1 wk into School Nursing ready to quit!! Is this normal?

Nunya, BSN · Sep 28, 2019

I'm on a FB page called School Nursing and these are pretty common complaints. First, join that page, they're great at support. I will tell you that someone lost her job recently because someone reported her so I would personally change my name on fb and take off all reference to where you live/work, to include check-ins and reviews of restaurants etc. I would also remove pics of yourself and your family. Make sure all your posts are set to friends only and your privacy is totally locked down, but be aware that people can still take screenshots. Or, and it may be easier, just get a new fb account to use for that page.

From what I've read (and I'm not a SN but I've been thinking about it so that's why I joined the group) many people have the problem of kids coming in for otc meds etc. Some schools can't give out without a doctor's order so check that first. Some schools put a limit to the number of otc meds they'll give out per semester without a doctor's order, one nurse said a student was coming in several times a week for Tylenol for HAs, so other nurses said at some point it becomes a concern that something else is going on. I would just get rid of the sanitary pads, either put them in the bathroom, get a machine to buy them to put in bathrooms etc. I hope you aren't paying for those out of your own money. Talk about responsibility to the girls, this is an event that happens every month. If it's a low income school then maybe talk to admin/PTA about funds to provide.

Talk to admin/PTA about getting another water cooler. People should not be coming into the clinic for water/bathrooms. This is an infection control problem as well as a FERPA/HIPAA problem. How do you maintain confidentiality if there are people in there all the time? You can't, and if someone overhears something confidential and it gets around there will be heck to pay. And as for teachers talking to you about their health problems, check your contract to see if you have to care for teachers as well as students. If not, you need to stop! If you tell someone something and it turns out to be wrong then you would be legally liable and you wouldn't have a foot to stand on as you aren't contracted for teachers. You also probably don't know all their health concerns/history so how can you be sure what you're telling them is 100 % correct? Yeah, it probably is but there's always that one time....If you are contracted to take care of teachers then you need to make them go through the same process as kids, check-in, do VS, med reconciliation etc. I would also want a complete health history from them, so that's something you can develop or ask for help on the FB page. So yeah, they'll have to give up some privacy and I bet that'll stop some of them. Take care of only the people you are contracted to take care of, and tell them nicely why you can't help them. You'll have to be consistent. And firm. Obviously if it's a life or death kind of thing you'll take care of them but all the little things it'll come in with, nope, not unless you're contracted to do so.

Obviously you'll need to talk to admin about all this because you'll need their support. And other SNs may have other ideas to bolster your case (in addition to infection control and confidentiality). You'll also have to personalize based on your clinic layout. If there's a problem with dirty bathrooms that no one wants to use them that's definitely a admin problem, and if they don't think it is then you have a much bigger problem there. If you decide to quit and things aren't better as far as cleanliness etc I would make the community aware of the problem, but that's me. ?

Good luck, people have been saying the beginning of the year is the worst and you have some institutional problems you need to change also. I don't know how you can email me but I know there's a way so feel free to do so. But join the fb page!!

Edit: just as you don't run the show in the classroom they shouldn't be running it in the clinic. You'll have lots of pushback and won't make friends but they'll come around....eventually. Oh, and many nurses refuse to give OTC meds to teachers because they don't know their health history and they consider it dispensing meds which is illegal for nurses to do. Some get around that by keeping some OTC meds in a secure place (that kids back get to) and then staff can help themselves, without advice from you. Don't buy them yourself though and of course run it by admin. These teachers are all adults, if they can't think to bring their own Tylenol etc then they can do what everyone else in the world does and go around and ask their co-workers! Plus, even if you are contracted to treat teachers you don't know everything and a lot of the nurses say " it might be this but I advise you to see your primary care provider". And CHART that so no one can come back and say that you never told them to go to their doctor. Yeah, it's a lot of responsibility for $48K, you'll have to see what you can/cannot change and decide if it's worth it.

StressedRN76 · Sep 28, 2019

Thank yo so much Elaine for the response. You provided a lot of insight. I brought up the issue of confidentiality and infection control to the nurse I’m working alongside with. She has been there for 25 years and doesn’t see it as an issue. This is the problem she has allowed this environment and I will not be able to change it as the newbie just starting. She couldn’t even show me where the standing orders where. I finally found them and they have not been updated in years. Such disorganization! As I lay here another sleepless night with constant thoughts of regret, I know I need to resign. I don’t feel safe working there from a legal perspective at all ! Again thank you for your detailed response !

