at separate nurse visits only. Many of these separate appointments were missed. Some students were still not being seen at all. Parents were afraid to bring their children anywhere, including to medical or dental appointments, even if they were available. So far this school year, most students have been in school full-time and mostly uninterrupted. When schools reopened, the Delta variant caused many worries about how it would play out with crowded classrooms and minimal social distancing. According to the New York Times October 7, 2021, a majority of the nations’ 50 million public school students have been in classrooms full-time and mainly uninterrupted this fall whether students are masked or unmasked, teachers vaccinated or not. Infection rates have actually declined 35 percent nationally through the month of September (NT Times, October 7, 2021). Most students have resumed in-person physical exams and routine vaccine administration. Many of our students 12 and over have received COVID-19 vaccines as well. Mitigation Strategies In Boston, Massachusetts schools, our mitigation protocols have included mask mandates for all staff and students, continued weekly pooled testing for all students whose parents have consented as well as “test and stay” for students who have been determined to be close contacts of a COVID-19 positive person. Test and stay consists of rapid antigen testing daily for one week at school for all students who are either part of a positive pool or who have been determined to have been in close contact with a positive person while in school. This has omitted the need for entire classes to be quarantined and keeps kids in school and learning. All staff working in the school must provide proof of vaccination for COVID-19 or proof of a negative PCR test weekly to stay at work or be placed on unpaid administrative leave. It is surprising to me how many staff working in schools are hesitant to vaccinate, even at the risk of losing their jobs or the need to go through the hassle of weekly testing and documentation of proof of negative COVID-19 status. Even more startling is the fact that staff are willing to risk their health and the health of others in a setting where social distancing is next to impossible. Schools are now at 100% enrollment with all restrictions lifted except masking. Persistent online disinformation has been one of the biggest obstacles throughout the vaccine rollout including unproven claims of infertility, altering of one’s DNA, and microchips being added to the vaccine. Some have religious beliefs and many just completely distrust the government or don’t believe in the science of vaccines. Let History Do the Talking Edward Jenner began his successful use of cowpox material to create immunity to smallpox in 1796. Louis Pasteur’s 1885 rabies vaccine was next to make an impact on human disease. Antitoxins and vaccines against diptheria, tetorifice, anthrax, cholera, plague, typhoid, tuberculosis and more were developed throughout the 1930s. By the mid-twentieth century, methods for growing viruses in the laboratory led to rapid discoveries including the creation of polio vaccines. This was followed by vaccine development for other common childhood diseases such as measles, mumps and rubella, which greatly reduced the burden of disease. Here we are now in 2021, still battling this pandemic. People are still dying. Some are wishing to change their minds about getting the vaccine once they become very ill, but by then it is too late. The miracle of science has given us a vaccine to prevent and even eradicate COVID-19, yet so many in America are hesitant to receive the life-saving vaccine. In a national climate fueled by politics, conspiracy theories, social media and other fears about the seemingly rapid development of a vaccine, we have become a divided nation. Why can we not look to history and science to make decisions about our health rather than seek out misinformation and folklore on the internet to keep us ever doubting this miracle of medicine? A lot has changed since the 1930s when technology was not where it is today. We never doubted the validity of vaccines then when many childhood diseases led to debilitating deformities and abnormalities or even death. School Nurses in the Spotlight of COVID-19 School nurses have been working hard and overtime consistently to make COVID-19 testing and contact tracing a success in schools while state guidelines for reducing transmission in schools have loosened. School nurses are the primary site facilitators for COVID-19 testing including symptomatic, routine pooled testing and Test and Stay. Massachusetts school nurses are reporting concerns about the health and safety of students with nurses working two jobs simultaneously possibly causing the potential for medication and treatment errors and missing acute health conditions or emergencies. This causes physical and emotional stress and burnout, resignations, early retirement, leaves of absence and taking sick days. It has become difficult to find substitute nurses willing to work with these new responsibilities in place. Some districts are even having difficulty hiring qualified school nurses who have mandatory Department of Elementary and Secondary Education licensure requirements. As a school nurse in Massachusetts, I feel the burden of this responsibility. It can be draining and exhausting. Needing to take a mental health day has been deemed nearly impossible by the lack of substitute