Should a school nurse diagnose?

[Pea-n-Me]

Stop "screening" my kids! Do your headlice checks and put bandaids on boo-boos and send them home if they are ill, but all this other nonsense is getting really expensive!

Thank you for giving me the opportunity to present some facts for you about the school nurse role since you seem astoundingly unclear about it.

FROM THE AMERICAN ACADEMY OF PEDIATRICS
Role of the School Nurse in Providing School Health Services
Council on School Health

The school nurse has a crucial role in the seamless provision of comprehensive health services to children and youth. Increasing numbers of students enter schools with chronic health conditions that require management during the school day. This policy statement describes for pediatricians the role of the school nurse in serving as a team member in providing preventive services, early identification of problems, interventions, and referrals to foster health and educational success. To optimally care for children, preparation, ongoing education, and appropriate staffing levels of school nurses are important factors for success. Recommendations are offered to facilitate the working relationship between the school nurse and the child's medical home. This statement has been endorsed by the National Association of School Nurses.

SCHOOL NURSE DEFINITION

The National Association of School Nurses defines school nursing as:
A specialized practice of professional nursing that advances the well-being, academic success, and lifelong achievement of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self-advocacy, and learning.1

BACKGROUND

After the child's home, school represents the second most influential environment in a child's life. As more students enter schools with health or mental health problems, pediatricians face the challenge of managing their care throughout the school day. The school nurse is the health care representative on site. An understanding of the school nurse's role is essential to ensure coordinated care. There is a recognized relationship between health and learning, as there is between school nurse availability and student well-being and educational success.2–4 The role of the school nurse encompasses both health and educational goals.5–7 Students today may face family crises, homelessness, immigration, poverty, and violence, which increase both their physical and mental health needs. School nurses perform a critical role within the school health program by addressing the major health problems experienced by children. This role includes providing preventive and screening services, health education and assistance with decision-making about health, and immunization against preventable diseases. In addition, school nurses may provide interventions for acute and chronic illness, injuries and emergencies, communicable diseases, obesity, substance use and abuse, adolescent pregnancy, mental health, dental disease, nutrition, and sexually transmitted infections.8–13 School nurses need to be physically present in schools to address these responsibilities appropriately. Improved student outcomes result where schools have a full-time school nurse.3 Inadequate staffing threatens the school nurse's role as medical home extender.

School nurses are well positioned to take the lead for the school system in partnering with school physicians, community physicians, and community organizations. They facilitate access to Medicaid and the State Children's Health Insurance Program to help families and students enroll in state health insurance programs and may assist in finding a medical home for each student who needs one.

This policy statement has been endorsed by the National Association of School Nurses.

SCHOOL NURSE ROLE

The National Association of School Nurses identifies 7 core roles that the school nurse fulfills to foster child and adolescent health and educational success.13 The roles are overarching and are applicable to school nurses at all levels of practice, in all geographic settings, and with all clients.

1.The school nurse provides direct care to students.13 The school nurse provides care for injuries and acute illness for all students and long-term management of students with special health care needs. Responsibilities include assessment and treatment within the scope of professional nursing practice, communication with parents, referral to physicians, and provision or supervision of prescribed nursing care. An individualized health care plan is developed for students with chronic conditions, and when appropriate, an emergency plan is developed to manage potential emergent events in the school setting (eg, diabetes, asthma). Ideally, this health plan is aligned with the management plan directed by the child's pediatrician and regularly updated through close communication. The school nurse is responsible for management of this plan and communication about the plan to all appropriate school personnel. The school nurse has a unique role in provision of school health services for children with special health needs, including children with chronic illnesses and disabilities of various degrees of severity. Children with special health needs are included in the regular school classroom setting as authorized by federal and state laws. As a leader of the school health team, the school nurse must assess the student's health status, identify health problems that may create a barrier to educational progress, and develop a health care plan for management of the problems in the school setting. The school nurse ensures that the student's individualized health care plan is part of the individualized education plan (IEP),14 when appropriate, and that both plans are developed and implemented with full team participation, which includes the student, family, and pediatrician.

