DearG1

I am a RN that works in a public school setting. I am in charge of the High School and upper elementary. I am having a problem with the fact that my degree and nursing ability are not valued by the staff much less the administration. In my state, an RN is a certified employee and we get the same benefits and pay as teachers. As you well know, a school nurse wears many hats! My background is Psyc. and High Risk Labor and Delivery and Pediatrics/PICU. I have really been fortunate to have my background many times. I love the connection and trust I can and do make with my adolescent students. The problem is that I am never able to finish paperwork much less spend time behind close doors with a parent or child in need without constantly being interrupted.

I know this sounds petty but I need you to understand that when I say interrupted, I mean from everybody! They will barge in if my doors is closed or if I am on the phone and start talking to me as if what I am doing is unimportant. I see probably 30 kids a day for paper cuts and chap stick in which I might add I never can see where the cut is.

I have given the teachers band-aids and other supplies but it hasn't done any good! My own principal does the same thing. I know that I have made a difference in peoples life on certain occasions and that is why I got into nursing! I just feel my education is not utilized at all. I just don't think I can stand this any longer! Do you have any suggestions as to what I can tactfully do?

I think the issue you speak of is a universal one for school nurses and one we all struggle with...how do we balance being available and responsive with being proactive and responsible. We don't want the most important things like screening, documentation, listening and confidentiality to be at the mercy of the least important things like paper cuts. Yet it can seem that way.

To us, being barged in on and interrupted for trivial things by students and staff alike feels like intentional disregard and even disrespect for our professional role, but I don't think that is what is necessarily behind it at all. I think people walk right in because that is what they have become accustomed to doing and they think it is all right because you may have been too nice to say it isn't or have not let them know how you would like them to access your services.

I want you to know I struggled with this issue myself. I wanted my staff and students to be well-served and happy with me, and my tendency is to be very nice. I also realize that ultimately, my role is to support the real work of the school....education....and so I felt that I had no say or control over when and what came my way. But I have found after years at this, that there are some things you can do to change the situation.

First of all, set up a schedule for the day and for the week. For example, maybe you will be screening and following up between the hours of 9-10 on Monday, Wednesday and Friday and catching up on paper work daily between the hours of 1-2 on Tuesday and Thursday. Let the staff know that this is your plan. Encourage them to let you know if there is a student who needs screening for an IEP meeting or because of concerns so you can prioritize those. Let them know that during this time, you will only see emergencies. Let them know nicely and matter-of-factly. Let the office know, and ask them if they would feel comfortable triaging anyone who shows up thinking it is an emergency, and to call you on the phone if they think it is.

Then, cover the window in your door with a shade ("to protect confidentiality"), put out a sign, and lock the door. If someone knocks, answer it, but ask them to come back at a specific time or do their best with it on their own. Don't let them in though unless you decide it is urgent. In time, they will realize that you really are busy during those times and won't see them unless it is an emergency.

When you have a student, parent or staff member who needs confidentiality, or a phone call that requires privacy, put out your sign that says "Privacy Needed: Please Return in Ten Minutes. If Urgent, Go to the Office" , lock the door, and close the shade. I have found that this works really well in my middle school, and even the staff respect it.

Am I the only school nurse in the country who is fed up with frequent fliers? Everyone I talk to seems to think this is what their job is all about. If it is, then I think I am in the wrong business. I do not agree that the majority of these children have deep unmet needs that only the nurse can tease out. These children have been conditioned to think that every bump needs to be seen by the nurse, every gas pain, every ache,every little twitch that is unusual must be evaluated. When did this begin?

Are we raising a society of complainers that cannot tolerate minor discomfort for a fleeting moment? These children absolutely feel it is their duty to report every uncomfortable body sensation to their teacher and their teacher, to deal with the rising number of complainers and litigious parents, sends them all down to the nurse. Since when is getting hit by the ball on the arm or the thigh an injury

I am not burned out, I see a dangerous trend! Please do not think that I or my entire department haven't tried numerous approaches from educating teachers about the 5 minute headache or stomach ache to educating classrooms about sick or well, to educating parents about appropriate use of the health office. Still, the numbers grow and the health office overflows. Teachers are overwhelmed. Playground supervisors fear law suits. In the mean time my colleagues and I spend all day doing what any warm body could do. Well, sorry, I break rank with all my nurturing, well meaning, nurse friends who feel that being there for the students means 6 to 7 hours of addressing the complaints of children who are not sick, injured, or emotionally needy.They simply are trained and conditioned to come to the nurse... because we are there. And this... is not a healthy trend.

