Day in the life of
School Nurse – Jo Fontana RN, BSN, AE-C
The myth of the school nurse only handing out Band-Aids and Tylenol is a common, yet inaccurate picture of the role of a school nurse. School nursing has duties that are not found in other specialties such as writing healthcare plans and accommodations into Individual Healthcare Plans (IEP’s) or 504 plans. We do administer medication, first aid, and provide comfort care. However, we are the only medical professional in a building dedicated to education and as such are autonomous. Most school nurses are itinerant, meaning they travel to different schools. Many times, this does not help the nurse’s cause because administrators don’t have the clinical training to evaluate nurse performance or understand the nuances of the position and the nurse isn’t always there to support the needs of the school.
As you can see, it is not ideal and many members of the community mistakenly believe a nurse can be replaced by unlicensed personnel. Let me explain. Yes, we train staff to deal with minor injuries and to administer medications safely as well as handle emergency situations in our absence according to state guidelines. However, there are things we cannot delegate such as clinical judgement, experience, knowledge, and health assessments for IEP’s which take up a majority of our time.
School nurses are responsible for handling medical emergencies (think first responder), care coordination (linking families to low cost or free medical resources within the community), health education, infection control, public health mitigation measures such as immunization education and tracking, disease tracking, and ensuring students are safe in the classrooms and school sponsored events. Our input may also be used in assessing the safety of areas within a building or the grounds. (Poor equipment designs that may cause injuries, etc.).
We also create healthcare plans for students to be safe in the classroom as well as accommodations so the teachers can individualize instruction that decreases the impact of the student’s health conditions on their learning. A good example of this is if a teacher has a student with diabetes in their classroom, the teacher can be taught to recognize signs of high or low sugars and if necessary, assist the student if their symptoms are severe until either the nurse or emergency services arrives. The teacher can also ensure the student goes to the health office to test their blood sugar before tests as high or low sugars can impact test scores. An example of an accommodation in an IEP would be the student has assistance in learning how to do carb counts during a math unit which would be an extra layer of support as they learn how to manage their insulin intake.
- Variety of duties
- Student interaction
- Making a difference for students and families
- Fast paced
- Large ratio of students to nurse
- Not enough time to spend on individual student needs
- Non-existent training programs
- Language barriers
- Not enough time in one school so that the majority of the nurse’s time is spent on paperwork.
- Pay is much lower than in other specialties yet we impact the overall health of the community
That being said, I love my job even during COVID.
Advice to aspiring School Nurses
I would advise those going into school nursing to do a year of medical surgical nursing for general experience and then at least 6 months in home health. This way they will have a feel for public health nursing in general. ER and ICU experience is helpful also due to the autonomous nature of the position.