2.The school nurse provides leadership for the provision of health services13 As the health care expert within the school, the school nurse assesses the overall system of care and develops a plan for ensuring that health needs are met. Responsibilities include development of plans for responding to emergencies and disasters and confidential communication and documentation of student health information.

3.The school nurse provides screening and referral for health conditions.13 Health screenings can decrease the negative effects of health problems on education by identifying students with potential underlying medical problems early and referring them for treatment as appropriate. Early identification, referral to the medical home, and use of appropriate community resources promote optimal outcomes. Screening includes but is not limited to vision, hearing, and BMI assessments (as determined by local policy).

4.The school nurse promotes a healthy school environment.13 The school nurse provides for the physical and emotional safety of the school community by monitoring immunizations, ensuring appropriate exclusion for infectious illnesses, and reporting communicable diseases as required by law. In addition, the school nurse provides for the safety of the environment by participating in environmental safety monitoring (playgrounds, indoor air quality, and potential hazards). The school nurse also participates in implementation of a plan for prevention and management of school violence, bullying, disasters, and terrorism events. The school nurse may also coordinate with school counselors in developing suicide prevention plans. In addition, if a school determines that drug testing is a part of its program, school nurses should be included in school district and community planning, implementation, and ongoing evaluation of this testing program.15

5.The school nurse promotes health.13 The school nurse provides health education by providing health information to individual students and groups of students through health education, science, and other classes. The school nurse assists on health education curriculum development teams and may also provide programs for staff, families, and the community. Health education topics may include nutrition, exercise, smoking prevention and cessation, oral health, prevention of sexually transmitted infections and other infectious diseases, substance use and abuse, immunizations, adolescent pregnancy prevention, parenting, and others. School nurses also promote health in local school health councils.

6.The school nurse serves in a leadership role for health policies and programs. As a health care expert within the school system, the school nurse is a leader in the development and evaluation of school health policies. These policies include health promotion and protection, chronic disease management, coordinated school health programs, school wellness policies, crisis/disaster management, emergency medical condition management, mental health protection and intervention, acute illness management, and infectious disease prevention and management.16

7.The school nurse is a liaison between school personnel, family, health care professionals, and the community.14 The school nurse participates as the health expert on the IEP17 and 50418 teams. IEP teams identify the special education needs of students; 504 teams plan for reasonable accommodations for students' special needs that impact their educational programs.18 As the case manager for students with health problems, the school nurse ensures that there is adequate communication and collaboration among the family, physicians, and providers of community resources. This is a crucial interface for the pediatrician and the school nurse to ensure consistent, coordinated care. The school nurse also works with community organizations and primary care physicians to make the community a healthy place for all children and families.

SCHOOL NURSE ACTIVITIES

The range of school health services varies by school district. The following health services are the minimum that should be offered, according to the American Academy of Pediatrics (AAP) manual School Health: Policy and Practice:19

•Assessment of health complaints, medication administration, and care for students with special health care needs;

•A system for managing emergencies and urgent situations;

•Mandated health screening programs, verification of immunizations, and infectious disease reporting; and

•Identification and management of students' chronic health care needs that affect educational achievement.

The AAP recognizes the need for appropriate management of student health conditions in its policy statement, “Guidelines for Administration of Medication in School.”20 It also recognizes the need for policies for emergency medical situations that can occur in school and the school nurse's role in developing and implementing these policies.21,22 The school nurse serves as an extension of traditional community health services, ensuring continuity, compliance, and professional supervision of care within the school setting.

SCHOOL HEALTH SERVICES TEAM

The school nurse functions as a leader and the coordinator of the school health services team. The team may also include a school physician, licensed practical nurses, health aides and clerical staff, school counselors, school psychologists, school social workers, and substance abuse counselors. The health team may also expand to create a coordinated school health team that integrates health services, health education, physical education, nutrition services, counseling/psychological/social services, healthy school environment, health promotion for staff, and family/community involvement.23 Occupational therapists, physical therapists, and speech-language pathologists may also be part of the school health team. A pediatrician often fills the school physician role, because pediatricians are knowledgeable about general pediatrics, school health, and adolescent health. School physicians review guidelines, policies, and programs related to health care in schools. In some schools, a pediatric or family nurse practitioner functions as the school nurse and may provide additional services. Unlicensed assistive personnel (unlicensed individuals who are trained to perform as an assistant to the licensed nurse) may be part of the school health services team. Although they may possess state certification in medication administration as a nursing assistant or other nursing tasks, they must be trained and supervised by the school nurse in accordance with state nurse practice laws to perform delegated nursing tasks. Under this approach, the school nurse has the responsibility to decide which nursing tasks may be delegated and to whom within the school setting, in accordance with state laws and regulations.

