Transition to School Nursing

[erinsbigsister, BSN, RN]

Hello All! 

I have been reading and reading on here and just had a light-bulb moment this morning that I could actually POST. 

This week, I will be signing on to become a school nurse. My last day in my current role will be Aug. 1 so that I will be covered for health insurance until my new position at the elementary school down the road starts at the end of August. My current role: I have been working for a health plan for almost 7 years. Prior to that I was a home health case manager for 4 years. (Prior to that: subacute rehab for a year, cardiac telemetry for a couple of years). When I started working for this health plan, I was part of an advanced preventive care program for Medicare Advantage members for management of chronic illness and health promotion. Basically, reducing unnecessary health care utilization. They ended that program after almost 6 years and transitioned us to telephonic care management with 1 home visit per person, then ended home visits, and now we manage care over the phone and work with people for 2-3 months at a time. I just got a raise to $108k per year. HOWEVER, I am working overtime every week (close to 50 hrs per week), vacations come at a price of wrapping things up before I go and then coming back to work that has piled up, I sit at a computer all day, and have just come to feel this is physically and mentally unhealthy for me. To top it off, I am currently working on my master's in nursing education, so I go from my computer/desk job to working on my computer for a few hours each evening. They have started auditing our charts more closely and monitoring how many calls we make and I am just no longer in the role I signed up for. 

A few weeks back, I called a friend that I had written a letter of reference for back in 2019 to ask her how she was liking her school nurse role and found out that there was a school nurse position being approved in her RSU that week. The timing was weirdly perfect. So here we are! My salary will decrease to $58k per year but good benefits, great hours, vacations (as you all know), and a pension if I stay there long enough. There are sick days also that we can bank...not really sure how that works yet and pretty sure they are just if we get sick, or maybe for MD appts? I am also looking forward to being around children in general and learning new things! The school is just 10 mins down the road from my house. My kids are all grown but I have grandkids (age 10 and 6) and they sometimes get off the bus at my house. Currently I set them up with playing outside for a certain amount of time, snack, then TV/coloring/an activity while I continue to make my calls (BLAH). New role will have me working from 8:15 - 3:30 and every Wed is an early-release day so will get out at 2:30 on Wednesdays. 

Here are my FEARS: I have been in geriatrics for a decade - no pediatric experience. I have not been providing direct care for the past 7 years. I feel like I need to take a first aid course, refresh my knowledge of Epipen use (have provided teaching but have never had to actually use one), and familiarize myself with insulin pumps/mgmt of type 1 DM in the school setting. I am signed up for a new school nurse orientation in August and have started looking up courses I could take to prep while I am off in August. 

Excited and nervous and all the things and would love any advice, encouragement, etc.! This week, I met with my advisor at college and will most likely be able to complete the clinical practicum in the school nurse setting. My friend also has her master's and should be able to be my preceptor for that. She will also basically be working alongside me - not in the same school but close by and will provide some support, though I will still need to be jumping in and figuring things out on my own. I oriented her to her role in home health and she is SO CONVINCED I am a perfect fit for this and will adjust quickly. I will still need to figure out my practicum in the educational setting but hopefully it can work with my hours...otherwise will have to push it to Summer 2027 when I am off. When I complete my master's, the pay will go up another $3k. Also, the RSU may be increasing our salaries by $10k for 2026 (I will be on teacher salary and they are talking about increasing it.) In my current role, I would have been using my vacation time to complete these practicums (5 weeks/year) and give myself a 3-4 day weekend once a month to work on projects for my courses. 

I know this was a little all over the place, so thank you for reading! Basically: Fears, learning/prep for this role to address those fears, and work/school/life balance are on my mind with this transition.

Thanks in advance for any words of wisdom!!

[sergel02, BSN]

Congratulations on the transition! It can be scary changing specialties, but most of my coworkers came from different nursing fields, and you'll manage. The orientation should help.

It is a lot to learn, but always try to prioritize the basics:

1. How to do First Aid effectively. If you're running the health office/clinic, this is the bulk of your day and time.

2. How to prepare for emergencies and respond. Haven't used Narcan or a Bleeding kit yet, and that is rare, but EpiPen use is the biggest thing you want to know how to do. 

