Too young to do school nursing?

Windchaser22 · Jul 20, 2017

Some food for thought...we have "patients" who yell, hit, and bite too. We have students with anxiety, depression, PTSD, bi-polar, suicidal etc. etc. Psych is a major component of school nursing. You deal with these kids while you are handling everything else, by yourself. Additionally, we are responsible for every human on the premises not just the students. If anyone has an emergency it's on us to respond.

The major difference is that on a unit you have help, supplies and when experienced, know what to anticipate. Everyone in a school looks to us when things go sideways. We school nurses can plan to a degree but rarely know what urgent issue is coming next.

HazelLPN, LPN · Jul 20, 2017

I'm legitimately wondering... to see if anyone can lay out the differences..

I worked in a hospital for 54 years...most of that time in critical care...before I came out of retirement to became a substitute assistant school nurse. I'm not the actual school nurse....I mainly work with medically fragile or special needs students that the regular school RN would not have time to care for with everything else she /he must deal with.

I used to joke that I wanted to be a school nurse when I had a difficult PICU shift and give out ice packs and band aids...other nurses did too. Little did I know how much responsibility the school nurse has.

IMHO, because the school nurse is highly autonomous, I don't think that one year is enough to prepare one for school nursing. You have to have excellent assessment skills. I work in a high poverty district, and the school RN is often times the only health care professional that our students see on a regular basis. Many of our school nurses have many years in acute care peds before coming to school nursing. One my favorite coworkers is a former flight nurse with the US air military. He won't tell you the job is easy either.

When we had inexperienced nurses in the various ICUs like yourself, we made sure that they were given appropriate assignments. When we didn't have great assignments to give them, they were given a lot of support from the veteran nurses. You simply don't have that luxury as a school nurse as you work alone.

Best to you,

Mrs H.

grobertson10 · Jul 20, 2017

I never meant to hurt anyone's feelings when I said "bored". I read a bunch of posts on school nursing and a lot of people said that would be an issue. That's the only reason I said that.

grobertson10 · Jul 20, 2017

And I will have a preceptor for 2 years at this school

FolksBtrippin, BSN, RN · Jul 20, 2017

Having a preceptor to 2 years is a sweet deal, and shows a lot of dedication on their part to support you.

You're not too young for the job, so put that piece out of your head.

OldDude · Jul 20, 2017

And I will have a preceptor for 2 years at this school

Not a chance. Most new school nurses are shown where their clinic is, minimal orientation to the campus, and that's it. The rest is on the job training. That's why it's so important to have pediatric assessment skills so your actual "learning" is administrative and procedural; not trying to figure out if a 5 year old is in physical distress or just mad.

shark_nurse14, BSN, RN · Jul 20, 2017

I think there are some misconceptions here that need to be addressed before you can really consider school nursing for being an "easier" nursing SPECIALTY (because that's what it is, a specialty). I think reading through the school nurse thread on AN will be very helpful to you, but also highly recommend substituting before even considering to apply to a full time position. I think you will be surprised how different it is than what you imagine it to be.

Let me break it down for you so you can see some real differences between school and hospital:

1.) The ratio between you and your patients is most likely 1:500. YOU, JUST YOU, ARE RESPONSIBLE for all of those little lives.

2.) We may not have a patient who has constant meds, Q2 turns, Q4 vitals, bladder scans, or I&Os to chart but we FREQUENTLY have 6-10 kids in our office at one time that all think they are the most important. And there are no call bells, just yells and crying, LOTS of crying. No other nurses to pop into room 32 for you. No aides to take those vitals.

3.) All kids come to school. You may see kiddos with diabetes, seizures, allergies, anxiety, bleeding disorders, cancer, asthmatics, CP, CF, and muscular dystrophy ALL IN THE SAME DAY. And you care for them, and you check up on them, and you chart their visits, and you make their care plans, and you talk to parents, and you discuss with doctors. You change diapers, you do tube feeds, you suction. You are the medical professional that sees them most days of the week. They are relying on you to keep them safe.

4.) When you step off the hospital floor, you know that patient you worked so hard with that day is being taken care of by a whole other TEAM of nurses, doctors, aides, and resource staff. When my kiddos leave me at 2:30, I worry. Weekends are the worst because I have a whole 48 hours to worry. Will they be fed? Do they really have an appointment at the urgent care for that cough? Are they going to come back to school with bruises?

5.) Teachers. The good and the bad. The ones that send you 13, yes 13, of their class of 22 all in one day because one student is out with a fever. Those 13 students add about an hour of your day because of assessments and charting. You now have no lunch (but, then again, when do you ever have a lunch?) Teachers take A LOT of time. Training them, because yes that's part of your 7 hours a day too. Convincing them they don't NEED to know everything medically going on with a child in their class. Reminding them I can't tell them everything because of HIPPA and FERPA, not that those acronyms mean anything to them.

6.) Parents. Also, the good and bad. The parents that want a call everytime their kiddo has a hangnail, or the parents that never pick up the phone, or never pack a lunch, or never show up at dismissal. Or there are also (and these are my favorite) the parents that ask you, "Are you even a real nurse, like how do I know you know what you are talking about?". Or the ones that question everything you say, and then sure enough an abx little Jimmy is taking for his strep comes to school (unlabeled) in a plastic bag that you knew he needed three days ago. You feel alone and unheard most of the time.