Some schools may have a school-based health center in or adjacent to the school, which may provide primary care and psychosocial services. The school nurse coordinates the activities of the school health services team with the child's primary care physician and/or with the school-based health center to provide continuity of care and prevent duplication of services.

PROFESSIONAL PREPARATION FOR SCHOOL NURSES

The AAP supports the goal of professional preparation for all school nurses and recommends the use of appropriately educated and selected school nurses to provide school health services. The National Association of School Nurses has determined that the minimum qualifications for the professional school nurse should include licensure as a registered nurse and a baccalaureate degree from an accredited college or university. There should be a process by which additional certification or licensure for the school nurse is established by the appropriate state board. The AAP supports national certification of school nurses by the National Board for Certification of School Nurses.24

CONCLUSION

The AAP supports having a full-time school nurse in every school as the best means of ensuring a strong connection with each student's medical home. Interim steps toward achieving this ideal can be made by achieving the Healthy People 2010 goal, which states that districts should employ at least 1 nurse per 750 students, with variation, depending on the community and student population.25 Schools with high percentages of students with special health needs would require more intensive ratios of nurse to students; for example, 1 nurse per 225 students when students require daily professional nursing services or interventions, and 1 nurse per 125 when students have complex health needs.26 The presence of the school nurse in every school allows the school physician to work most efficiently in providing the coordinated care that each student requires.

The AAP recommends and supports the continued strong partnership among school nurses, school physicians, other school health personnel, and pediatricians. These partners serve the health of children and youth best by facilitating the development of a coordinated school health program, facilitating access to a medical home for each child,27 and integrating health, education, and social services for children at the community level. School nurses, as part of a coordinated school health program, contribute to meeting the needs of the whole child and supporting their success in school.28

RECOMMENDATIONS

1.Pediatricians should establish a working relationship with the school nurses who care for their patients with chronic conditions to ensure that individual patients' health plans are executed effectively within the school. In addition, pediatricians' communications with school nurses concerning their patients should be sufficiently clear and detailed to guide school nurses in overseeing the care of individual children.

2.Pediatricians can offer direct support of school nurses by serving on school wellness policy committees, school health advisory committees, emergency preparedness committees, or other school-related decision-making bodies. In addition, local physicians may be asked to consult on or assist in writing school health-related policies.

3.School-based screening for vision, hearing, or other conditions may require coordination between local physicians and the school nurse to ensure students are referred for additional evaluation and treatment, and for communication with students, families, school administration, and the community.

4.Pediatricians should play an active role in supporting the availability and continuing education of the school nurse. This role may encompass updates on new AAP recommendations and research findings that would keep the school nurse's practice as aligned as possible with current AAP policy.

http://pediatrics.aappublications.org/content/121/5/1052.full

 

[kaytieeldr]

I've had 3 occasions this year where our school nurse was playing "doctor" and diagnosed incorrectly. First, she told me that my middle son had scoliosis and he needed to be seen by our physician. Took him and paid for an appointment and the doctor said "What? There's not even a hint that he has scoliosis." $140

Youngest son came home with orders that we needed to see his eye doctor because he failed his vision test and he is color blind. Took him to the eye doctor. Not only is his vision 20/20, but he isn't color blind either. $80

Then middle son came home with a note that he needed to see the eye doctor because he failed his vision test. I ignored the note. Then I got a second notice and I ignored it. I then got a phone call. I made the appointment, but I also told her what her diagnosis for the kids had cost me already this year. Sure enough......son's vision is fine. Another $80.

