This is How COVID Has Changed My Job as a School Nurse
By Amy Isler, MSN, RN, CSN
The year 2020 has changed what it means to be a nurse. It has elevated our strength, compassion, expertise, and shown the world that nurses are instrumental not only in guiding a nation through a pandemic, but communities and hospitals would collapse without us.
If you work in a hospital, it is more than likely that your nursing skills have been challenged in a way that you have never experienced before. Figuring out how to treat severely ill patients with an unfamiliar virus, along with the fear of contracting it yourself is not something that is taught in nursing school. You have adapted quickly amongst an ever changing landscape while continuing to keep your patient’s best interests as your top priority.
The reason we do it, the reason we become nurses is to help people, and treat your patients with the best possible care. But, what happens when schools close and school nurses are left with no children, no patients, a lack of purpose, and little guidance? What happens when the reason you became a nurse is taken away from you? I will tell you what you do. You adapt quickly, pivot your purpose, and figure it out right beside the rest of them.
How COVID-19 Changed the School Nurse Landscape
On March 13, 2020, during my sixth year working as a school nurse, an automated message was sent by the school district announcing that schools were shutting down effective immediately due to the rapidly spreading novel coronavirus. It was the last day I saw children on our campus, and the last day I was a school nurse in the traditional sense.
During a regular school year, a school nurse is responsible for a number of health, safety, and emergency action items. A few examples are:
- Managing all children with chronic conditions (diabetes, epilepsy, food allergies, asthma, sickle cell anemia, cystic fibrosis, etc.) including creating individual health and safety plans for each student
- Educating and training teachers and staff on student health, safety, and emergency plans; Epi-Pen administration, glucagon administration, signs of hypoglycemia and hyperglycemia, seizure first aid, concussions, emergency first aid, asthma symptoms, CPR and AED training, etc.
- Act as a health advocate during Individualized Education Program (IEP), 504 Plan, and Student Success Team (SST) meetings
- Manage the immunization status of each student ensuring they are up-to-date and compliant with state laws
- Conduct both vision and hearing screenings on mandated grade-levels and students with an IEP
- Overseeing and ensuring that all processes and procedures related to medication at school are compliant with state laws
- Ensuring that all board policies regarding health and safety are up-to-date and reflect best practices
After schools closed, my role quickly shifted from the caretaker to the informer. I started a blog from home that outlined everything we knew about the virus so far, how to keep you and your kids sane indoors, and trying to educate our small community on how to stay safe. I researched PPE and thermometers for our schools, I kept up-to-date on public health guidance, but to be honest, I was lost. I didn’t know how to be a nurse for a school with no children.
In August, distance learning continued, and I returned to a near empty school site. My role and responsibilities now encompassed developing a safety plan for when schools did eventually re-open. Currently, my days are now filled with:
- Logistics Committee Meetings- Physical and social distancing, classroom setup, pickup and drop off plans, school lunch distribution, etc.
- Developing a COVID-19 Nurse Plan- Identify isolation room, COVID-19 symptom flowcharts, contact tracing, PPE, infection control, first-aid, etc.
- Teacher and Staff Education- healthy hygiene, how to properly sanitize, when to send a student to the nurse, COVID-19 symptoms, in-room first aid, etc.
- Communication to Parents- Newsletters, mental health and self-care guidance, etc.
- Immunization management- My state law still enforced that each child be up-to-date on immunizations regardless if they were in school or not
- CPR/AED Training for school staff- following updated RedCross guidance
- Virtual IEP, 504 and, SST meetings
In late October, our schools opened with a staggered hybrid model; first with kindergarten in October, and ending with middle school and high school students coming back after the New Year. This plan went smoothly until after Thanksgiving break when cases in our community skyrocketed and the district decided to go back to distance-learning.
As we travel into a new year, the fate of our school children is still unclear, but as nurses we adapt and pivot to meet the needs of our patients and our community.
Overview of School Nursing
School nursing is considered a specialized practice of nursing that is rooted in the public and community health models of care. According to the National Association of School Nurses (NASN), school nurses are grounded in ethical, evidence-based practice, are the leaders that bridge health care and education, provide care coordination, and advocate for quality student-centered care.