No, you are not the only one who feels this way, I sometimes have these same frustrations myself. What you are describing is about not wanting to foster learned helplessness and not wanting to teach children to use or abuse the health care system inappropriately. After all, we do not want our schools to become the training grounds for The Future Hypochondriacs of America.

I do not think that as a school nurse you can change the way every staff person views minor injuries and complaints, wanting it to be the nurse's call. They do not want to be the ones to decide whether it is "something" or "nothing." Those of us who have been school nurses for many years have our own stories of the teachers who said to the frequent whiner, "You're fine, sit down," only to learn the hard way that the child had a fractured wrist, or a concussion or walking pneumonia. One incident like that, complete with angry parent, is all it takes for teachers and aides to thank their lucky stars that there is a school nurse whose job it is to make an assessment, whether it's a five minute headache or a paper cut.

Likewise, most teachers and aides have had the experience of facing an angry parent who is demanding to know why her child was denied being able to see the school nurse. To the parent, the school nurse is the expert, the one in whom she has the trust when it comes to health and safety issues. Possibly, that parent is a taxpayer who defended keeping a school nurse in the budget for that very reason.

Those things you have already done...educate parents and teachers and handing out band-aides are good things to do. But I do not think that the answer is to get teachers to stop sending kids and deal with these things themselves.

What is the difference between a school with a school nurse and a school with no school nurse when it comes to illnesses, complaints and injuries, whether big or small? If there is no school nurse, the teachers or secretary make the decisions. They don't want to make a wrong call, and the tendency is to err on the side of caution. They call the parents for everything that is more serious than chapped lips! Kids get sent home for minor or needless reasons a lot. I know this because my children were students in a school without a nurse through much of elementary school. Every headache and belly ache warranted a call, and students missed lots more classroom time than kids in a school with a nurse do.

Your school did not hire you just to deal with the big things, they hired you because you are a nurse and you know if it is a big thing or not, and that is what any warm body cannot do that a nurse can. By making the assessment as a nurse, you keep a lot of children in school who would otherwise be sent home by cautious staff. That has been one of the benefits of having a school nurse for the past 100 years...before that, every little thing meant missing school.

My thought is to use those teachable moments when those kids come in, because you are teaching children how to use or not use the health care system, and that might mean telling them how to decide when to come to you or not. That is part of our role. Also consider that your school staff see you as the expert who can deal with issues quickly and correctly, saving them from teaching interruptions and liability fears, one of the main reasons teachers are often school nurses staunchest allies when we ask for comparable pay or we face threats of being cut. And lastly, look at a busy day with no real injuries or issues as proof that your prevention and safety efforts are working. As a school nurse, you are more than an ER nurse only there in case something big comes along, otherwise why not replace you with an EMT?

In my own moments of frustration like those you expressed in your letter, I try to remind myself that there is really only ONE job in a school...education. I am there to support the teacher so she can teach and the students so they can learn.

Yes, I agree there is a trend...today, most children expect that when anything bothers them adults are avaibale and that they care. So much better than the trend 100 years ago when children were often just one more mouth to feed, and sent out into the mills to work. As adults today, we focus childhood on teaching those children how to make their way in the world and not need us for every little thing, fostering self-reliance and self-responsibility. Some kids take longer to learn it. The lucky ones have a whole village helping them learn it...parents, teachers, community. School nurses are part of that village, and have something unique to offer. Your many small daily encounters do make a difference in the goals of the school and the lives of the children.