So, here's the recap: One school nurse who believes she is an MD = $300 in extra medical bills.

Okay, so, other posters have explained that these weren't tests, they were screenings. While your kids have doctors to visit, many kids don't. The only medical professional they see is the school nurse or the ER doctor.

Yes, $300 is a lot of money - but would you have felt better about spending it if your kids did have the conditions the screenings indicated? Compared to what you could have ended up paying (for scoliosis treatment, glasses/contacts, yearly exams) it's downright cheap!

 

[badblackpug]

Okay, so, other posters have explained that these weren't tests, they were screenings. While your kids have doctors to visit, many kids don't. The only medical professional they see is the school nurse or the ER doctor.

Yes, $300 is a lot of money - but would you have felt better about spending it if your kids did have the conditions the screenings indicated? Compared to what you could have ended up paying (for scoliosis treatment, glasses/contacts, yearly exams) it's downright cheap!

Amen! Between the 3 of us in this house that wear glasses we spent $1300 this year alone.

...and my father's last set of hearing aids before he died were $7500 a piece, and insurance didn't cover a penny.

...and most pediatricians don't do eye exams, and none do hearing tests. I would pay $300 for peace of mind any day.

 

[XYSRUS]

A scoliosis screening done at school caught my child's scoliosis- and just in time for bracing vs surgery! Happy Nurses' Week to all who give their all, everyday!

 

[kaytieeldr]

Youngest son came home with orders that we needed to see his eye doctor because he failed his vision test and he is color blind. Took him to the eye doctor. Not only is his vision 20/20, but he isn't color blind either. $80

Then middle son came home with a note that he needed to see the eye doctor because he failed his vision test. I ignored the note. Then I got a second notice and I ignored it. I then got a phone call. I made the appointment, but I also told her what her diagnosis for the kids had cost me already this year. Sure enough......son's vision is fine. Another $80.

I found some interesting information when I searched for "screening for color blindness", including

Because the Ishihara test requires the person being screened to recognize and identify numbers, the test may be less reliable when testing the color vision of very young children.

and

670 million people worldwide are blind or visually impaired simply because they don't have access to an eye exam and eyeglasses. All About Vision is a Gold National Sponsor of the efforts of Optometry Giving Sight to eliminate avoidable blindness due to uncorrected refractive error. We also encourage our readers to consider supporting these humanitarian eye care organizations.

Information from http://www.allaboutvision.com/eye-exam/color-blind-tests.htm and emphasis mine .

 

[tyniknate]

Then call your state because most states have mandated vision screenings at certain ages written into the school regulations.

Believe me the nurse has other things they would much rather do than all the paperwork and hassles of vision screening 500 to 1,000 kids!

Like everyone else has said they are there for the general well being of the school and community.

And do you honestly think that every child in that school gets a thorough yearly exam at a DR's?

You are very insulting to what you think a professional nurses abilities are.

I also would talk to my kids as to why they were fooling around during the screening because something caused them to fail it.

No, this is what a school nurse is supposed to do. I have the utmost respect for professional nurses, it's not a job I would want in any lifetime. My point was that I don't need all the constant interference in our lives. My kids are mandated to have a physical every year before school and my physican does a very thorough exam. This is where my child is (and should be) screened for scoliosis and such, not at school. I'm insulted that this person has cost me so much extra money this year for reasons that were completely unfounded. (even after speaking with her and telling her my child had already been screened, she insisted we be seen again.) If my child is sick or hurt at school please let me know. Otherwise....let our family physician or physician's assistant or nurse do their job. I'm not trying to be insulting. I just think the constant intrusion into our lives is a bit much, but I guess I can see the point if its a family who doesn't have access to healthcare. I did not mean to insult any heathcare professional. Maybe we just have a problem with the one who is at our school? Is it possible we just have one who isn't administering properly or is hyper-cautious?

 

[kimmyann]

Believe it or not, but I actually appreciate the school screenings that are provided every year. Eye screenings were what prompted all three of my kids to go to the eye doctor & now they all have glasses.