staffing. Anxiety levels are high among many students in my K-8 school. For our most vulnerable kids already experiencing anxiety, continued mask-wearing and adherence to school protocols regarding COVID-19 are pushing their stress levels even higher. I want to be there for every one of them. I teach them stretching exercises to do in class to reduce headaches and neck and back tension, which affects every grade level. We do deep breathing exercises next to the open window outside of my office. We talk about the importance of drinking lots of water, eating breakfast and lunch, getting enough sleep, spending time in nature and staying away from screens as much as possible. These are things we talk about every day, even without a pandemic. Sometimes the conversation turns to how COVID-19 has affected us during the past almost two years. But what is always evident to me is that our youth are living in and accepting a pandemic and doing it with more grace than many of their adult counterparts. I’ve watched my four-year-old granddaughter (now 5 and in kindergarten) don a mask every day without a single complaint other than why she couldn’t have chocolate doughnuts for breakfast. An Autumn of Hope As school nurses, we need to stand strong. This is our time to show how important our jobs really are. Many of us have felt unappreciated by the medical community. We are the ones who sit in our offices waiting to put on a bandaid or take a temperature. Or so it seems to some. We have always had to justify our purpose in school buildings, particularly when nurses have been required to cover multiple schools. Now we are on the cutting edge of turning the tide on COVID-19 through educating the youth that we care for. Let’s give them the knowledge and tools they need to affect a change in the direction of this disease. Let’s persevere with confidence in the work we do every day to keep students healthy, at school and learning. They are our future and change truly starts with them. Resources: National Association of School Nurses Massachusetts School Nurse Organization New York Times The History of Vaccines / An Educational Resource by the College of Physicians of Philadelphia.
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Experienced school nurses, we've all had that frightening moment. You have vomiting Vanessa in your office and you need to call THAT parent to pick her up. Her mother had used profanity when you called to ask for the student's required Kindergarten physical and then posted all over social media how poorly she was treated. You take a deep cleansing breath and dial. Maybe today she might be in a better mood. School nursing is yet another venue losing staff in droves. It's not because of poor pay or long hours, because both are really not bad (with the exception of contact tracing when Covid was at its peak). It's absolutely not the kids, although there are days when they can be mischievous. It's not the heartbreak of being the witness to neglect or abuse and having to work with authorities. As a certified school nurse, IEP and 504 caseloads can be high in the economically challenged communities where up to 25% of the students may need special education services or accommodations, but this is not the reason. So what is the problem? FACT: Parents who cannot respect reasonable boundaries are the problem. I am a parent of three children and have worked as a school nurse since 2013 in seven elementary schools and one high school. I have been the camp nurse for many summers while my children attended. I have been both the girl scout and boy scout leader and worked vacation bible school for several summers; so it is a fair statement that I have spent a fair amount of time working with children. The idea sounds light and fun, and for the most part, it can be. But if there are children to be supervised, there are parents to be managed and this can drastically alter the experience. All school nurses face being sworn at, being argued with about policies and student pickup, and admittedly, most of my school nurse stories are not as serious as the situation I will now describe. The one that finally broke me in the high school setting occurred during the 20-21 school year when guidance surrounding Covid had its greatest impact on student attendance. I had contacted a father to pick up his son because he was identified as a "close contact" to a positive case. He was unvaccinated and was going to have to be quarantined, as was health department protocol at the time. His father was angry because the student was going to miss a highly anticipated football game. This physically intimidating former military veteran stood in the lobby making physical motions like he was going to hit me because he deemed this my fault. Security was watching and called the principal and the two went into a conference room so that the father could vent and I went back to waiting students. Later that afternoon the father returned and angrily told the security guard, "Tell that nurse to get out here!". The security guard came to tell me about the father's reappearance at the door and his demands and stated that he had shared this with the principal and then offered to escort me to my car at the end of the school day. The principal never spoke to me about it, even after I requested a meeting to discuss it. There was no administrative follow-up with that parent, nor were any assurances made to me that I would remain safe in the building. Several weeks later, the principal