What's school nursing like where you are?

Specialties School

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Specializes in School Health.

I used to be an ICU nurse in Central Illinois, but I've since moved abroad internationally to be a school health officer. In the event I return to the United States, I'd like to hear what school nurses do on a daily basis. I'll share what happens here, and I know it's different because it's closer to urgent care which is very typical here in larger schools. It's a nursery through year 12 school with 4000 students, students come from several rural towns nearby. 

I have an EMT level aide who arrives along with me at around 7am. We split responsibilities for opening up the health office, turning off the UV sanitizer in the health office & isolation room that's on overnight, doing inventory, placing orders if we're nearing out of something, turning on the computers, doing water quality testing, indoor/outdoor air pollution testing, checking the weather, posting all of that, checking the national EHR for any new COVID+ students, looking at appointments, etc. 

Volunteer student helpers arrive at 7:45am, we screen them then we give them thermometers, face shields, walkie talkies, and signs that list COVID symptoms. 2 volunteers to each entry, they do thermal & symptom screening for everybody else entering including staff. If the volunteers pull someone out, we do a rapid COVID test and depending on our assessment (regardless of neg rapid results) send them home if needed. 

Unless you have an appointment doors open at 8, school starts at 8:30, between 7:45 and 8:30 we see our first group of scheduled appointments (in addition to whatever walk-ins come). These scheduled appointments might be staff or students, and they are pretty broad ranging - immunizations, student hearing/vision tests, student needing a pregnancy test, teacher who's doctor ordered a 12 lead, student who's stitches time are due to be removed, minor illness/ailments, minor wound care, some testing, whatever. Sometimes a student might need help getting an appointment with a dentist or some specialist and we can schedule that  Often if students or staff call the national health hotline or go to an urgent care clinic, there might be a nurse follow up appointment with us. 

We get walk-ins throughout the day, occasionally an emergency, have a supervised lunch group for eating disorder / socal anxiety students, dispense other student medications around lunch as well. We also have a second appointment window from 2pm to 4:30 - most students day is over at 2:30 but some clubs or special classes go to 4:30. End of the day we just clean, chart, turn on the UV room sanitizers on our way out. We're always out by 5. 

We actually have very permissive standing orders - in accordance with those we're regularly giving medications both OTC & script, with access to emergency meds as well. We also have near instant access to over-the-phone doctors for orders or get a videochat telehealth consult. If we need extra help for something that is very low acuity we might have a community health physician or community nurse come out, or if it's more urgent the emergency ambulance service paramedics regardless of if transport is needed, or if non-urgent transport is needed there's nonemergency ambulance services. 

Our room has 6 normal cots, 2 waiting benches, a meeting table with chairs that we fold out as needed, and an isolation cubicle. We're well supplied, have EHR access, could run a code if God forbid it was needed. We generally do keep pretty busy but it's not always super repetitive and for the most part we leave on time. 

We have a physiotherapist that stops in mostly for sport injuries management but occasionally something else, we interact with the community nurse frequently as she stops in pretty frequently,  ambulance service stops in frequently to say hi if nothing else because they have a posting location on the side of the school building, and we frequently do have a nursing student or paramedic on clinicals with us.

Edit: sorry for posting in PACU, I meant to post in school nursing

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Specializes in School Nurse, past Med Surge.

Well, I'm on AN in the middle of my day, so...  ??

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Specializes in pediatrics, school nursing.

WoWiE! This sounds a lot more like my private boarding school gig, which operates like an urgent care center, but we only have around 650 students and we aren't seeing adults at the moment. My public school full time gig is Pre-k through 6th, hours are 8:30-3:15, and only around 165 students at the moment. During normal times, I often have days where I am constantly seeing kids, charting, and just generally busy. These days, it seems the most action I see is walking up a couple flights of stairs to see my fragile diabetic 3x per day. 

You sound super organized and I can imagine you stay plenty busy with 4k kids on campus! 

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Specializes in School Health.
24 minutes ago, k1p1ssk said:

WoWiE! This sounds a lot more like my private boarding school gig, which operates like an urgent care center, but we only have around 650 students and we aren't seeing adults at the moment. My public school full time gig is Pre-k through 6th, hours are 8:30-3:15, and only around 165 students at the moment. During normal times, I often have days where I am constantly seeing kids, charting, and just generally busy. These days, it seems the most action I see is walking up a couple flights of stairs to see my fragile diabetic 3x per day. 

You sound super organized and I can imagine you stay plenty busy with 4k kids on campus! 

Really the only bad thing is we have to see members of the general public a day or two each month, which isn't that big of a deal but not exactly fun. Most schools have a very similar situation, and extremely large schools aren't uncommon here. 

We do get lots of independence, access to the national EHR system, easy access to help when it's needed, and it's not hard to get physician guidance. There also isn't so much legal liability or risk of Karen mom showing up because you gave the kiddo tylenol. 

As an example — last week, 5y/o with an obviously dislocated elbow after a peer yanked her arm. I check the EHR, see the diagnosis of recurring nursemaids elbow, call the doctor for orders, and call the parents to let them know what's going on. Probably 5 minutes tops there. Premedicate for a few minutes with nitrous oxide & oxygen for analgesia, manually reduce it in the clinic, d/c the nitrous, give a tylenol, call parent to let them know it's reduced just fine. Another 5 minutes. Monitor for 10 minutes for nitrous to completely wear off, send back to class. 20 minutes total of class missed instead of hours or the rest of the day.

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Specializes in School nursing.
2 hours ago, k1p1ssk said:

WoWiE! This sounds a lot more like my private boarding school gig, which operates like an urgent care center, but we only have around 650 students and we aren't seeing adults at the moment. My public school full time gig is Pre-k through 6th, hours are 8:30-3:15, and only around 165 students at the moment. During normal times, I often have days where I am constantly seeing kids, charting, and just generally busy. These days, it seems the most action I see is walking up a couple flights of stairs to see my fragile diabetic 3x per day. 

You sound super organized and I can imagine you stay plenty busy with 4k kids on campus! 

I was going to say this sound like urgent care! I can't do many of the things you can (12 leads, stitch removal, immunizations, reset a dislocation!). We have about 720 students at my school, across two buildings. Staff of four nurses now (2 RNs, 2 LPNs). One of those nurses is me and I also act as school nurse leader.

Right now we only have ~60 kids in person. I run a weekly on site COVID testing program and honestly running that and the work on the backend is taking up a large part of my time right now. That and the daily screeners for entry. I use my awesome LPN to help with my other day to day stuff. 

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