And no, people who don't wear glasses & don't get an eye exam do not realize they can't see. After 40 years my husband had to get glasses because he failed the vision screening for a new job. His reaction was the same as the kids when they put the glasses on for the first time "wow, I can see". Btw, they all have an astigmatism, the eye doctor says it is hereditary.

 

[Nancyg56]

I've had 3 occasions this year where our school nurse was playing "doctor" and diagnosed incorrectly. First, she told me that my middle son had scoliosis and he needed to be seen by our physician. Took him and paid for an appointment and the doctor said "What? There's not even a hint that he has scoliosis." $140

Youngest son came home with orders that we needed to see his eye doctor because he failed his vision test and he is color blind. Took him to the eye doctor. Not only is his vision 20/20, but he isn't color blind either. $80

Then middle son came home with a note that he needed to see the eye doctor because he failed his vision test. I ignored the note. Then I got a second notice and I ignored it. I then got a phone call. I made the appointment, but I also told her what her diagnosis for the kids had cost me already this year. Sure enough......son's vision is fine. Another $80.

So, here's the recap: One school nurse who believes she is an MD = $300 in extra medical bills.

I find it odd that your children managed to "fail" screenings on three separate occasions. I am not suggesting that a school nurse is infallible, far from that. I am suggesting that perhaps there is a common denominator when two children in the same family fail three screenings.

 

[SaraJayne]

Amen! Between the 3 of us in this house that wear glasses we spent $1300 this year alone.

...and my father's last set of hearing aids before he died were $7500 a piece, and insurance didn't cover a penny.

...and most pediatricians don't do eye exams, and none do hearing tests. I would pay $300 for peace of mind any day.

As insulting as a couple posters have been to nurses, I wanted to say our ped does do hearing tests. Both my kids had a hearing test at their annual physicals a couple months ago.

 

[tyniknate]

I find it odd that your children managed to "fail" screenings on three separate occasions. I am not suggesting that a school nurse is infallible, far from that. I am suggesting that perhaps there is a common denominator when two children in the same family fail three screenings.

Yes, the school nurse. If it had been one child failing three tests I would blame my child. Since it is two children, it's the nurse. My kids hate going to the doctor for physicals and I can assure you that neither one thought it would be a good idea to purposely fail a screening because they know that would mean another doctor appointment. It couldn't possibly be that the school nurse is at fault. Whatever!

This whole disboard has gotten ridiculous. Doesn't matter what topic you post your opinoin on, it turns into a huge battle. I think way too many people with way too much time on their hands just come on here trolling for fights. Heaven forbid you post your true opinion. People only want to hear the answer that agrees with what they believe. This is not the place it was when I joined here in 2008. Now it's just a bunch of nasty, catty people lookin for trouble. Have a grand time picking each other apart. I'll find my Disney nirvana somewhere else! Peace out, yall!

This message will "self-destruct" (disappear) in 29....28.....27....26..... (or whenever a moderator gets their hands on it.

 

[npmommie]

As insulting as a couple posters have been to nurses, I wanted to say our ped does do hearing tests. Both my kids had a hearing test at their annual physicals a couple months ago.

yes, our pedi does hearing test as well.

 

[SaraJayne]

Yes, the school nurse. If it had been one child failing three tests I would blame my child. Since it is two children, it's the nurse. My kids hate going to the doctor for physicals and I can assure you that neither one thought it would be a good idea to purposely fail a screening because they know that would mean another doctor appointment. It couldn't possibly be that the school nurse is at fault. Whatever!

This whole disboard has gotten ridiculous. Doesn't matter what topic you post your opinoin on, it turns into a huge battle. I think way too many people with way too much time on their hands just come on here trolling for fights. Heaven forbid you post your true opinion. People only want to hear the answer that agrees with what they believe. This is not the place it was when I joined here in 2008. Now it's just a bunch of nasty, catty people lookin for trouble. Have a grand time picking each other apart. I'll find my Disney nirvana somewhere else! Peace out, yall!

This message will "self-destruct" (disappear) in 29....28.....27....26..... (or whenever a moderator gets their hands on it.