had come to discuss a parent complaint about one of my nurses with me as her supervisor and I brought up the incident that had been occupying my thoughts daily. He shrugged his shoulders and said that was not what he recalled. He did not ask any questions and expressed no interest in addressing the matter. He sat across from me with a flat expression and remained stoic and silent. It was astonishing to me, given the continuous stress from that year including a fire to fights and the nursing team's level of dedication to providing our best care to the 4000 students in that building, that there was no disputing how little I was valued. So what was I hoping for and what is the answer? The first and most obvious solution is supportive administration. Most school nurses are supervised by non-medical personnel who do not truly understand the role or know what it takes to manage a busy health office. Regular communication between the administrator and the nurse is paramount to growing the relationship and establishing trust. The principal/vice principal/dean should feel confident in standing up and supporting the nurse's decisions. They can have faith that evidence is weighed carefully and protocol followed as dictated in the district. When an angry parent calls or a teacher complains, the administration should not automatically apologize for nursing staff behavior, but should investigate complaints and respond accordingly. I am not saying that nurses never make errors because we are human and certainly do. I am simply asking for fair treatment and a reasonable level of support. We should not have to stand alone against unnecessary abuse. Many youth sports programs require the parents to sign a code of conduct that prohibits swearing, yelling at players, and aggressively confronting the referees. The parent handbook and online registration systems have a student code of conduct that must be signed that addresses plagiarism, appropriate use of the school computers, and the dress code. If either the parent handbook or the online registration included a section that also addressed parent conduct we might feel that the school board supported the respectful treatment of all school staff. That is what we seek, after all. FACT: We want to be treated with common courtesy and moderate respect.
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Over the past number years, I have encountered an increasing flaunting of policy and rules, both by kids and parents. What changes in school district policy when they move from middle school to high school? Nothing. In my world. In theirs, lots of things! Cellphones ...Cellphones are ubiquitous. Even elementary school kids can maneuver a smart phone. This is really mostly since 9/11 and the explosion of technology. But kids have been in public schools for at the very least 150 years, when Massachusetts passed the first laws requiring kids to attend schools. When I started working in public school in 1994, (and having attended public school since 1965), parents were always able to contact the school to get information to a student re pick up., drop off etc. Today kids self-dismiss themselves EVERY SINGLE DAY. They have a little cellular device in their hand they use to bypass the health office and just call for permission to leave. Sometimes they are not sick and sometimes they are. I don’t want them here if they are sick, but I think we would all agree, it is important for the nurse to have an idea about what germs might be floating in the building. Kids seems shocked that I would need to know their business. Parents have emboldened them, for sure. “You just call me, and I’ll come right there and get you!” There are times when a kid really should see a counselor or an administrator if things are going down. Running away is not the only answer. If there is something contagious going on, it would behoove all of us if I knew about it. I need to have current knowledge of health issues and be able to explain to the next parent that calls looking for info what is actually going on in the building. Like the mom of a kid who has no immune system, They are VERY interested in knowing if there is any influenza in building. Or Measles. Or strep throat. It is important that I be able to assess them. It can actually be an advantage to the child and family when all of a sudden they are missing too much school. I can review my notes and see what my assessment was, as to whether or not they should be in school. I can help them if they are at a precipitous number of days out. Or help them get through the day with a little TLC, or antacids or headache medication. But not if they are told to “Just call me and I’ll get you”. The Necessary Forms ...Students need inhalers and Epi pens and our state and local law allow (as they should) for the students who can, to carry them on their person. Awesome! They eat something with peanuts, they can take care of any reaction almost immediately. The start wheezing when their asthma is exacerbated by dust in the shop area. Yes! Poof! 2 puffs of their MDI and they are feeling much better. But there are rules around this. The rules include an ANNUAL medication form and asthma action plan. The very same form they needed in 1st grade, or middle school, is the same form they need in high school. Why is it so hard for parents to understand that? They are emailed in the spring with the form attached, asking they be taken care of over the summer. I will even fax the form with the parent signature