	Dear Gerri, First I would like to thank you for your wonderful web-site! It is a pleasure to be able to have your insight when needed. I guess that is why I am emailing you! I am a RN that works in a public school setting. I am in charge of the High School and upper elementary. I am having a problem with the fact that my degree and nursing ability are not valued by the staff much less the administration. In my state, an RN is a certified employee and we get the same benefits and pay as teachers. As you well know, a school nurse wears many hats! My background is Psyc. and High Risk Labor and Delivery and Pediatrics/PICU. I have really been fortunate to have my background many times. I love the connection and trust I can and do make with my adolescent students. The problem is that I am never able to finish paperwork much less spend time behind close doors with a parent or child in need without constantly being interrupted. I know this sounds petty but I need you to understand that when I say interrupted, I mean from everybody! They will barge in if my doors is closed or if I am on the phone and start talking to me as if what I am doing is unimportant. I see probably 30 kids a day for paper cuts and chap stick in which I might add I never can see where the cut is. I have given the teachers band-aids and other supplies but it hasn't done any good! My own principal does the same thing. I know that I have made a difference in peoples life on certain occasions and that is why I got into nursing! I just feel my education is not utilized at all. I just don't think I can stand this any longer! Do you have any suggestions as to what I can tactfully do? Thank you! Anonymous School Nurse **** Dear Anonymous, Thank you for the nice feedback about my web page and for the compliment of bringing your question to me I think the issue you speak of is a universal one for school nurses and one we all struggle with...how do we balance being available and responsive with being proactive and responsible. We don't want the most important things like screening, documentation, listening and confidentiality to be at the mercy of the least important things like paper cuts. Yet it can seem that way. To us, being barged in on and interrupted for trivial things by students and staff alike feels like intentional disregard and even disrespect for our professional role, but I don't think that is what is necessarily behind it at all. I think people walk right in because that is what they have become accustomed to doing and they think it is all right because you may have been too nice to say it isn't or have not let them know how you would like them to access your services. I want you to know I struggled with this issue myself. I wanted my staff and students to be well-served and happy with me, and my tendency is to be very nice. I also realize that ultimately, my role is to support the real work of the school....education....and so I felt that I had no say or control over when and what came my way. But I have found after years at this, that there are some things you can do to change the situation. First of all, set up a schedule for the day and for the week. For example, maybe you will be screening and following up between the hours of 9-10 on Monday, Wednesday and Friday and catching up on paper work daily between the hours of 1-2 on Tuesday and Thursday. Let the staff know that this is your plan. Encourage them to let you know if there is a student who needs screening for an IEP meeting or because of concerns so you can prioritize those. Let them know that during this time, you will only see emergencies. Let them know nicely and matter-of-factly. Let the office know, and ask them if they would feel comfortable triaging anyone who shows up thinking it is an emergency, and to call you on the phone if they think it is. Then, cover the window in your door with a shade ("to protect confidentiality"), put out a sign, and lock the door. If someone knocks, answer it, but ask them to come back at a specific time or do their best with it on their own. Don't let them in though unless you decide it is urgent. In time, they will realize that you really are busy during those times and won't see them unless it is an emergency. When you have a student, parent or staff member who needs confidentiality, or a phone call that requires privacy, put out your sign that says "Privacy Needed: Please Return in Ten Minutes. If Urgent, Go to the Office" , lock the door, and close the shade. I have found that this works really well in my middle school, and even the staff respect it. I think that once you feel some sense of control over your time you will feel more effective, more appreciated and more valued as a professional. Don't give up in discouragement, you sound like a wonderful school nurse, your schools just need a little training : ) Good luck, Gerri ********************** Dear Gerri, Am I the only school nurse in the country who is fed up with frequent fliers? Everyone I talk to seems to think this is what their job is all about. If it is, then I think I am in the wrong business. I do not agree that the majority of these children have deep unmet needs that only the nurse can tease out. These children have been conditioned to think that every bump needs to be seen by the nurse, every gas pain, every ache,every little twitch that is unusual must be evaluated. When did this begin? Are we raising a society of complainers that cannot tolerate minor discomfort for a fleeting moment? These children absolutely feel it is their duty to report every uncomfortable body sensation to their teacher and their teacher, to deal with the rising number of complainers and litigious parents, sends them all down to the nurse. Since when is getting hit by the ball on the arm or the thigh an injury worthy of interrupting play to be evaluated