School NursingSchool NursingSchool NursingSchool Nursing

Mary Lou Findley RN, MSN,CSNMary Lou Findley RN, MSN,CSN

History of School Nursing

• First school health services in the US started in Boston in 1894 for medical inspections only. These inspections were designed to identify for exclusion from school students with serious communicable disease (scarlet fever, diphtheria, pertussis, chickenpox, mumps).

• Later inspections were broadened to include screenings for parasitic diseases (scabies, impetigo, ringworm).

• The problem with these medical inspections were no follow-ups were done on those children who were excluded from school.

• Enter Lillian Wald…

• Ms. Wald challenged NYC officials and the Board of Ed. to allow her to place a public health nurse in selected schools on an experimental basis to increase school attendance by educating school officials, parents, and children regarding disease control and by home visit follow-up on known cases. In Nov. 1902, Ms. Wald placed Lina Rogers as the first school nurse in 4 NYC schools with the greatest exclusions.

The superintendent of nurses, Ms. Lina

Rogers, inspecting school children.

                                       

            The superintendant of nurses, Ms. Lina Rogers, inspecting school children.

• Shortly after, the NYC Board of Ed. hired 25 more nurses.

• A statistical comparison of the number of students excluded for communicable diseases before and after the hiring of the school nurses revealed: In Sept. 1902, 10,367 students were sent home, whereas in Sept. 1903, only 1,101 students were excluded.

The 21st century school nurse

There is more to the job that meets the eye of the casual observer. Today’s SN does :

Screenings, ensures immunization compliance, develops individual health care plans (IHP) for children with complex or chronic health conditions, does injury/illness assessments, provides health counseling, educates parents, staff, and students about health issues, administers and monitors medications, treatments and self care,

…responds to neglect and abuse issues, prevents emergencies, teaches, inspects school’s building, play grounds, sports fields for compliance with OSHA (Occupational Safety & Health Administration), deals with crisis, writing reports (grants), budgets, entering data into the computer (sports physicals, immunizations), reviewing and interpreting medical reports, documentation, documentation, documentation…meetings, conferences.

Why Schools Hire Nurses• Schools want children in schools, ready to learn.

Both conditions depend upon being healthy.• Schools need someone to intervene around

health-related barriers to learning.• Schools need specialist in dealing with complex

health conditions, chronic illness management and acute conditions which impact individuals and population.

• Schools need someone skilled in performing first aid, illness assessment and care.

Rewards for the School Nurse

• Making a difference before it’s too late.

• Whole person nursing.• Autonomy.• Wellness focused care.• Diversity in role. • Schedule (school vacation/summer).

Challenges• How a nurse impacts educational issues.• Funding/Budgets/Resources.• Public misconceptions, professional

isolation.• Unpredictable and non-medical setting• Teaching to groups.• Schedule.

Pay• National avg. around $33,500. New Jersey

$35,311, avg. teacher/SN salary $53,192.• Pay scale is determined on teaching, not

nursing, experience. May start at Level I.• No merit pay, but increases are automatic if

SN has contract.• Pay more for degrees and longevity.• May be able to negotiate for a higher starting

salary.• Can spread your salary over the summer.

Job Description• Tend to focus on the task• Focus on education needs, not health

needs• May have been written by a non-nurse• May be antiquated or non-existent• Might include things you don’t consider a

nursing function (e.g. lunch duty)• May include classroom teaching

Qualifications• Vary by state.• RN with child health experience in most

states.• Some states require BSN or other BS,

specialty certification in SN (state or national), degree in education, public health or relative field (Nsg. Adm., NP).

Skills & Qualities Schools Want

Expansive view of nursing, organized, flexible, likes variety and the unexpected, good communicator, creative, leader, collaborative, high energy, public health minded, computer literate, understands budgets, self directed, varied experienced, outcome focus, understands educational goals.

Who doesn’t make it as a School Nurse

Looking for an easy job.Likes a plan and likes to stick to it.Nervous making independent nsg. interventions

without a doctor’s order.Believes nsg. is caring for the sick and injured

only, the rest isn’t a nurse’s job.Mommy focus (do everything for them instead of

teaching stds. how to care for themselves).Wants to save the world (guaranteed to lead to

fast burnout).

Sees documentation as just needless “paperwork”.

Believes head lice, hygiene and sick kids are the parents responsibility, not shared by the school.

Would rather report than support parents.Expect 9 to 3 with summers off and won’t

work a minute longer.Wants enforceable policies and rules for

everything, easier than educating and supporting parents.

Trying out School Nursing

Substitute, net work, find a mentor, volunteer.

These are great ways to get SN experience, inside scoops from principals and other School Nurses.

…on the other hand, these might convince you that SN is NOT for you and save you from making a career move you might regret.

Finding SN JobsAsk other SN. Go to their conferences, join

state, local SN associations.Send applications to a district even if

there is no opening advertised (address to superintendent).

Jobs are usually advertised in newspapers under “education” (not under health/medical).

Typically advertised in April/May, when contracts are up.

Visit www.njhire.com

Your Resume FocusHighlight community involvement (volunteer and

paid) with kids, health, education.Diverse work experience (since the SN must do it

all).ER experience often a plus, though they may not

see your ICU experience might be relevant (be prepared to convince them).

Your flexibility and communication skills.Your ability to work independently but also a

team player.Your ability to work with a diverse population.A philosophy of supporting kids and families for

school success.

Best ReferencesSchool administrators, teachers, SN,

parents: Why these? Educators are not concerned with nursing skills or nsg. experience (they see this on your resume)… they want to know, can your transfer these skills to an educational setting. Can your take direction from a non-nurse, non-medical boss? Will you get along with teachers, students, parents, who may not understand nsg. goals.? Can you speak OUR language?

Things they may ask…Why do you want this position?Tell us what you think a typical day here in the nsg. office

might look like.How does your past nsg. experience relate to this role?What strengths’ would you bring to the school and the

team?What weaknesses do you have?What are you like in a crisis? Under pressure?How would you handle an irate parent?Scenario? Such as: what would you do if 40% of the stds.

Had not turned in their immunizations documentation by the due date? (HINT: the school’s role is to keep children IN school, not out).

12 worst things to say in interviews

• I want this job so I can be off when my kids are off.

• I am looking for something less demanding/easier.

• I have always wanted to get into the schools.

• I am burned out with hospital (or wherever you are now) nursing.

• I am sick of working with doctors/other nurses/my boss.

• I want this job so I can have the summers off.• That’s the parents’/teachers’ responsibility.• I just think kids are so cute.• If I wanted to teach, I would have become a

teacher.• I would call the doctor to ask what I should do.• I would call DYFS/the authorities/the police/the

state.• If I don’t see blood, vomit or a temp. over 101, I

would send that child right back to class!

(Good) Things To Know• You may have a non-nurse or a nurse

coordinator, but maybe you won’t.• The Principal is usually your boss.• The Superintendent in the Principal’s

boss.• The School Board is the Super’s boss.• HOWEVER…parents, teachers,

counselors, union contract, town/city budget committees ALL have a big say too.

In Summary• SN is an inter-disciplinary specialty which

includes nsg. and education. You need to invest in both.

• Experience matters: SN is autonomous and is not for the novice nurse.

• Schools see the SN role as one that supports the mission of education, not the other way around (even though schools are crucial in meeting public health goals around children.

• You have most the skills you need already.

• You can acquire the additional skills around educational goals and outcomes that none of us learn in nursing school.

• Substitute, volunteer, read the ads, in order to find a job.

GOOD LUCKGOOD LUCK