to the MD, if the child is current and not in need of a visit, to make it easier (on the parent, not me). What changes for the parent that these forms are no longer of any importance? Why is the annual contact information form so difficult to fill out and give back to the child? Why do I have to connect with the child 5, 6 or 7 times? Why is the form ignored when mailed home with a return self-addressed stamped envelope???? Just do it! Injuries and Policies ...And the last of this article is when parents, adults who are entrusted to protect their OWN children, work really hard to bypass a policy in favor of a game. Yep, I’m talking concussions here. Your child was observed when they got hit. They came off the field and were clearly showing signs of a mTBI, because that is in fact, what a concussion is, a mild traumatic brain injury. It is not just getting their bell rung. There is a reason why kids should NOT be retaking any repeat neurocognitive testing while they are still symptomatic, ya know? They need to rest their head for a bit to allow it to heal. But, wait!! The next game is Homecoming, or a tournament game or the big D1 scouts are going to be there…That is when parents (mostly) and kids lose their absolute minds. I think coaches are better than they used be...but there is still room for improvement. Parents, who, in a normal conversation about kids and concussions, totally support the school policy (which is based on evidenced based state and national policy). Until THEIR kiddo is affected. That is when head pain is caused by lack of water or food, fatigue, allergies, you name it, because it couldn’t possibly be linked to the field hockey ball that hit them in the head, could it? Or the head to head contact with another player followed by their head hitting the almost frozen ground. All of this witnessed by the athletic trainer. Nah... And when the policy CLEARLY reads that the clearance to return will release them back to the Return-to-Play process, but it really means full contact on the field, right? It means they should not be observed while gradually increasing their physical activity to see if they if they have recurrence of their symptoms, right? All in the name of keeping their child from pouting and being unhappy. The policy is in place to protect the child. And secondarily, the school district. I could go on, but this has been the start of my school year. Chasing Kids. Chasing Paperwork. Chasing Common Sense.
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The perception of school nursing, even within the nursing community, is of a retired older nurse passing out ice packs and bandaids and maybe reading magazines during down time. Truthfully, there are a lot of ice packs passed out, yet the breadth of practice is so much more. When my generation attended elementary school in the 1970’s and 80’s, there were not any medically fragile children attending my school. This changed when Free and Appropriate Education (FAPE) laws were passed as part of the Americans with Disabilities Act (ADA) in 1990. “The ADA was modeled after the Civil Rights Act of 1964 which prohibits discrimination based on race, color, religion, sex, or national origin”1. FAPE protects the rights of people with disabilities by guaranteeing access to any program funded by the federal government. Section 504 of FAPE requires public schools to provide an appropriate learning situation to meet students with disabilities needs, including nursing care and transportation to school, “regardless of the nature or severity of the disability”2. Advances in medical care in the last 25 years have made it possible for children to survive serious traumas and survive outside of the hospital setting. The next step then was the movement to mainstream these children into the public school classroom3. The goal of most individual education programs is to place the student in the least restrictive environment with the best possible support. Test your knowledge. See if you can identify the responsibilities that are managed daily in the public school health office: Collect proof of state-mandated health requirements, pursue families that are not compliant and enforce exclusion. Monitor diabetic students' blood sugar throughout the day and maintain prescribed range. Administer medication for ADHD, OCD, Anxiety/Depression, and other behavioral health conditions. Provided 1:1 nursing to a student with a tracheostomy. Monday morning triage for weekend accidents for students without primary care. Care for a student in hospice. Manage active student with Tetralogy of Fallot wearing a Holter monitor. Provide first aid for injuries from scratches to broken limbs. Arrange medical care and transportation to receive it for McKinney-Vento students. Provide CPR to an unconscious student. Manage students on concussion protocol and other medical exemptions. Work with pregnant teens to try and prolong their own education and connect with resources. Care for mother if she goes into labor at school. Provide peg tube feedings. Evaluate students suspected of being under the influence of illegal drugs. Organization of vaccination or dental clinics for students. Coordinate with behavioral health hospitals to create re-entry plan for hospitalized students. Provide vision and hearing screening. Pursue follow-up for failed screenings. Providing disease process and family living education to students and families. Supervise emergency situation and administer Narcan, Diastat, or