by the nurse? Since when does every tumble on the play ground necessitate a trip to the nurse? I am not burned out, I see a dangerous trend! Please do not think that I or my entire department haven't tried numerous approaches from educating teachers about the 5 minute headache or stomach ache to educating classrooms about sick or well, to educating parents about appropriate use of the health office. Still, the numbers grow and the health office overflows. Teachers are overwhelmed. Playground supervisors fear law suits. In the mean time my colleagues and I spend all day doing what any warm body could do. Well, sorry, I break rank with all my nurturing, well meaning, nurse friends who feel that being there for the students means 6 to 7 hours of addressing the complaints of children who are not sick, injured, or emotionally needy.They simply are trained and conditioned to come to the nurse... because we are there. And this... is not a healthy trend. Fed Up Dear Fed Up, No, you are not the only one who feels this way, I sometimes have these same frustrations myself. What you are describing is about not wanting to foster learned helplessness and not wanting to teach children to use or abuse the health care system inappropriately. After all, we do not want our schools to become the training grounds for The Future Hypochondriacs of America. I do not think that as a school nurse you can change the way every staff person views minor injuries and complaints, wanting it to be the nurse's call. They do not want to be the ones to decide whether it is "something" or "nothing." Those of us who have been school nurses for many years have our own stories of the teachers who said to the frequent whiner, "You're fine, sit down," only to learn the hard way that the child had a fractured wrist, or a concussion or walking pneumonia. One incident like that, complete with angry parent, is all it takes for teachers and aides to thank their lucky stars that there is a school nurse whose job it is to make an assessment, whether it's a five minute headache or a paper cut. Likewise, most teachers and aides have had the experience of facing an angry parent who is demanding to know why her child was denied being able to see the school nurse. To the parent, the school nurse is the expert, the one in whom she has the trust when it comes to health and safety issues. Possibly, that parent is a taxpayer who defended keeping a school nurse in the budget for that very reason. Those things you have already done...educate parents and teachers and handing out band-aides are good things to do. But I do not think that the answer is to get teachers to stop sending kids and deal with these things themselves. What is the difference between a school with a school nurse and a school with no school nurse when it comes to illnesses, complaints and injuries, whether big or small? If there is no school nurse, the teachers or secretary make the decisions. They don't want to make a wrong call, and the tendency is to err on the side of caution. They call the parents for everything that is more serious than chapped lips! Kids get sent home for minor or needless reasons a lot. I know this because my children were students in a school without a nurse through much of elementary school. Every headache and belly ache warranted a call, and students missed lots more classroom time than kids in a school with a nurse do. Your school did not hire you just to deal with the big things, they hired you because you are a nurse and you know if it is a big thing or not, and that is what any warm body cannot do that a nurse can. By making the assessment as a nurse, you keep a lot of children in school who would otherwise be sent home by cautious staff. That has been one of the benefits of having a school nurse for the past 100 years...before that, every little thing meant missing school. My thought is to use those teachable moments when those kids come in, because you are teaching children how to use or not use the health care system, and that might mean telling them how to decide when to come to you or not. That is part of our role. Also consider that your school staff see you as the expert who can deal with issues quickly and correctly, saving them from teaching interruptions and liability fears, one of the main reasons teachers are often school nurses staunchest allies when we ask for comparable pay or we face threats of being cut. And lastly, look at a busy day with no real injuries or issues as proof that your prevention and safety efforts are working. As a school nurse, you are more than an ER nurse only there in case something big comes along, otherwise why not replace you with an EMT? In my own moments of frustration like those you expressed in your letter, I try to remind myself that there is really only ONE job in a school...education. I am there to support the teacher so she can teach and the students so they can learn. Yes, I agree there is a trend...today, most children expect that when anything bothers them adults are avaibale and that they care. So much better than the trend 100 years ago when children were often just one more mouth to feed, and sent out into the mills to work. As adults today, we focus childhood on teaching those children how to make their way in the world and not need us for every little thing, fostering self-reliance and self-responsibility. Some kids take longer to learn it. The lucky ones have a whole village helping them learn it...parents, teachers, community. School nurses are part of that village, and have something unique to offer. Your many small daily encounters do make a difference in the goals of the school and the lives of the children. I hope these thoughts give you a little different perspective, for in the big picture, you are giving them what no one else can. Best of luck to you, Gerri