What to do... Help

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I've been reading posts on here for a while but finally decided to try and get some advice. I've been a school nurse since August and I am a new grad (from May). I currently work in a middle school with almost 1000 kids in a very large urban district. I feel like I made a horrible mistake taking this job, I feel very anxious everyday that I have made some nursing judgment decision that was wrong and that I will be liable for that decision. I was told in my interview that I would have a good amount of orientation and would not just be thrown to the wolves. However, my orientation consisted of 2 days of going through the policy and procedures manual and then 2 hours of another nurse coming to my school with me to give me an idea of what to do prior to the school year starting. I feel as though nothing in nursing school prepared me for this. It's a constant struggle between parents, teachers, and policy and I am frequently overwhelmed with doubt in my nursing decisions. I had students coming in for lice checks and I had never even seen lice before! I am expected to do head injury assessments and had never even done a neurological assessment outside of getting my validation checked off in the nursing school lab. My supervisor tells me that I am doing fine when she does her monthly visits and there are days when I feel as though I have a handle on things (such as when I only have to see 15 sick/injured kids rather than the usual 30), but there are times when I don't sleep for days and feel like I'm having palpitations due to the stress. I am confused why I was hired to do this position as they must have known I would struggle, however it seems the district cannot keep nurses as I have heard of 3 recent hires quitting soon after starting (1 after the first day!). This job has made me doubt my personal judgment in taking this position, as well as doubt whether I am even cut out to be a nurse altogether. I feel like I am a liability to myself and the district and it's beginning to affect my mental health. Any advice? I am very sad as I had hoped to love this job and had only met school nurses who absolutely loved their profession. Perhaps I am an anomaly. :no:

Specializes in IMC, school nursing.
Whats the Loyola guidelines?

The first hit on a Google search of school nurse protocols

http://www.luhs.org/depts/emsc/Schl_Man.pdf

A lot of repetition, but it helps newbies.

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Specializes in School Nurse.

Your complaints are exactly what we moan about every day on this site. I would prepare yourself before parent calls - know school policy, and health issue you will be discussing. This will relax parents instead of alarming parents if you sound unsure or hesitant. Calls can quickly go from routine to opening a can of worms you were not expecting. Of course you know children don't usually have heart disease, and if they do it is probably on their emergency card. Children have serious heart consequences when their airway is compromised - usually. A good assessment is your friend - yes it may take a while at first, but you WILL get better at it. You have plenty of willing students I am sure - use them to get comfortable with your skills. Continue to go through the school nurse archives here, we have many great ideas and how-to's we have shared. You will be fine and reach out every day if needed, I have found the school nurses to be the most supportive on AllNurses.

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Specializes in Telemetry, Gastroenterology, School Nrs.

I still say a prayer before I get to work and give thanks when the bell rings and everyone is still breathing ;-)

Me too! Every. Single. Day.

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I would prepare yourself before parent calls - know school policy, and health issue you will be discussing. This will relax parents instead of alarming parents if you sound unsure or hesitant.

To expand on this, sometimes it is better to stay silent so as not to falter over your words. I have started doing this in the last few years and it is an amazing communication technique in all aspects of my life.

For example: BEFORE

Me: This is Nurse T from the school. I am just calling because we still need a physical for Little Timmy.

Parent: We haven't had it done yet, my doctor's office is booked. I can't get in before December and by then my car will have broken down and I will have no way to get there. I'll let you know when I get it

Me: Oh, um, I know it can be hard, but, well, we really do need to have it because there are state laws and if your student wants to do sports, um, he does need it.

Parent: I'll let you know, I have 16 other kids I need to do stuff for. The physical can wait.

Me: Ok, but because of the state law, it needs to be here before October 15 or Little Timmy can't be in school and we don't want him to miss any class....

Parent: WHAT??? That is BS! Your school with your stupid rules! I pay your salary with taxes! I'm calling the school board and the news and your mother! Shame on you! Shame!

NOW

Me: Hi this is Nurse T from the school. I'm looking over the records and we don't have Little Timmy's physical yet.

Parent: I didn't know he needed one. We can't get in, the office is booked. I'll do it when I can.

Me: It is a state requirement for kids at this grade level. We need to have it before October 15.

Parent: Well I can't get it before then.

Me: .....

Parent: ....

Me: .....

Parent: *dramatic sigh* Ok, I'll try to get it but this is a huge pain.

Me: Great! You can have your student bring it in once it's completed or the doctor's office can fax it before October 15. Have a great day.

