School nursing involves more than just band-aids and head lice. Nearly 13 percent of U.S. children have special health care needs, ranging from asthma to anxiety to life-threatening allergies. Ensuring that kids are healthy and ready to learn requires care coordination and collaboration, which is often facilitated by the school nurse. This responsibility is coupled with assessing and caring for the slew of illnesses and injuries that occur during the school day. Having summers off may be enticing, but read on to decide whether school nursing is right for you.

A School Nurse's Average Day

A typical day begins with students coming in for their ADHD medications. I have doctors' orders and parent permission slips for all medications in a binder on my desk. A teacher walks in with a sobbing kindergartener who is covered in vomit. I find a clean shirt in my cupboard, get her cleaned up, and check her temperature before calling home. While I'm looking up the phone number, an older boy comes in with blood dripping down his leg. "Wash it off with soap and water and put a band-aid on it," I instruct him as I dial the phone number for the kindergartener's mother.

In an elementary school of 600 students, it isn't unusual to have 35 to 50 visits on a typical day. Each visit must be documented in the electronic health record system. The school nurse's office essentially serves as an urgent care clinic that's staffed by one nurse without a provider to write orders or prescriptions. In addition to students, teachers and other school staff also come in for care. Kids who are too ill to stay at school are referred to their parents with guidance on when to contact a pediatrician.

Reasons to send a child home include:

  • Fever greater than 100 degrees
  • Excessive Coughing
  • Vomiting or Diarrhea
  • Conjunctivitis
  • Excessive Nasal Drainage
  • UnidentifiedContagious Rash
  • Active/Live Head Lice

Even School Nurses Have Regulars

There are a handful of regular visitors to the nurse's office. Some have chronic conditions like asthma, diabetes, or ADHD. Others are avoiding class for various reasons. They typically have vague complaints at the same time each day. A drink of water, trip to the bathroom, and a few moments of quiet rest is often enough to get them through the day. Maddie* is one of these kids. She comes into my office with a sad face and wide eyes. "My stomach hurts," she says. I've spoken with her parents many times and we have a plan in place. Maddie gets a drink of water and lies down on one of the vinyl-covered cots. Within 10 minutes, she pops up, announces that she feels better, and heads back to class.

Many of the kids who frequent the school nurse's office have a diagnosed mental health disorder. The Centers for Disease Control and Prevention (CDC) estimates that among children:

  • 4% have attention-deficit hyperactivity disorder (ADHD)
  • 4% have a diagnosed behavior disorder
  • 1% have a diagnosed anxiety disorder

Some students even have an individualized education plan (IEP) that includes taking a time-out in the school nurse's office.

Diabetic students come in before lunch to check their blood sugar and get their insulin. Most are able to prick their own fingers and check their blood sugar under the nurse's supervision. Their insulin doses are calculated based on an equation that incorporates glucose levels and the number of carbohydrates that they will be eating for lunch. I calculate the insulin dose for each child and give them each an injection before sending them to the cafeteria.

Documentation - With a Few Interruptions

Before recess, a couple of rambunctious boys come in to use their inhalers. A few more come in for ADHD medications. Another needs his antibiotic for strep throat. Recess brings a whole new set of minor injuries requiring ice packs, band-aids, and emails home to parents. After recess, I pull my door shut and sit down to eat lunch while catching up on notes. I get three bites in before I hear a knock at my door. "I have a bug bite," says a little boy who is holding out his arm. I get up and dab some calamine lotion on the bite before sending him back to class.

The office quiets down after recess, which grants me a moment to review the list of missing physicals and vaccinations. I send home another batch of letters with requests for documentation of these items. I look at the calendar to schedule a week for hearing and vision screenings. A few kids bring back their ice packs from recess and I reassess their injuries.

At 2:45pm, the school buses pull up outside and kids shriek as they wait to embark. The diabetic students come in to check their blood sugars before getting on the bus. After an end-of-day nosebleed, a lost baby tooth, and a few bumped heads, the buses finally leave for the day and the building is quiet. Now it's time to catch up on paperwork, make phone calls, and put the office back together. With no major injuries or angry phone calls from parents, today was a good day.

* Name changed to protect confidentiality

Wendy Arena, RN, BSN
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