The mission of NASN is that there is a registered school nurse in every school, all day, every day. However, according to a study conducted by NASN in 2018, fewer than 40 percent of schools in the U.S. employ full-time school nurses, creating a nursing shortage that will more than likely get worse post-pandemic.
Framework for the 21st Century Nursing Practice
In 2016, NASN published the new Framework for the 21st Century Nursing Practice, which is a streamlined foundational plan that helps guide school nurses in ensuring the health and safety of school aged children.
This framework outlines four main pillars of nursing care; Care Coordination, Leadership, Quality Improvement, and Community/Public Health that help drive the profession forward into what it means to be a school nurse today.
The below graphic goes into more detail on each pillar:
Pros and Cons of Becoming a School Nurse
As a new graduate of an accelerated bachelor of science in nursing program (ABSN), I entered school nursing blindfolded. My plan was never to become a school nurse- they never really talked about it in nursing school- but as I was in search of an acute care position, I took a part-time job at a local school district and never looked back.
It has fulfilled my professional expectations in ways I didn’t think were possible, and I have developed a great appreciation for public, community, and school based nurses.
Here are what I consider the pros and cons of being a school nurse:
- The schedule- No nights, weekends, or holidays. Paid time off for thanksgiving, Christmas, and spring breaks as well as summers off
- Strong relationships- Building strong and lasting relationships with students, parents, and staff. Watching a student with Type 1 diabetes grow from kindergarten to high school is priceless
- Family oriented- If you have small children, you won’t miss their milestones. As they progress through school, you will be on their same schedule. No more missed activities
- Autonomy- You can coordinate and set up your nursing practice in a way that works for you and your nursing style
- The pay- All school districts are different, but the pay is usually significantly lower than working in acute care. But if you keep the schedule and hours in mind, then it balances out.
- Autonomy- Depending on your personality type and confidence level, this could be a pro or con. You will most often be the only health professional at your school site and possibly your district. It can also be isolating to be the only nurse.
- Lots of Grey Area- Working in a school is nothing like working in a hospital. There is a lot of grey area that you will have to work through. The processes and procedures are not as streamlined like they are in acute care.
- Different skill set- You will use a different skill set when working as a school nurse, which can be disheartening to those that spent years building acute care skills.
Is School Nursing Right For You?
Nurses who are flexible, creative, open-minded, problem solvers and have the ability to be a team player are those that also thrive as a school nurse. The ability to build relationships with teachers, staff, and administrators is also key to a successful career at a school.
Depending on the size of the district, you may join a well-established health services team that has spent time and resources in ensuring that nurses are represented at all their school sites. However, in rural areas, or smaller districts, you may be the only nurse on staff. In this instance, you need to be a self-starter who can figure things out with little to no direction. This is where your creative, critical thinking and problem solving skills will shine.
Since school nursing is a specialized branch of nursing, some states require a continuation of education. For example, the San Diego County Office of Education defines the credentialed school nurse role as a bachelor’s degree prepared registered nurse, licensed by the California Board of Registered Nursing and credentialed with a specialization in health authorizing services as a school nurse by the Commission on Teacher Credentialing.
Depending on the state, becoming a credentialed school nurse could require the following;
- Bachelor of Science in Nursing degree
- Current RN License
- Preliminary School Nurse Credential (applied for usually through the department of education)
- Graduation from a School Nurse Credential Program (usually a one year program that must be completed within 5 years of being hired as a school nurse)
School nursing may not be for everyone, but if you're looking for a change in your nursing career, or looking to step away from the beside, I encourage you to check it out.
Nursing is not defined by where we practice, or the severity of our patients. Nursing is defined by our ability to quickly adapt, pivot our purpose, and react to the needs of our community.
Amy Isler, RN, MSN, CSN, is a registered nurse who has over six years of experience working as a credentialed school nurse. She has built a school health services department from the ground up that incorporates staff training, health policies and procedures, safety and emergency guidance, individual healthcare plans, mandatory screenings, special education services, and most currently, COVID-19 guidance.
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