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Career Story: School Nurse In An Elementary School

School Nurse In An Elementary School

Job Title: School Nurse

Type of Company: I work for a school district in a large city just outside of Boston, MA. There are 11 elementary schools, 4 middle schools and 2 high schools. The school nurses work for the city health department, not the school department.

Education: BSN, Boston College •• MBA, Boston College

Previous Experience: I worked as an RN staff nurse in a major medical center for two years then transferred to the operating and recovery room where I worked for 15 years. I did not have a lot of specific pediatric experience but my years in the hospital gave me a wide background in adult/child illness and injury, giving me good assessment skills and emergency decision-making experience. Both of these things are important in the school nurse role, especially if the nurse is the only on-site medical provider.

Job Tasks: School nurses are responsible in my school district for assuring compliance with state immunization law, for annual hearing, vision, height/weight and scoliosis screenings per state law, for the development and maintenance of individual care plans for those students with medical conditions, for the dispensing of medication to students, for staff training in the use of emergency EpiPens for students with life-threatening food allergies. Each student has a medical record on file at school which the nurse maintains.

Although the primary purpose of the nurse in the school system is compliance with state law and emergency medical care, the majority of my time is spent in direct care of minor illness and injury of the students. Teachers put on bandaids and evaluate stomach aches, but most times the student does come to the nurse since I am in the building. It is a very busy day usually and the health room door is open all the time.

I work in an elementary school; the type of problems the students bring are very different from a middle or high school. The main illness is stomach ache or headache, and the main injury is a bump or a scrape. There is an increasing number of food-allergic students coming to school with life-threatening food allergies, and also asthma. Both diagnoses carry the potential for an emergency event and I have had to call an ambulance for a serious asthma attack and have given emergency epinephrine for an allergic reaction. This is a constant concern and requires emergency planning with staff and parents. These students have written care plans and the staff has specific instructions in the event the nurse is out of the building. (My district does have a nurse in each school and tries to send a substitute if I am ill/absent. Many school nurses in other districts are responsible for more than one school.)

I have my own space - the health room- with two couches, a sink/medical supplies, file cabinet, medicine cabinet and computer. We maintain paper medical records but use software also to document office visits, immunizations and annual screenings. It is a little like an urgent care walk-in clinic, but with a very specific population. I work 8:00 AM - 3:30 PM, Monday through Friday; I do not leave the building during these hours.

Best and Worst Parts of the Job: The best part of the job is the environment - an elementary school. The students are excited about school, interested in everything you have to teach them, fun to be around. The staff is always modeling proper behavior so there are no disgruntled outbursts, rude comments, lack of interest in the present activity. The city I work in has a strong investment in the schools and the socioeconomic status of the population is high. This has been shown to make a great difference in the quality of the schools; not every elementary school is like this.

The worst part of the job is the anxiety of a serious event, which is rare but possible. Second to this is the frustration of not having enough time for my paperwork because the health room is so busy with the students.

Job Tips: Most school nurse positions in public schools require a bachelor's degree in nursing and solid experience (five years) with a broad medical - surgical base. Of course, specific pediatric experience is ideal but many of my colleagues did not have this before being hired.

My nurse manager has said she would not hire a new graduate, as most times the nurse is the medical expert on site. The nurses I work with generally have had 10-15 years nursing experience before moving to a school setting, but there is always the exception. One candidate was hired with less than two years experience because there were few applicants and she had taken a group of elementary students on a two-week wilderness trip in the mountains. Within the applicant pool, she had demonstrated a high level of interest in the age group, the confidence in her independent decision making and emergency preparedness skills.

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