School nursing entails much more than band-aids and head lice removal. Nearly 13% of children in the United States have a disability, ranging from asthma to anxiety to life-threatening allergies. To keep children healthy and ready to learn, care coordination and teamwork are required, which is frequently supported by the school nurse. This obligation is in addition to assessing and treating a variety of diseases and injuries that arise throughout the school day. Summers off may sound appealing but continue reading to determine whether school nursing is suitable for you.
An Typical Day in the Life of a School Nurse
“A typical day begins with children reporting to the office to receive their ADHD medication. I save all pharmaceutical prescriptions and parent permission slips in a folder on my desk. A teacher enters the classroom, accompanied by a sobbing kindergartener who is covered in vomit. I dig through my pantry for a clean shirt, clean her up, and check her temperature before phoning home. While I’m looking for the phone number, an older boy enters, his leg soaked in blood. “Wash it with soap and water and apply a band-aid,” I urge him as I call the kindergartener’s mother’s phone number.”
On a regular day in a 600-student elementary school, 35 to 50 visits are not uncommon. Each visit must be recorded in the patient’s electronic health record. The school nurse’s office functions effectively as an urgent care clinic, with one nurse in charge and no provider to make orders or prescriptions. Along with children, teachers and other school personnel are cared for. Children who are unable to attend school due to illness are referred to their parents with instructions on when to visit a pediatrician.
Among the reasons for returning a kid are the following:
- Fever exceeding 100 degrees
- Coughing Excessively
- Diarrhea or Vomiting
- Conjunctivitis
- Nasal Drainage Excessive
- Unidentified
- Rash that is Contagious
- Head Lice that are Active/Alive
Even School Nurses Have Regulars
The nurse’s office has a small number of frequent visitors. Some suffer from chronic diseases such as asthma, diabetes, or attention deficit hyperactivity disorder. Others are skipping class due to a variety of factors. They frequently grumble vaguely around the same time each day. A glass of water, a trip to the restroom, and a few peaceful moments of rest frequently suffice to carry them through the day. One of these children is Maddie*. She enters my office with a sad expression on her face and wide eyes. “My tummy aches,” she explains. I’ve spoken with her parents numerous times and we’ve agreed on a course of action. Maddie sips some water and settles into one of the vinyl-covered cots. Within ten minutes, she reappears, declares that she is feeling better, and returns to class.
Numerous children who visit the school nurse’s office have been diagnosed with a mental health issue. According to the Centers for Disease Control and Prevention (CDC), among children:
- 4% have been diagnosed with attention-deficit hyperactivity disorder (ADHD)
- 4% have a diagnosable behavioral condition.
- 1% have a diagnosable anxiety disorder.
Additionally, some children have an individualized education plan (IEP) that involves a time-out at the school nurse’s office.
Before lunch, diabetic children come in to get their blood sugar checked and to receive their insulin. Under the guidance of the nurse, the majority are able to prick their own fingers and monitor their blood sugar. Their insulin doses are computed using an equation that takes into account their glucose levels and the carbohydrate content of their lunch. I calculate the insulin dose for each child and administer it to them individually prior to sending them to the cafeteria.
Day in the Life
“Prior to recess, a couple of rowdy boys enter to use their inhalers. A couple additional patients are seen for ADHD medication. Another requires his strep throat antibiotic. Recess introduces a new set of minor injuries that require the use of ice packs, band-aids, and emails to parents. I close my door after recess and sit down to have lunch while catching up on notes. I manage three bites before being startled by a knock at my door. “I got an insect bite,” a small child explains as he extends his arm. I rise and apply calamine lotion to the bite before returning him to class.
After recess, the office is quiet, which gives me a chance to study the list of outstanding physicals and immunizations. I send another round of letters home, this time requesting verification for these items. I consult the calendar to arrange for a week of hearing and vision examinations. A couple children return from recess with their ice packs, and I reassess their injuries.
At 2:45pm, the school buses arrive outside, and children shout in anticipation of boarding. Before boarding the bus, diabetic children come in to have their blood sugars checked. After a nosebleed at the end of the day, a lost baby tooth, and a few bruised heads, the buses eventually go for the day and the building becomes quiet. It’s now time to catch up on paperwork, make phone calls, and reassemble the workplace. Today was a pleasant day, with no serious injuries or angry phone calls from parents.”