Glucagon. Empty an ileostomy bag, catheterize a student, or change an adult diaper. Write 504 plans and participate in Special Education evaluations. Working with the health dept. to report specified disease occurrence. Treat staff for emergencies: accidents, heart attacks, high blood pressure, etc. Supervise ill student who was never picked up because parent did not respond to call. Supervision of extended health office staff. If you selected all of the above you either work in a school or are starting to get the idea. School nursing is not a fallback career. It requires continuous prioritization and diplomacy and a heart for serving children and families. Nurses providing this dedicated care are not looking for a parade in our honor, but would appreciate being recognized as the competent nurses that we are by teaching staff, administrators, parents, and nurses outside school nursing practice. References/Resources 1The Americans with Disabilities Act (ADA) protects people with disabilities from discrimination 2Who Is Entitled to FAPE? 3Medically Fragile Students Pose Dilemma for School Officials What is and isn’t covered under FAPE
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Hi All, I have been a nurse for 3 1/2 years, with the most recent job being a pediatric inpatient nurse at a specialty transition hospital. I am working there now on a casual basis, but I also applied for a substitute school nurse position in my town and have an interview next week. I was surprised to see that I would be considered a "health aide" since I am not a certified school nurse - even though the aide position requires an RN. As a health aide, I would make $15/hr which is about 60% less than I make at my current job. None of this bothers me- I was just surprised. The good news is, and please don't hate on me for this, I don't work for the money. I am a second-career nurse and I don't really have to work at all from a financial standpoint anymore, but I work because I like it. It's either volunteer or work - so $15 an hour is more than I'd get paid if I were volunteering so it's a win either way. My question is this - how does one get certified as a school nurse? I've looked around and it looks like expensive and time-consuming college certification classes are what is required. It seems counterintuitive to spend $15,000 or more on a certification process where if I come out I'd still be making less than I'd make in inpatient without the certification. I may not need to work but I still want to make sound financial decisions! I'm going to see how I like being a substitute before deciding if I'd want to embark on the whole thing - but I'm pretty much over working inpatient at this point and I'm wondering what others have done. Has the school district ever paid for you to obtain the certification? Are there less expensive online reputable programs?
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Good morning, So to give some background, I am currently working part-time and am in the beginning of my second year at a new school. Our school last year only had Kindergarten (125 kids). They moved to first grade this year and now we have K and First, so 250 kids. I only work 9-1:30 which has been a great schedule since I have two kids (in 3rd and 5th grades). With this schedule I am able to take them to school in the morning, come to work, then get home to be there when they arrive home from school. With the doubling of the number of kids, I have been a lot more busy with paperwork and am already feeling the struggle of getting through files, documenting immunizations, sending letters home, screenings, etc. in those 4.5 hours. It is extremely likely that for the 2017-2018 school year, they will ask me to increase my hours to 8:30-3 (doable but not something I would love), as well as now have 375 kids, one grade of which might be on a different campus, meaning I would have to travel mid-day to another site (not something I am excited about). If things next year would stay just as they are this year I wouldn't even be considering leaving. I LOVE the staff here, feel totally supported to do my job as I see fit and the admin staff pretty much are happy and eager to help me in any way they can. The teachers are all amazingly dedicated and just a great bunch. I get 6 weeks off in the Summer and three weeks vacation (Dec/Feb/April). In my home school district, as well as the neighboring town school district, they are eagerly looking for School Nurse substitutes. I am considering leaving at the end of this school year and subbing instead so I can decide when I work, and be more involved in my own kid's school activities (their school welcomes parents for lunch, help teach, etc. and I have not been able to do this with my current job). Sub nurses are paid a LOT more in my district ($35/hr vs. $26/hr) but of course hours are not consistent. For those of you who sub, what is it like subbing? Are you getting a call early in the morning on the day of, asking if you can work? Are you functioning like a regular school nurse or are you doing mostly admin tasks? I am sure this varies from school to school, but overall I am curious. Obviously I would ask all of these questions in an interview, but I don't want to interview unless I am already pretty much decided I am not coming back next year (people talk and news gets around). I have to make a decision by March 1st when I re-sign my contract for 2017-2018, or tell them I am not coming back. Thanks for any advice.
