After working in a state-of-the-art pediatric emergency department for thirteen years, my career took a different path…sort of. I had triplet daughters that were starting Kindergarten and with no extended family anywhere near our city, I felt that I needed a career that would allow me to be on their schedule. That’s when I began to search for a school nurse position. Initially I was concerned that I would be ‘bored’. The thought of leaving an exciting emergency department to work in an elementary school setting seemed worlds apart. What I soon realized was that even though the settings are drastically different, in many ways, the job responsibilities are strikingly identical.
I have over 670 students in my school. I triage twenty-five to sixty students a day in my clinic. The complaints range from simple, non-urgent illnesses or injuries to more serious, emergent illnesses or injuries. I quickly found that making a triage decision or developing a plan of care in the school setting is far different than that in the hospital setting. In the hospital setting, there are Physicians, Registered Nurses, or Respiratory Therapists to confer with; however, in the school setting, I am the sole decision maker for these students. While I can not diagnose the problem, I must evaluate the student and make the most effective decision that I can for the best outcome and well-being for each student. Just as in the hospital setting, I rely heavily on my critical-thinking and problem-solving skills to make these decisions for each student.
Patient care in the school setting involves assessment, evaluation, observation, medication administration, screenings, and teaching. I have physician orders for daily and “as needed” care of students with Asthma, Diabetes, Sickle Cell Anemia, severe food allergies, and various other syndromes. Staying on top of health care is imperative for me as the school nurse. Just as in the hospital setting, if there is a problem with the physician order, I am responsible for notifying the physician before carrying out the order. Also, just as many people use their local emergency department for their primary healthcare needs; many others use the school nurse as their primary access to healthcare. Unfortunately, many families cannot afford healthcare for their children, so sending their child “to see the school nurse” has become a very common entity. Astute assessment skills and student/family teaching often go hand-in-hand. Additionally, the state mandates that all students in Kindergarten, First, Third, and Fifth Grades undergo screenings. I screen approximately 400 students annually for vision, hearing, and Acanthosis Nigricans. Referrals, family teaching, and financial assistance are provided if indicated.
The adrenaline rush of the “bat phone” reporting that a child is being transported to the ER with head and neck pain after a fall is now replaced with a call to the clinic to come to the playground because a child has fallen from the monkey bars and is complaining of head and neck pain: same adrenaline rush…different setting. As I perform my trauma assessment, I secretly miss having my colleagues around and the state-of-the-art equipment to assist with the plan of care for this student. The “what to do” is left up to my professional judgment.
School nursing may not be as “glamorous” as emergency nursing, but it definitely requires the same ability to problem solve, utilize critical thinking skills, and practice autonomously. I may not get the opportunity to “start the I.V. on the first stick” or “start 2 units of PRBC’s for the trauma patient”, but there is a subtle sense of pride when a parent approaches me with a “Thank You for taking care of my son yesterday. He did break his arm.” or “I never realized that she was sitting so close to the T.V. because she needed glasses. Thanks for the referral!” While the parts of my career that used to bring me job satisfaction are different now, I can definitely find joy in the difference I make at my school.
Susan Hancz, RN
The Colony, TX
As you can see, today’s school nurse is more than just a person who bandages scraped knees and hands out lolly pops. To work as a School Nurse, one must be prepared for a wide variety of medical conditions, ranging from the standards flu like illnesses to students who have chronic conditions and need the assistance of the nurse to help administer prescription medications such as Ritalin or to monitor a child’s asthma or diabetes. If you are considering a job as a School Nurse, you can access our extensive database at www.nurserecruiter.com or fill out our Rapid Apply Form to submit your profile to healthcare employers who fit your requirements.