School Nursing: Working With Children and Teens Day to Day

Peggy Dryden, RN, MSN, MBA

Disclosures

June 11, 2003

In This Article

Introduction

Our past eLetter interviews have taken us overseas to Afghanistan and Israel, inside prisons, and up to 30,000 feet with a flight nurse. For this interview, we have our feet solidly on the ground in the United States as we catch a glimpse of the busy day of a school nurse, Barbara Traver, RN, MSN, Addictions Specialist (Figure 1).

Barbara Traver, RN, MSN

Question: Barb, tell us a little about how you chose school nursing as a career.

Response: My career has taken some twists and turns on the road to becoming a school nurse. After college, I began my nursing career as a medical-surgical nurse. While I was busy raising a family, I held positions as a recovery room charge nurse and staff nurse at a skilled nursing facility. From there, I began to work as an office nurse in a pediatric allergist's practice, on to the office of a family practice doctor, and finally to a position at an allergy practice. When an opening came up in our local school district, I applied for a position. I have remained in the school district for 15 years.

My nursing education began in 1969 when I obtained a BSN. In 2001, I received my MSN in community health, where I researched pathological gambling. I plan to attend a PhD nursing program in the fall of 2003.

Question: You continue to be actively involved in professional nursing. What are some of your interests and activities?

Response: I am president of a Sigma Theta Tau chapter. I am also cochair of a local inaugural university nursing alumni organization. I serve as a countywide coordinator of our diocesan Catholic Charities Drive, and I am responsible for 21 parish campaigns. I also love to sing and have had the great opportunity to sing in opera choruses since 1977. I play golf with my husband, and we garden as well.

Question: Would you describe the multifaceted role of the school nurse and the school environment in which you practice?

Response: The school nurse has to be a "jack of all trades" and have a broad knowledge base in order to practice independently in the profession. Understanding and awareness of the stages of the students' physical and emotional development is a priority. Nursing interventions can only succeed if steps are taken that are developmentally and emotionally appropriate. Having a grasp on the community resources available, and developing relationships with these resources is important. Good communication skills and a professional manner give the nurse credibility.

Question: What are the top 2 or 3 most difficult issues facing school nurses today? How would you say these issues affect your ability to perform your work?

Response: There are many difficult issues facing the school nurse. While the community expects each district to provide nursing support in each building, this is often not the case. Some states only require that the district employ "a school nurse." This results in inadequate staffing. The National Association of School Nurses advocates adequate staffing levels of 1:750 for the general school population, and 1:250 for buildings with students who have special needs.

Another great concern of all school nurses is accessibility to proper healthcare for all students. The difficult economic conditions in this country, including forcing employee layoffs and termination of health insurance, have led to a crisis for many families. As a result, the school nurse is often the only health professional the child sees in his or her school career.

States provide low-cost and free health insurance for persons in need. Some families do not apply for this assistance. Children who are acutely ill, or who need medication for chronic health problems such as asthma and hypertension, are not getting care or medications. Collaborative efforts between the school nurse and local organizations attempt to meet the needs of this population.

Just keeping up to date on new health concerns is a full-time job. Being certified in cardiopulmonary resuscitation and automatic external defibrillator usage, keeping informed about severe acute respiratory syndrome (SARS), and developing responses to terrorism and disasters in schools have all become issues within the last 2 years.

Question: Could you describe what a "typical day" is like?

Response: My typical day is never the same, but here is what I usually do on an average day. Kids come in with symptoms of upper respiratory infections. Often, they want to go home or rest. I check them and make sure they don't have temperatures. Also, I might see children with physical education (PE) injuries, which are a challenge. For example, a jammed thumb can sometimes be fractured, and a very bad swollen ankle may just be a minor sprain. Teens can be aggressive in PE classes. There are days that consist of running to the gym with the wheelchair, calling parents, and completing incident reports. Otherwise, it seems that altercations between students happen toward the end of the week, or at the end of the day. In these situations, we will often call in the local police, and the school files charges of disorderly conduct.

Other problems students come to me with are asthma flare-ups, poor control of diabetes (often in adolescent males), and stress-related symptoms. Recognizing the stress-related illness takes a little time. When I have a "frequent flyer" (a student who visits the nurse often) who presents with an upset stomach, I take the time to chat and find out what's going on. A few minutes can help a student recognize what may be causing problems, and we can discuss a plan of action to reduce the stressors.