7.) There problems become your problems. The stories these kids have told me break my heart. I drive home crying. There are the kids that lost their parents. The kids who don't know when their next meal will be, or if they'll have electricity and heat when they get home. The kids that don't go home, but go to a homeless shelter. The psych! If you are going to be a school nurse you must be comfortable with you psych nursing. The amount of kids with GAD, OCD, PTSD, bipolar, and schizophrenia would probably shock you.

8.) Emergencies. It's on you. There are no doctors. No nurses. No code team. No meds at your disposal. It's you and your assessment skills. And PLEASE FOR THE LOVE OF ALL THAT IS HOLY do not think for one second that emergencies do not happen at school. Allergies happen. Asthma attacks happen, and can be deadly. Injuries, boy do they happen. Just sent a kid via ambulance this week for obvious deformity of RUE after a fall from the playscape. This child needed 2 surgeries and 4 days in the hospital. I got him there. I made the 911 call. I splinted it. I iced it. I coordinated his ambulance ride to the RIGHT hospital for him. I advocated for him, as this child is nonverbal. And this week I'm revising his care plan for accommodations. And this is summer school. There were 22 kids here the day that happened. But you just never know and you always have to be ready. Kids lose lives from accidents that happen at school and aren't handled properly.

I'm sure I could think of 100 more things to say, but kiddos are showing up for summer school, so duty calls. About to go change a diaper, do a tube feed, take vitals, and assess a wound all in the same STUDENT :up: I love my job!

3peas · Jul 20, 2017

I struggled with my decision to leave bedside just like you. But the minute I made the decision I never looked back and I can't imagine being the hospital again. It's not for everyone and when you see the impact you make on the students you will get it.

peacockblue · Jul 20, 2017

Twenty years of hospital experience prior to becoming a school nurse. I won't repeat everything said above because it's all true. The 1:500 ratio is generous. The law in Pennsylvania is 1:1500 and many states it is higher. I have about 1,000 students with two,other schools I cover that I am required to do all the screenings. It takes the better part of the school year to get that done, because there is no one to cover your other work, you're just expected to get it done. Also if you get a preceptor, good for you! I was given a set of keys and the phone number of a nurse in another school. All that said, I love my job and plan on being here till retirement. There is ne easy, boring speciality in nursing.

Love2Sleep, BSN, RN · Jul 21, 2017

My advice is to try the school nursing. If you don't like it, you can always go back. Keeping your current job per diem is a good idea so you can keep up on your skills in case you do want to go back. I was in the same boat. I worked medsurg for 4 years by the time I got burnt out. I switched to working in the clinic and quickly learned that I missed medsurg. I'm glad I took that chance because now I know that I enjoy what I do and I won't be questioning myself "what if?" You'll never know unless you try it.

Flare, ASN, BSN · Jul 26, 2017

So my esteemed colleagues have hit the nail on the head. School nursing is a lot of things - autonomous, inspiring, heartbreaking at times, handling emergencies, balancing the needs of students, anticipating the needs of your community just to name a few - but boring is not a word i would use. Down time - yes - on occasion we do get a moment to get our heads together. It's usually short lived. Before you know it, a student will come barging through the door with their head in a trash can and a staff member will act like it's the absolute end of the world. I swear, talking the staff member down is the harder job than dealing with the sick kid.

Yes - most of us have nursing experiences outside of school nursing -i've done quite a few different things from working on an orthopedic and a trauma unit to working a a hospital ADN. In between i have worked home care, corrections, clinics and a few other random assignments that an agency sent me.

As far as age for what it's worth, i was in my early 20s when i started school nursing. When I went to the public school and worked the high school it made for some interesting encounters like the time I went to the principals office to do a screening for a student SUI and was asked for a hall pass or the time I was given homework on a field trip by a teacher that didn't know me (that time I was mistaken for a 9th grader - i had just turned 30 so i was pretty happy)

The bottom line is that if you are not happy in what you are doing, then you should look to find a different placement. That's one of the great things about nursing. You can try different specialties to see what fits. BUT - don't go into a specialty thinking that it's peaches and sunshine and that you'll be bored working there - if you're looking for a job that's easier on your back, yes, school nursing will probably require less heavy lifting. But so will a lot of other specialties.

Please - take some time - browse about our posts and try to get a feel some of our thoughts on the job. You'll see running themes of contention that we all see.

JerseyTomatoMDCrab, BSN · Jul 27, 2017

You will NOT be bored. Ever. It's an entirely different type of stressful and business but it's stressful and busy nonetheless. In hospital nursing, you are surrounded by other nurses and medical professionals who not only can take a look at a patient and give you a second opinion but act as a forum where you can vent about problems that only other healthcare folks can understand. In a school, you are it. You have nobody else to look at little Johnny's pupillary reflex and determine if he needs to be sent out for a concussion workup, nobody to ask about a confusing piece of paperwork. And the listening ears around you are teachers who know absolutely nothing about medicine (but like to pretend they do)

You can always call another nurse but without someone there to take a look it can be very nerve-wracking.

To answer your question, I went to school nursing after 3.5 years at the beside. I was a little worried about parents not taking me seriously because I am in my 20s and don't have any children but those concerns were unfounded. 99% of the parents were very accepting and appreciative of the care I provided. Being young shouldn't be a deterrent.