Nunya, BSN · Sep 28, 2019

14 minutes ago, StressedRN76 said:
Thank yo so much Elaine for the response. You provided a lot of insight. I brought up the issue of confidentiality and infection control to the nurse I’m working alongside with. She has been there for 25 years and doesn’t see it as an issue. This is the problem she has allowed this environment and I will not be able to change it as the newbie just starting. She couldn’t even show me where the standing orders where. I finally found them and they have not been updated in years. Such disorganization! As I lay here another sleepless night with constant thoughts of regret, I know I need to resign. I don’t feel safe working there from a legal perspective at all ! Again thank you for your detailed response !

You're welcome! I didn't realize the 25 year nurse was still there! I agree, if she doesn't see it as a problem you would have a hard time working there. I would encourage you to mention some of these things before you leave, stress FERPA and legalities. That way when they get into trouble they'll have no one to blame but themselves! ?

Home Health Columnist / Guide · Sep 28, 2019

Allnurses School Nursing forum has numerous posts that may help you.

Editorial Team / Admin · Sep 28, 2019

Hello @StressedRN76 and welcome to allnurses.com

We moved your topic to the School Nursing forum. This is a great forum where you will receive a lot of advice and support.

JustJai, ADN, LPN, RN, EMT-I · Sep 30, 2019

Oh my goodness, what a terrible start to your new job in a new field. Big hugs to you. The first year in any new job is a learning curve, but your biggest hurdle is going to be the nurse that has been there forever. Last year I moved to a new school in the same district. My predecessor was less of a stickler for policy and procedure than I am. I frequently heard "we never did that when _________________________ was here." I just smiled and said "there's a new nurse in town." That is not an option for you.

Unfortunately, you are not going to change a Health Room climate that has been in place for years. Additionally, you have uncovered her persistent habit of disorganization and a lackadaisical attitude towards the job. Any complaints about this to admin is going to lead to a hostile work environment for yourself if they bother to address it with the other nurse.

Is your new co-worker an RN, an LPN, or a MA? If she is an LPN or MA is she working under your license? That is a game changer.

StressedRN76 · Sep 30, 2019

Hi Just Jai,

Thanks for the reply. My co-worker is a Master's prepared RN. She has been in the same school for 25 yrs and it seems that they have had an issue with retaining a second nurse in this school. I wonder why??! I am very by the book, and on my first day I noticed there was no policy/procedure manual to follow. When I asked her about it, she was like "oh we never really had one". I asked her to see the standing orders from the school district's physician and it took her 3 days to find it and when I reviewed it, the last time it was updated and signed was 2009. I feel like I am in the twilight zone. This is not how I operate at all. Not to mention, the layout of this clinic is so backwards. Nothing flows, supplies are here and there and everywhere. I am running around looking for things. I do not understand how this clinic was set up like this and obviously it has not changed in 25+ years.

At this point, it is not worth my sanity to keep bringing up all the disorganization as nothing will change. The other day she gave a child his seizure medications with an expired MD order. She said" Its ok, I don't expect you to do this, I just know the child and they will eventually get me the paperwork'. This is not how I practice, so its creating such a conflict with me. I have decided I will be handing in my resignation this week. It is for the best, I do not feel comfortable staying at this school and the dread that I feel each night is not normal.

GmaPearl BSN RN · Sep 30, 2019

Dear Stressed,

I am so sorry your introduction to school nursing has been such a disaster. I would suggest you try subbing for awhile with different age groups and see if you find this unique job a good fit. There are toxic admins in schools as well as hospitals, but there are far more wonderful educators than the few bad apples.

As stated above, the existing nurse is the really sad and potentially dangerous issue here. I think you are wise to save your sanity.

Wishing you all the best!

JenTheSchoolRN, BSN, RN · Sep 30, 2019

School nursing has a lot of frustrations. Read this board and you will see them all - but so many of us still love what we do :).

I have a private restroom that every. single. MS and HS boys wants to poop in because of privacy. And it isn't a short visit. It is rather insane. I'm honest and not tactful with teachers when I see them writing a pass for some students and tell them that their pass equals 20+ lost minutes of instruction time.

