What is a School Nurse?
Gerri Harvey, RN, MEd
School nursing is different from other specialties. Perhaps the most striking difference is the autonomous nature of the work. As the only health professional in a world of educators, the school nurse is in a position of either being highly valued and regarded for her unique interdisciplinary role or under-utilized and misunderstood because she does not function in quite the same way as an educator.
Most school nurses love the autonomy but chafe at the misunderstanding of their role. Even other nurses tend to under-value what a school nurse does. How often we hear, "Oh, a school nurse? Well that must be a nice little job with summers off and all." Little do they know that the only nurses who make it as school nurses are those who are experienced, confident, multi-skilled, self-directed, independent, creative, collaborative, communicative, flexible, tactful, and passionate about kids' health? School nurses must strive for best practice, adhering to their state's nurse practice act while also working in a non-medical, unpredictable setting, usually without benefit of health care colleagues and always without benefit of a medical team. It's a lot more than putting on bandaides. Only the best, the mature, and the experienced need apply.
School nursing is not for wimps or "medical model" nurses who think that a school nurses' office is a mini ER. It's not. A school nurse must be good at everything, not only emergency care, but also nursing assessment, chronic illness management, complex medical conditions, epidemiology, prevention, safety, teaching, screening, documentation, counseling, health promotion, crisis management, coaching, communicating, care management, policy development, social work, budget and fiscal issues, program development, grant-writing, employee health, community health, legal issues, politics, advocacy, care plan development, pharmacology and computer documentation. It also helps if you can produce newsletters, bulletin boards, staff in-services, and school board presentations. And that's just for starters.
School nurses must also be able to speak the language of education. While the nurse might see her role as one of providing health care in the school, educators will see her as a supporter of the real job of schools; to educate kids. For that reason, the nursing that is performed in schools has a different focus than nursing in an acute care setting. The school nurse is more than a nurse. She is also a bridge between the health care community and the school. She translates health issues into language educators can understand and vice versa. She develops IHP's, Individual Health Plans, which complement and support IEP's, Individual Educational Plans, and EAP’s, Emergency Action Plans, for children with a health risk. She also must train and delegate procedures routinely done by the nurse, because she is unable to be at the school every day. She must sign off on and stand behind her training and let her license back the paraprofessionals doing the procedures, such as medication administration.
Former Surgeon General, Jocelyn Elders said, "You cannot educate a child who is not healthy, and you cannot keep a child healthy who is not educated." Most nurses are able to understand and articulate why good health is a prerequisite for educating a child. Part of school nursing is also being willing to educate the public about what a school nurse contributes to the education of kids, not to mention their health. Societal changes have impacted schools tremendously, and children today come to school needier and sicker than they did in the past. The school nurse ensures that they do so safely.
There are not, as you might imagine, many ho-hum nurses working in schools. Those who see the challenges as exciting opportunities thrive there. School nurses who stick with it tend to feel pretty passionate about what they do. School nursing is more than a job it is a vocation. You take the job home with you at night, there's no escaping it. The school nurse is more than a school nurse to the people who live here; she is really our community nurse. There's not a parent who has raised a child here who doesn't know her and owe some small or major miracle to the nursing care she bestowed upon our child in school. She has saved lives outright in emergencies, and less dramatically when she has spotted some small problem that would have grown enormous were it not for her nursing intervention. She knows us all and loves our kids and families.
No school nurse goes out in public without being on unofficial duty, for your "patients" are everywhere. Little kids shout out to the world, "LOOK!! It's my nurse!!!" Bigger ones say shyly, "Remember me? You're my old nurse!" (Not "old" you say with a smile, "former".... and yes, of course I remember you," because you do.