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Keep your head held high and a smile on your face! The kids can sense fear!

I came into school nursing with a few years of hospital experience, but it didn't matter, school nursing is a whole new ballgame.

My advice with...

*Lice...after looking at pictures online, I knew it when I saw it. Nits don't come right off like dandruff. If you can flick the tiny white spot off the hair, it's dandruff. Look first at the roots of the hair behind the ear and neck because they love to live there. If you aren't sure that what you are seeing are nits, have handouts/letter that you send home with the student saying that you checked their child for lice and they should do the same at home.

*The students who come in with "major" complaints (chest pain, trouble breathing) but are not symptomatic of a major health issue...do a full assessment on them (temp, BP, O2, respiratory & heart rate) and then call home. You are a nurse, you are not there to diagnose their child. "M'am, your son is complaining of chest pain. His BP, O2, heart rate, and respiratory rate are all normal. He is not showing any signs of distress. I am planning on sending him back to class but I wanted to make you aware first."

*The students that come in all the time...I am also in a middle school and they students have a different teacher each period. They don't know that each of the other teachers have sent the student down. I will first email all of the student's teachers and let them know the issue. (This usually solves it.) If that doesn't work, I will start calling the parent every time the student comes in and have them talk to their child. The parents eventually tell their child to quit going to the nurse unless they are throwing up.

*Diabetics (specifically noncompliant)...follow the doctor's school plan to the letter. If the student is not coming to check their blood sugar, track them down and pull them out of class to do it. If their blood sugar is high or low, the orders should tell you what to do. Follow it, follow it, follow it! That is the only way to cover yourself. The kid might be annoyed because at home they don't do it that way, but you just let them know that YOU are in charge them at school, and they must follow what the doctor says. If they are high and don't have any insulin, they go home. If you can not get in touch with anyone to pick them up, they get a free ride to the hospital. It's that simple. You are there to make sure the doctor's orders are followed, and if the student is putting you in a position where you can not do that, then they must leave because you can not be responsible for that.

*Head injuries...I fill out the CDC checklist on each student. No matter how minor, a parent is always notified and I let them talk to me and their child. I also let them know that I am sending a copy of the checklist home.

HEADS UP to Schools: School Nurses | HEADS UP | CDC Injury Center

*When in doubt, call the parent and document! The parent knows their child and can make a judgement call on whether the student should go back to class or be picked up.

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Specializes in School Nurse.

LOVE the awkward silence - putting that in the trick bag today! :up:

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What state are you in? Did I read this correctly, you're the only nurse for 1000 students?

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What state are you in? Did I read this correctly, you're the only nurse for 1000 students?

We have nurses here that have more than that.

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T, I do that as well. It really works.

Sometimes less is more.

Sometimes.

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Specializes in School nursing.

I went straight into school nursing as a new grad. Subbed first, then took a full time job after subbing for 3 months. It can be done.

My number #1 rule - fake it until you make it. Parents, teachers, staff will take advantage if you show uncertainty. Do I know everything? Heck no! But what I do know, I know and I know I need to sound confident. A confident tone goes a long, long way. Even when you admit you are uncertain, using a confident tone still works! (i.e. "I am not certain what the exact issue is with you son/daughter, but the evidence I have from my assessment tells me they need to be dismissed and seen by a doctor today. Thank you for arranging that.")

Also, consider joining the National Association of School Nurses - there is likely a branch specific to your state. It will cost ~$150, but it is a wonderful resource and I get the Journal of School Nursing every month. Also, are there courses in your state? MA has some (https://www.neushi.org/ - online and may even be useful to those not in MA) with low to little cost. I took the 4 required by my state and it was overwhelming, but very, very helpful. I did have to realize that Rome wasn't built in a day, however, when it came to bringing my health office and school up to code on a few things.

Deep breath. It is scary as a new nurse to not have another medical professional at your side. If you think you need to call 911, don't doubt your instinct - I bet it will be right.

OP, hugs.

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Specializes in Peds, School Nurse, clinical instructor.

This site New York Statewide School Health Services Center is amazing. It literally has everything you could possibly need. It truly saved me my first year as a school nurse and I was not a new grad! You can do this! As my esteemed colleagues already stated...utilize us, we are more than happy to help!

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This site New York Statewide School Health Services Center is amazing. It literally has everything you could possibly need. It truly saved me my first year as a school nurse and I was not a new grad! You can do this! As my esteemed colleagues already stated...utilize us, we are more than happy to help!

Yerp.

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