As for sanitary supplies - these can actually fill a great need for those that need them and can't afford them. I don't mind having and I don't mind giving them out. But I have a supply on the table in the front of my office and in my bathroom so it doesn't clog up my time - those that need know where to go. I got several of these supplied donated. However, my school is supportive in my providing them, so they also give me the budget for them (yep, I'm lucky, I know).

School nursing pros outweigh the cons for me.

No weekends. Vacations. Summers. A regular schedule. Being with a student as they grow and change. Getting a Wonder Woman mug from one of my students with a chronic illness as a thank you. Watching my diabetic students transition from needing a check-in with me to teach to becoming fully independent. I teach sex education as part of my role and find that so rewarding.

As for "I'm a stickler for the rules" - that isn't a bad thing, trust me. But also realize that change in a school can take time. You can do it, just not all at once. Need that order for that student with seizure? If parent isn't timely, ask parent if you can call the doctor. Parent often is grateful and I can get that order in 24-48 hours faxed to me - less even if the doctor's office has sent it before. (Maybe even a great way to show your colleague...I know some folks are set in their ways.)

My OTC orders were outdated as well when I started - and signed up by a doctor the school didn't work with anymore. It took so much work and time, but finally convinced my boss to find $$ to hire a new one (volunteer calls were not working), got updated orders, and even finally orders for stock Epi. I felt like Queen of the World when I got those! ?

Welcome to the fold. Come here and chat with us. We are a great bunch and the support is amazing.

Flare, ASN, BSN · Sep 30, 2019

Welcome to the school nurses board. I'm an NJ nurse aw well, so feel free to reach out if you ever need anything state specific.

I think a lot of people think that school nursing will be "a nice, slow pace change" when in reality, you're the only medical reference for hundreds to thousands. The things you're seeing are very typical and are equally aggravating to us all. The malingering visits such as bandaids for invisible cuts, ice packs for days old injuries, pads (which i don't mind, but i do when i see the same faces constantly hitting up my supplies), or the get out of class visits that we can do nothing for such as the sour tummies, head colds, or eye strain headaches, are simply annoyances that you can, hopefully in time, whiddle down as the school year gets into its groove.

The bathroom visits are also annoying to me. I am the sole nurse for my two buildings. 90% of the time, i am in my office, so no big deal, but there are times that i need to make my own copies, leave to see a student, attend a meeting, go to lunch... and it annoys me to no end when i get called back to my office for a huge emergency to find it's just someone who wanted my bathroom. I shake it off, reminding myself that for bathroom attendant, i get paid extraordinarily well.

As far as the co-worker consults go, I fully realize that if I have a staff member come through my door, 98% of the time they're asking something of me - health advice or trying to get confidential info on a student of another staff member. Most of the time they are disappointed when they leave, as i usually just tall them they should see their dr (after telling them in a dead pan voice that I have begun charging a co-pay of my own - however most don't get it)

I can't dictate to you whether or not to stay. I can say this though - the first year is the hardest. It gets better, it gets easier. Once you amass the countless pieces of info in your head that just make the day flow, you won't believe how much more flow you get to the job. I always say the at least 40% of what i do is just in my head and couldn't be written down. But that being said, as a person coming in with fresh eyes, if you think there are things that could be done to make your office flow better, whether it's rearranging the office, putting a basket of sanitary supplies in the bathroom, making a jar of bandages availaible, whatever you see, discuss it with the other nurse, chances are that she/he is just as annoyed with a lot of these things but has just grown accustomed and doesn't notice it as much now.

JenTheSchoolRN, BSN, RN · Sep 30, 2019

21 minutes ago, Flare said:
The bathroom visits are also annoying to me. I am the sole nurse for my two buildings. 90% of the time, i am in my office, so no big deal, but there are times that i need to make my own copies, leave to see a student, attend a meeting, go to lunch... and it annoys me to no end when i get called back to my office for a huge emergency to find it's just someone who wanted my bathroom. I shake it off, reminding myself that for bathroom attendant, i get paid extraordinarily well.

Lol, when you put it that way...

(My bathroom has a back door that goes out into the hallway. When I leave my office, I unlock that door and lock the one going into my office so I'm not called out for bathroom "emergencies." All the admin know this thankfully.)