3. How to triage well. Most complaints are minor but maybe 1% in the day require some sort of intervention. I'm new and I haven't had to call 911 yet.

The case management experience will be valuable when you're trying to find resources for families, and the nurse education aspect will be super useful for teaching students, their parents, and necessary staff like their teachers.

Once you get all that down you'll be able to focus more on other skills and tasks like immunization compliance, tracking potential outbreaks, screenings if your district/state does it. 

It's a broad specialty, but it all builds on each other. Let me know if you have any other questions!

[RatherBHiking, BSN, RN]

Congrats! Sounds like you're excited and I hope you enjoy it!  I spent 20 years in school nursing. I never once had to administer an epi pen so it's not a common thing. Lots of asthma attacks, occasional seizures, fainting, and broken bones. Lots of diabetic management. Kids sugars can be super high one minute and drop fast and become low the next. They're all over the place. You'll deal with lots of little injuries that aren't serious and more stomach aches that you can count. You'll play the game is it due to eating too fast or too much, playing too hard after lunch, needing to poop, getting sick, appendix issue (rare) or just wanting to miss math or just go home to play video games. All day every day. You'll have to administer meds usually for ADHD. Assessment skills will be important. Lots of earaches and sore throats.  Learn about lice. 
 

The hardest part for me wasn't the nursing aspect. It was the politics. Some teachers will insist you send students home that don't need to go home and will try to go above your head and sometimes the principal will let them call the shots. Some teachers, no matter how much you train them, just don't get it. They'll care more about a kid threatening to puke than a kid with a blood sugar dropping fast. Then there's the parents. Some will get mad you didn't call them because their child came to see you for a hangnail and others you'll be calling again and asking where they are when they told you over an hour ago they were on their way for their child having a 103 degree temp. Or the ones who refuse to take their child to the doctor, dentist, eye Dr etc after repeated requests. You have to have thick skin and stand up for the kids.

Remember the kids are healthy. Your job is to help them get through the school day. Having someone close by is invaluable. I didn't get an orientation so that was a little rough.

There's lots of things to enjoy like the kids obviously! Lots of hugs and smiles. You get to see their excitement on the first day of school, all the holiday fun, Christmas programs, etc. They say the cutest things.
 

It's not super stressful-just busy. It's easy once you learn the role. You're home fairly early each day, have every single weekend and holiday off, Summer off, etc.  Best wishes!

[kbrn2002, ADN, RN]

Congratulation's on the new position. It's scary to transition to a whole new specialty, I did that when I flexed from LTC to dialysis It's like starting your career over again. Scary and exciting all at once. You must be excited for this new chapter in your career to be willing to take that kind of a pay cut, the wages are about half of what you are used to making. Unless you have a pretty large cushion that is going to require some careful financial management to adjust to that big of a wage reduction. 

[erinsbigsister, BSN, RN]

Thanks, @RatherBHiking and @sergel02!

I just found out which school I will officially be working at in the district. I will have pre-K and grades 2-4 (approx. 325 students). Appreciate your advice and am just going to give myself grace as I find my way with this....novice to expert as I have done in past roles. I was actually able to set up a day to shadow the Summer school nurse in August so that will be helpful.

And thank you, @kbrn2002! Yes, it's a huge pay cut and transitions are always tough, despite the reasons. My husband and I looked at this together and decided it is worth it (and doable) for our quality of life. I honestly am not sure how long my current role will continue with the cuts and changes they are making within the health plan and am thinking I might have been in the position of looking for a new job anyway within the next 3 months. A few of my coworkers have shared with me they are also looking. 

Thanks again for the advice and encouragement with this!!

[NutmeggeRN, BSN]

Welcome to the friendliest thread on this site! And to school nursing. I would suggest you join your state and national Association of school nurses.

Get to know your immunization rules, get to know your front office staff get to know the thanks counselors or social workers and make nice with the custodial staff! I would review the files for who you need to be mindful of for allergies although remember that allergies can pop up at any point in time.

I would also encourage you to network with other nurses in the district. Play with an EpiPen trainer, play with an AuviQ trainer, pretty much all of the nasal preparations for seizures and Narcan are the same type of delivery device. Make sure you're familiar with traumatic bleeds that you're current with your AED and CPR. And keep us posted!