 

[DopeyDame]

No, this is what a school nurse is supposed to do. I have the utmost respect for professional nurses, it's not a job I would want in any lifetime. My point was that I don't need all the constant interference in our lives. My kids are mandated to have a physical every year before school and my physican does a very thorough exam. This is where my child is (and should be) screened for scoliosis and such, not at school. I'm insulted that this person has cost me so much extra money this year for reasons that were completely unfounded. (even after speaking with her and telling her my child had already been screened, she insisted we be seen again.) If my child is sick or hurt at school please let me know. Otherwise....let our family physician or physician's assistant or nurse do their job. I'm not trying to be insulting. I just think the constant intrusion into our lives is a bit much, but I guess I can see the point if its a family who doesn't have access to healthcare. I did not mean to insult any heathcare professional. Maybe we just have a problem with the one who is at our school? Is it possible we just have one who isn't administering properly or is hyper-cautious?

As another poster pointed out, schools almost always have an opt-out method if your child has recently been evalutated for a physician for vision, hearing, or scoliosis. Because of a surgery I had when I was little, I ALWAYS got tagged in the scoliosis screening. So after two years of that, my mom just sent in the doctors note and medical record, and I was excuses from the scoliosis screening - no biggie.

You should look into that for next year.

 

[minniecarousel]

I am amazed that schools have school nurses! In a HS of 2000 students, we have a school nurse one day a week. And she is here just for paperwork. I know that middle and elementary schools have a nurse assigned to them, but I imagine she stops by each campus maybe once every other week. Our secretaries have sick kids call their parents. So a school nurse "diagnosing" wouldn't happen.

 

[kaytieeldr]

Yes, the school nurse. If it had been one child failing three tests I would blame my child. Since it is two children, it's the nurse. My kids hate going to the doctor for physicals and I can assure you that neither one thought it would be a good idea to purposely fail a screening because they know that would mean another doctor appointment. It couldn't possibly be that the school nurse is at fault. Whatever!

This whole disboard has gotten ridiculous. Doesn't matter what topic you post your opinoin on, it turns into a huge battle. I think way too many people with way too much time on their hands just come on here trolling for fights. Heaven forbid you post your true opinion. People only want to hear the answer that agrees with what they believe. This is not the place it was when I joined here in 2008. Now it's just a bunch of nasty, catty people lookin for trouble. Have a grand time picking each other apart. I'll find my Disney nirvana somewhere else! Peace out, yall!

This message will "self-destruct" (disappear) in 29....28.....27....26..... (or whenever a moderator gets their hands on it.

You don't say how old your sons were at the time of the screenings. As the information I located and posted indicates, a child too young to recognize numbers in the color-blindness screening (not test) might fail that screening for that reason without actually being color-blind. You also don't say if your kids' doctor includes vision screening (again, not tests) in their physicals - but since these are non-invasive exams, there's no reason your kids should "hate" to have these screenings, and ultimately tests by professionals,

 

[SaraJayne]

I am amazed that schools have school nurses! In a HS of 2000 students, we have a school nurse one day a week. And she is here just for paperwork. I know that middle and elementary schools have a nurse assigned to them, but I imagine she stops by each campus maybe once every other week. Our secretaries have sick kids call their parents. So a school nurse "diagnosing" wouldn't happen.

No school nurse here, either. I've never gone to a school that had a nurse.

 

[minkydog]

This thread makes me sad. Sad for all the kids who don't have a school nurse, sad for the ones who don't have a *good* school nurse, and sad for the parents who obviously don't trust the school nurse.

I've been a school nurse for 5 years, but I've been a nurse for 35 years (28yrs in pediatrics.) I see my role as keeping children healthy so they can stay in school. My style is a mixture of Tough Love and Warm/Fuzzy. I can be sweet when I need to be or I can be firm when the situation calls for it. I know all the school nurses in my district and they are some of the best educated, most experienced nurses I have ever met. Our skills go waaaaay beyond head checks and ice packs. We screen hearing & vision *required by law in certain grades*.We give insulin, epipens and breathing treatments. We stand in the gap for kids whose parents have beaten the crap out of them. Or the ones whose parents just don't give a fig. And of course, we wipe noses, clean up vomit, issue bandaids & ice packs, and change the occasional pee-pee or poo-poo pants. All this for $19/hr and we do it every day, with a smile.