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Hi all! I am an LPN with almost 4 years clinic and urgent care nursing experience and have an interview for a substitute school nurse position this Friday. what does a typical day ( if there is such a thing as typical 😜) look like. From my understanding I will be a sub for the entire school district, all age groups. I am looking forward to it. Thanks in advance! freesia29
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Hello all, I really need help! I am very anxious about starting this school year. I do not feel as though I am prepared enough and am ready to quit! I am a new nurse and I just landed a job with an agency as a substitute school nurse. I went to the school today (just to look through the files, tour the room, and meet the staff, kiddos aren't in school until next week!) and left with even more anxiety! The school nurse prior did not leave me much and I am very confused. I found binders for the 15-16 school year, but that's it. Thankfully, the new nurses are supposed to be mentored and I believe someone is coming to the school, but I have not yet been informed of my mentor and am stressing out about that as well. I have been looking at the posts on here and they have helped me. I have some ideas; however, I feel as though I'm going to be a total pushover and too nice. I really need help being stern and not letting my room become total chaos. Thank you all for reading and any advice will be very much appreciated!
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I am a substitute school nurse. I love the job. I love the students. All around, it's just great! But I have come across an issue that is baffling me, and I'm wondering if anyone else has had this issue. So when I came onboard I received a letter stating that I would get paid $28.71/hr because I have my BSN. But as I've been getting my paychecks, the amount paid out is significantly lower than I estimated. So I checked the public school web address and found a Misc. Salary pay for a bunch of groups, and sub nurses were there. It says 190.32/day which adds up to the gross amount being paid. I have emailed my supervisor to clarify what is going on. Again, has anyone else had this happen? What was the resolution? Any advice on what to do or what can be done?
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Hello!! This is my first time posting I have read so many posts on here about this topic but I decided I would would ask it again anyway LOL! I am a new grad and I am scheduled to take the NCLEX in one week! My dream job is to be a school nurse, it's what I've wanted to do for as long as I can remember (and really what pushed me to finish nursing school!) I know ideally that I should have some hospital experience before applying but I have talked to the recruiter for my local hospital and she said very rarely do they have open positions in their peds unit. She suggested that I take a job in another area to "get my foot in the door" and that I could transfer when/if a job opened on the peds floor. I agreed to an interview for an opening on the mother/baby floor but every time I start thinking about it I start dreading it more and more. One of the school systems in my area just posted a job listing for substitute school nurses. I really want to apply after I take the NCLEX (if the job is still open) but my question is, is it possible to transition from nursing school to a sub school nurse position or is that just asking for trouble? On the previous post that I have read the few people that said they started out as a new grad suggested starting as a sub first. I did work as a medical assistant in a busy pediatric office for 3 years prior to nursing school but that's the only medical experience I have besides my clinical experiences in nursing school. Sorry if my thoughts sound jumbled.. it's late and my eyes are crossing from studying and answering practice questions! Thanks for your time and any input is appreciated. - Taylor
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Hi! I've been approved to be a substitute school nurse at my children's school. It's a private school with infants through 12th grade. I have 6 years of experience as a level III NICU nurse, but no school nurse experience. I'm looking for any resources and tips to help me prepare. I've joined the National Association of School Nurses. Thank you in advance for your help!
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I was recently hired as a float/substitute school nurse in my area. I was never told I would be working mainly at a school for special needs kids, and this will be my first experience working with this population. How much on the job training should I be receiving? How do you handle walking into a school that you have never been too and doing an effective job as the school nurse? How did you learn about all the paperwork and how to do it correctly?
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Does your state/district have a mentoring program for new school nurses? Have you been either a mentor or mentee? Our district is looking into starting one, with me as the person in charge of spearheading this ?. I actually LOVE teaching and mentoring but I also know that one of the main reasons we have this forum is because in real life and in our day to day we don't have the luxury of an actual orientation or mentorship. I am hoping to change that in my district. It is sadly stemming from a current school nurse within the district who has been doing this for many years and we are only now aware at how ineffective and at times putting herself and students at risk, but somehow has just been VERY lucky. The new principal brought it to light after several new parents called in the first week of school and shared they were uncomfortable and nervous. It's a long story. So....here I am being volunteered to come up with a way to mentor someone set in her ways, but also focus on a more widely used mentorship program to new nurses within the district. I would love any feedback from those who have BTDT.
