Health Matters

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A DAY IN THE LIFE OF A SCHOOL NURSE

By Jill Beach, BSN, RN, Toni Wilhelm, RN, and Sheri Johnson, BSN, RN, LSN

School nurses make a big difference in supporting and improving student health and academic achievement. This specialized practice of nursing protects and promotes student health, facilitates optimal development, and advances academic success. In this column, we outline the important activities of a school nurse and the best ways to recruit, support, and retain them, as they are key to the healthcare continuum of services.

A Day as the School Nurse

The role of a nurse working in a school is very complex. Every day is full of challenges and new opportunities to assist students of all ages. In the following example, the school nurse serves three school buildings, and has not been in this building since the previous week.

Morning

The school nurse reports to work at 7:00 a.m. and finds three new student records to process. In addition, there are immunizations to analyze and record with a state-required immunization report to submit. While reviewing the records for the new students, the nurse finds a student with asthma, another who takes ADHD medications each day at lunch, and one student missing immunizations required for attendance. What is the next step regarding these new students? The school nurse’s first call is to the parent of the child with asthma to get answers to important questions: Does she have a local healthcare provider? Does she need an inhaler at school? May the school nurse send her provider an Asthma Action Plan and a Medication Authorization for completion? The nurse initiates an Individualized Healthcare Plan to keep the student safe at school. The nurse updates the Asthma Team about the student. Next, the school nurse contacts the student’s parent on ADHD medication. A Medication Authorization form is required and also requires answers to questions: Who is the provider, and may the school nurse send the form? Medication must be brought to school by the parent – when will that arrive? What designated trained school employee will give the medication when the nurse is not on site?

Finally, the school nurse contacts the new student’s family about missing immunizations and finds out that the parent has a new complete immunization record and will bring it to the school today. To round out the morning, the school nurse provides a brief training to the kitchen staff on reading labels to increase awareness of hidden allergens.

Lunchtime

Administration of lunchtime medications and diabetic student management begins. This building has two students with diabetes, five with lunchtime medications, and a student recovering from an auto accident who comes to the clinic each day at lunch to rest and relax. This student’s management plan has improved her afternoon class attendance and grades, and requires the nurse to provide quiet space during a hectic time. Today, both students with diabetes are having issues with high blood sugar: one forgot her new insulin pen, and the other is not feeling well and has nausea. The nurse calls both sets of parents. The child’s parent, who forgot her insulin pen, decided to pick her student up early and try to manage the situation at home. The other child’s parent is unreachable, so the nurse keeps the student in the clinic, gives him some water to drink, and takes him for a couple of walks around the gym. Finally, his blood sugar responds to the treatments, he feels better, and returns to class.

came to see the school nurse. She contacts the classrooms to talk with the other students. One states his medication changed on Friday, and he is no longer taking it at school. The nurse calls the student’s parent and confirms the medication change and arranges for the parent to pick up the leftover medication for a pill count the medical provider requires. The school nurse discovers that the other student left early for an appointment.

Afternoon

The school nurse sets up for a two-hour, on-site flu vaccination clinic for school staff provided by the local health department. Recess injuries require the school nurse to administer first aid and reassurance. A student comes into the clinic with a fever and vomiting. She will go home, but it will take several phone calls to contact a grandparent and arrange transportation. The school nurse begins managing afternoon medications. One of the students with diabetes has returned, not feeling well, with low blood sugar. As the end of the school day nears, the nurse has given medications and helped the student stabilize his blood sugar so he can ride the bus home. Throughout the afternoon, the nurse sends four students home with various illnesses, manages the flu clinic for staff members, and has about 60 minutes of paperwork to complete (including submission of the school’s state immunization summary). It has been another busy day in the life of a school nurse.

Recruiting School Nurses

Recruiters should understand that registered nurses (RNs) who choose to work in the school setting have other options for employment. They could be working in a hospital and earning significantly more money per hour than in a school setting. They would be able to take a vacation at any time of the year (not just during school breaks), and could work in an environment where everyone understands their role. Registered nurses could also work in home health or a wide variety of settings with similar benefits.

However, schools can offer registered nurses an opportunity to positively impact the lives of students, staff, families, and their communities through their work as school nurses. School schedules appeal to many, especially if the nurse has schoolaged children, and some school districts may offer continuing education and professional development benefits.

Retaining School Nurses

Like other school staff, there are many opportunities to support and retain school nurses, such as: • Providing the school nurse with administrative support for immunizations, screening, excluding illnesses, and working with challenging families. • Encouraging all staff to recognize the expertise of the school nurse. • Allowing the school nurse opportunities for professional development, including providing the nurse with time away from the building to attend conferences or other training

opportunities. • Ensuring that school nurses have the space and supplies needed to serve students. • Providing school nurses with the time and administrative support to train other school employees on medication administration; care for students with special healthcare needs such as asthma, seizures, or diabetes. School nurses can also train staff in organizing CPR, AED, and First Aid training for school safety teams. • Including school nurses in various teams/committees such as emergency preparedness planning, school wellness programs, staff recognition and support activities, and capital improvements planning (especially if student health areas are included). School nurses are professionals who use an evidence-based Framework for the 21st Century School Nursing Practice¹ that includes care coordination, leadership, quality improvement, community/public health, all encompassed by national Standards of Practice.² Research indicates that schools with a nurse present daily have less absenteeism in students with chronic illnesses. They also keep students in classrooms, learning, and engaged with teaching staff.³ School nurses are colleagues, working alongside school staff, experiencing the same victories and challenges, and sharing common goals: to keep students safe and healthy in the classroom so they can learn to be productive members of our community. School nurses can play an essential role in helping foster an environment in the school setting that promotes healthy kids, healthy schools, and healthy communities.

About the Authors: Jill Beach, BSN, RN Ohio Department of Health Region 1 School Nurse Consultant Toni Wilhelm, RN Ohio Department of Health, Region 2 School Nurse Consultant Sheri Johnson, BSN, RN, LSN Ohio Department of Health, Region 5 School Nurse Consultant

References: ¹National Association of School Nurses. Framework for 21st century school nursing practice. Retrieved 9/16/2022. https:// www.nasn.org/nasn-resources/framework .

²National Association of School Nurses. School nursing; Scope and standards of practice (4th Ed.). Retrieved 9/16/2022. https:// www.nasn.org/nasn-resources/resources-by-topic/scopestandards .

³National Association of School Nurses. Position statement: School nurses – an integral member of the school team addressing chronic absenteeism. Retrieved 9/16/2022. https:// www.nasn.org/nasn-resources/professional-practice-documents/ position-statements/ps-absenteeism