I also attend team meetings, and student cases are discussed. These sessions are valuable to me, and what information I have on the student is valuable to the team. We look at options for students who are not performing well, or who may need academic or emotional support.

Whatever situations have occurred, each day, as I leave my office, I ask myself, have I been an effective nurse today? Have I met the needs of those in my care? I have learned a lot from these students and their families about the stresses they face on a daily basis.

Question: What has been your most memorable work situation? Or what has been your most difficult case/patient situation?

Response: The most satisfying part of school nursing is having the day-to-day contact with students and being able to help them in times of illness and personal crisis. For example, I learned of chronic physical and substance abuse within a new family entering our district and was able to direct the family to the proper counseling sources.

I have learned that students who are in a substance abuse crisis are often hard to identify. In their initial visits to my office, the students may complain of stomachaches or need rest. After a few visits, some will disclose the problems they are having. I take the time to sit with the students in a private area in my office and discuss the situation. Because I have expertise in this area, I have literature available for the students and parents.

Teens need factual information regarding drugs and alcohol. When they realize the effect that drug use is having on their lives and school situation, they need support and encouragement to change. My most memorable incident was with a young male, who had been brought to school by the police early one morning. He had been drinking heavily. His father was called in to accompany him to the hospital with the paramedics. I was able to talk with the parent and wrote a note to the family, offering to assist when they were ready. About a month later, the young man returned to my office, and asked me to sit with him while he rested from a headache. He informed me that he had been sober for 31 days. He wanted more information, because his folks were still drinking. I find that most students will return eventually and thank me for the help.

Question: What are the minimal educational requirements for a school nurse position? How important is it to gain other types of nursing experience before becoming a school nurse? How well are school nurses compensated?

Response: Most school districts will require a school nurse to have a current registered nurse (RN) license. Other districts or states are more demanding and may require a BSN, with certification as a school nurse, or an MSN. It is important that all school nurses gain knowledge of the community resources and have a broad knowledge base. Having experience in the hospital settings, clinics, and physicians' offices gives a nurse a sense of organization and triage training.

Conferences and continuing education emphasizing the age group you are dealing with is extremely helpful. Throughout the year, I have attended sessions on diabetes, Crohn's disease, asthma, and substance abuse. These programs are sources of information and support. Having literature available for students and families about these conditions gives the family a sense that the nurse is informed about their situation.

Knowledge of pediatric illnesses, communicable diseases, reproductive health, surgical procedures, mental illness and emotional health, orthopedic problems, and asthma are vital to every school nurse. (Also, a good sense of humor helps when it comes to our all-time favorite -- lice). Automatic external defibrillator and cardiopulmonary resuscitation certification and training are necessary as well to our practice as independent health professionals.

Salaries have always been an issue for school nurses. Pay scales for nurses in the educational setting vary. There are districts that will pay top wages for a school nurse practitioner to assume responsibility for physicals and management of the other nurses in schools. Other districts will hire a single nurse and have unlicensed assistive personnel provide care to students. Most districts consider nurses as "support" personnel and offer pay scales that are not in line with the teaching faculty.

Question: Finally, do you have any suggestions for those readers interested in a position like yours? Do you have any recommendations to readers about whom they should contact for more information about this type of work?

Response: Nurses who would like to work on the same schedule as their children should definitely consider school nursing. Nurses considering a school nurse position should apply to work as a substitute in a local school. The school nurse practices independently. If you believe that your nursing career has given you the expertise to practice as a school nurse, apply to your local school district. Interested nurses can offer to shadow other nurses as they care for students at different grade levels.

Some informative resources available include the National Association of School Nurses, and the California School Nurses, an excellent resource that offers job descriptions and requirements for school nursing. The Journal of School Nursing keeps the nurse up to date on current issues. Nurses caring for children in grades 6-12 would benefit from resources available through the NIDA (National Institute of Drug Abuse) and NIAAA (National Institute of Alcoholism and Alcohol Abuse).

Thank you, Barb, for telling your story. Readers interested in contacting Barbara Traver may email her at: b.traver@att.net

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