My job is not to diagnose--that would violate the Nurse Practice Act in my state. My job is to look at all the symptoms and decide 1) can this wait until the child gets home or does it need a doctors eval right away? 2) could this get worse before 3pm? 3) does the symptom picture seem to point to contagious illness? 4) is this life-threatening? The answers to those questions are either call parent, send a note home, recommend evaluation, or call 911. Diagnosis doesn't have a place in my work.

If i could have one wish it would be that all children would get the medical and dental care they need, when they need it. That every child would have parents who love them and put them first. I wish every school could have a nurse, because nurses *want* to help kids stay healthy and do well in school.

 

[minniecarousel]

this thread makes me sad. Sad for all the kids who don't have a school nurse, sad for the ones who don't have a *good* school nurse, and sad for the parents who obviously don't trust the school nurse.

i've been a school nurse for 5 years, but i've been a nurse for 35 years (28yrs in pediatrics.) i see my role as keeping children healthy so they can stay in school. My style is a mixture of tough love and warm/fuzzy. I can be sweet when i need to be or i can be firm when the situation calls for it. I know all the school nurses in my district and they are some of the best educated, most experienced nurses i have ever met. Our skills go waaaaay beyond head checks and ice packs. We screen hearing & vision *required by law in certain grades*.we give insulin, epipens and breathing treatments. We stand in the gap for kids whose parents have beaten the crap out of them. Or the ones whose parents just don't give a fig. And of course, we wipe noses, clean up vomit, issue bandaids & ice packs, and change the occasional pee-pee or poo-poo pants. All this for $19/hr and we do it every day, with a smile.

my job is not to diagnose--that would violate the nurse practice act in my state. My job is to look at all the symptoms and decide 1) can this wait until the child gets home or does it need a doctors eval right away? 2) could this get worse before 3pm? 3) does the symptom picture seem to point to contagious illness? 4) is this life-threatening? The answers to those questions are either call parent, send a note home, recommend evaluation, or call 911. Diagnosis doesn't have a place in my work.

If i could have one wish it would be that all children would get the medical and dental care they need, when they need it. That every child would have parents who love them and put them first. I wish every school could have a nurse, because nurses *want* to help kids stay healthy and do well in school.

well said!!

 

[SaraJayne]

This thread makes me sad. Sad for all the kids who don't have a school nurse, sad for the ones who don't have a *good* school nurse, and sad for the parents who obviously don't trust the school nurse.

I've been a school nurse for 5 years, but I've been a nurse for 35 years (28yrs in pediatrics.) I see my role as keeping children healthy so they can stay in school. My style is a mixture of Tough Love and Warm/Fuzzy. I can be sweet when I need to be or I can be firm when the situation calls for it. I know all the school nurses in my district and they are some of the best educated, most experienced nurses I have ever met. Our skills go waaaaay beyond head checks and ice packs. We screen hearing & vision *required by law in certain grades*.We give insulin, epipens and breathing treatments. We stand in the gap for kids whose parents have beaten the crap out of them. Or the ones whose parents just don't give a fig. And of course, we wipe noses, clean up vomit, issue bandaids & ice packs, and change the occasional pee-pee or poo-poo pants. All this for $19/hr and we do it every day, with a smile.

My job is not to diagnose--that would violate the Nurse Practice Act in my state. My job is to look at all the symptoms and decide 1) can this wait until the child gets home or does it need a doctors eval right away? 2) could this get worse before 3pm? 3) does the symptom picture seem to point to contagious illness? 4) is this life-threatening? The answers to those questions are either call parent, send a note home, recommend evaluation, or call 911. Diagnosis doesn't have a place in my work.

If i could have one wish it would be that all children would get the medical and dental care they need, when they need it. That every child would have parents who love them and put them first. I wish every school could have a nurse, because nurses *want* to help kids stay healthy and do well in school.

My sister was a school nurse for a few years before she went into Public Health and she wants the exact same thing for children.