What School Nurses REALLY Do?

Many people think the responsibilities of a school nurse are limited to handing out Bandaids and ice packs all day long. While that's certainly a small part of the job, school nurses actually do a lot more than most people realize. From emergency preparedness (and response!), to keeping track of immunization records, managing concussions, fractures, sprains, and strains, caths, tube feedings, blood sugar checks, or just a little TLC during the day, school nurses do it all.

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In response to this comment from a previous thread:

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"Can you tell us what you actually do in detail? That would actually be a more interesting read."

Give out Bandaids and ice packs, that's it.

Just kidding! Although that's what the majority of the general public thinks we do. What school nurses do varies from school to school, depending on student populations, state laws or district policies, etc. I'll get the list started with just a few things I personally do at work and my fellow school nurses can chime in!

Things School Nurses Do

1. I personally cover only 1 school and see 30-40 kids a day, and I know I'm one of the lucky few with such great numbers! It's not unusual for school nurses to see 60, 70, even more on a daily basis---from multiple schools or even the entire district. I assess, monitor, treat students for quite a variety of things: wounds minor and severe, sore throats, headaches, stomachaches, N/V, SOB r/t asthma, menstrual cramps, head injuries that may or may not turn out to be concussions, sprains, strains, nosebleeds, chest pain, many more. You name it, a school nurse has probably seen it.

2. Ensure students with chronic conditions (most commonly asthma, severe allergy, seizure, diabetes---but many school nurses also see students with more specialized needs such as those with cystic fibrosis, spina bifida, etc.) have plans in place that ensure the safety AND success of the student while at school. For example, a diabetic student would have emergency meds/supplies/a plan for hypo- or hyperglycemia. That's in addition to their day to day maintenance plan (e.g., checking in with the nurse before lunch for a blood glucose check and any necessary treatment.)

3. Administer daily and PRN medications, making sure all necessary forms are on file, calling parents when meds expire or run out, monitoring for any adverse effects, etc.

4. Educate students on self-care, healthy lifestyle choices, puberty, or more specific info related to their particular condition or situation.

5. Educate and train staff on common chronic conditions present in our school, s/s to look for, step-by-step response to emergency situations (anaphylaxis, hypoglycemia, etc.) Many school nurses also do CPR training for staff.

6. Working with administration to develop policies/protocols related to school health that ensure all students are safe and have equal opportunities to thrive and succeed.

7. Managing the occasional "special cases"---post-op student for example might need to learn how to use crutches/wheelchair to get around school, pain management plan, special accommodations in class (sitting near the door, needing a way to prop a limb up, etc.)

8. Document thoroughly on EVERY SINGLE STUDENT I see. That alone takes up a chunk of my time.

9. Annual vision, hearing, height, weight, acanthosis nigricans, scoliosis screenings for certain grades as mandated by state law.

10. Being the "safe place" for students with anxiety, other mood/behavioral disorders, and all students really. I'm fortunate to have counselors AND social workers but many schools don't so the school nurse plays that role.

11. Connecting students/families in need with community health resources.

12. Navigating the tricky world of teachers and education. You're the ONLY "medical person" in the entire building, nobody understands your job (but thinks they could do it since you just sit around handing out ice packs and Bandaids all day), if you're lucky another nurse is nearby or a phone call away but sometimes not, you are SOLELY responsible for your students' health needs and outcomes during school hours. It's tough being a nurse in a "teachers' world."

Anyway, I could go on but I know the other school nurses have plenty to add. TGIF!

Specializes in School nurse.

I document EVERY visit electronically and count every phone call too. This is reported, with reasons for the visit, in a monthly report. There are a variety of benefits to the reports, like trends etc., but it is also useful for justifying additional support.

Specializes in cardiac, ICU, education.

I work PRN for a nurse at my kids' school (1500 students). The nurse is out this week so today:

We had a small fire in the theater while the kids were performing and the teacher needed to use a the fire extinguisher right in front of some kids. We needed to evacuate asap, so as the parents and grandparents were walking outside, 2 fell from the freezing rain storm and had to be treated. After we got the kids back inside, a number of kids started to come in throughout the day for smoke inhalation like symptoms. Not to mention the 40+ kids I saw who had the flu or strep throat. Good times...

msn10 said:
I work PRN for a nurse at my kids' school (1500 students). The nurse is out this week so today:

We had a small fire in the theater while the kids were performing and the teacher needed to use a the fire extinguisher right in front of some kids. We needed to evacuate asap, so as the parents and grandparents were walking outside, 2 fell from the freezing rain storm and had to be treated. After we got the kids back inside, a number of kids started to come in throughout the day for smoke inhalation like symptoms. Not to mention the 40+ kids I saw who had the flu or strep throat. Good times...

Oh, my! What a day!

Specializes in kids.
msn10 said:
I work PRN for a nurse at my kids' school (1500 students). The nurse is out this week so today:

We had a small fire in the theater while the kids were performing and the teacher needed to use a the fire extinguisher right in front of some kids. We needed to evacuate asap, so as the parents and grandparents were walking outside, 2 fell from the freezing rain storm and had to be treated. After we got the kids back inside, a number of kids started to come in throughout the day for smoke inhalation like symptoms. Not to mention the 40+ kids I saw who had the flu or strep throat. Good times...

Yowsa! Another skill set for the resume/job title....Fire putter outer...for real!! High five for you!

Specializes in Acute Care, CM, School Nursing.
msn10 said:
I work PRN for a nurse at my kids' school (1500 students). The nurse is out this week so today:

We had a small fire in the theater while the kids were performing and the teacher needed to use a the fire extinguisher right in front of some kids. We needed to evacuate asap, so as the parents and grandparents were walking outside, 2 fell from the freezing rain storm and had to be treated. After we got the kids back inside, a number of kids started to come in throughout the day for smoke inhalation like symptoms. Not to mention the 40+ kids I saw who had the flu or strep throat. Good times...

Yikes!!

Specializes in School nursing.
Tina, RN said:
Ugh, I hate this! I, too, feel like the Urgent Care for everyone in the building, plus the parents. Some doozies:

"Johnny fell and banged his head really hard on Saturday. He was dazed and lost his memory for a little while. Can you take a look at him to make sure he's OK?" Received a note like this on a Monday morning!!

From a staff member: "I don't feel good. Can you listen to my lungs and see if I need an antibiotic? I don't want to waste a copayment." GRR!

A dad at Open House: "You know, my knee has been hurting for a week or so. What do you think it could be?"

GO TO THE DOCTOR!!!

Yes, yes, yes!

I referred two kids out this year that were "Johnny hit his head really hard at [insert outside sports practice here] and head hurts." Both times Johnny was sent home by me, referred out, and was diagnosed with a concussion. Both times Johnny was not checked out after the incident, despite lingering headache, nausea, etc. that I saw and documented. Bite the bullet, pay the co-pay if your child has symptoms after a blow to the head!

rant>

But seriously, I don't have x-ray vision. If I did, I would very wealthy and way more awesome than I am now.

I work in both worlds, school nurse at a middle school, and ED nurse at a children's hospital on weekends. This is a public school in GA so I get paid as clerical staff, not as a nurse. I tell everybody, we do it for the love of the kids, not for the money.

By the way, you guys haven't touched the subject we all, school nurses "love", checking for head lice. Because we all know kids get head lice only at school (per one of my parents). :roflmao:

Thanks for laying out in detail the role of school nurses. Hopefully some individuals will be enlightened and their concepts about school nursing will change. We do a great deal that go unrecognized.

Great suggestion! I can attest to your statement concerning getting lice at school. That kind of gotten old. Usually, some of these parents/guardians would demand that the entire class be checked and not only that, they also turn around and call the district and report you to the principal. This is usually followed with a nasty e-mail. "The school needs to hire someone who knows about lice..."

However, lets look on the bright side. Recently, I have at least three cases who called up the clinic to say their kids had lice and they thought it was from the neighbor or they went and spend time with friends. Goodness, I was spared from the task of checking every student in those classes. When I asked for evidence of treatment according to policy, the response would be: "I pulled them out with my hand." I am still waiting for some proof of treatment. I guess these are some of the things that makes school nursing unique.:saint:

Specializes in School Nursing; Nursing Education.

Health Fairs

Staff immunization clinics

504s and ARDs

Specifically nursing professional development

Health and Safety Committee

Attendance committee

The list goes on and on...

I wish people could see how often we juggle many things at once. A kid vomiting in the trash can, a parent trying to check in meds, the phone ringing, a kid running in from PE saying they can't breathe while a teacher staring you down wanting their BP taken. Oh, and here come 2 more that bumped heads with each other during lunch. And 1 kid waits for 32 minutes for a band-aid for a microscopic scratch whose teacher has probably 452 bags of band-aids from you already this school year. Secretary popping her head in wanting to know why you didn't answer the phone, band-aid teacher sending a student down to see why the microscopic scratch kid is taking so long to come back to class. AND then, it gets busy!!

Specializes in kids.
18 hours ago, EnoughWithTheIce said:

I wish people could see how often we juggle many things at once. A kid vomiting in the trash can, a parent trying to check in meds, the phone ringing, a kid running in from PE saying they can't breathe while a teacher staring you down wanting their BP taken. Oh, and here come 2 more that bumped heads with each other during lunch. And 1 kid waits for 32 minutes for a band-aid for a microscopic scratch whose teacher has probably 452 bags of band-aids from you already this school year. Secretary popping her head in wanting to know why you didn't answer the phone, band-aid teacher sending a student down to see why the microscopic scratch kid is taking so long to come back to class. AND then, it gets busy!!

True Story!!