Exploring School Nursing
For the Nurse Who is Thinking of Making the Switch
Gerri Harvey, RN, MEd
As any school nurse will tell you, 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 interdiciplinary 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 band-aides. 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 assessent, 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 inservices, 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
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." Although most nurses are able to understand and articulate why good health is a prerequiste for educating a child, many educators do not readily see the link. School boards, who control the budget, are also notorious for asking why in the world they should fund nursing salaries when they themselves might be living proof that kids can survive without a school nurse. Part of school nursing is also being willing to educate the public and the holders of the purse strings 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.
OK, if the above description sounds like you, read on for how to find the most rewarding and challenging job you will ever have.
Qualifications
Every state requires a school nurse to be an RN, but beyond that, the requirements vary state to state. More and more (but not all) are requiring that a school nurse hold a Bachelors Degree, and some require that a Masters be in progress or completed in order to practice as a school nurse. Many excellent school nurses have not advanced their education beyond the basic preparation, and even those states who require degrees are grandfathering these nurses, though new hires in those states must have the degree.
Many universities offer MSN's with concentrations in School Health Nursing. Some school nurses seek an interdiciplinary education and hold Masters in Education or othe specialty, such as Public Health or Counseling. There are plusses to all of these, and often the role reflects the strengths that the nurse brings to it. Most nurses who persue advanced degrees began "in the trenches" too, and believe that the degree enhances their skills as school nurses. The issue of requiring a degree or not is a sensitive one in school nursing, especially because the average school nurse brings a wealth of experience to the job.
Like other specialties, school nursing offers a national certification, (CSN) required in some states but not in all. Dual certification both as an RN and as a teacher is required in some states, with extra coursework, and continuing education in both nursing and education expected. Therefore, it's quite possible that the most extensively educated person in a school could very well be the school nurse. But that doesn't mean she will necessarily be the best paid.
Pay Scales and Benefits
As you may have guessed, these vary too. Some districts compensate their nurses comparable to teachers and other professional staff, and some see her more as a paraprofessional, and the pay is more comparable to that of classroom aids and secretaries. Although one might expect that if the district requires a degree and certification comparable to teachers that the pay would also be comparable, that is not always the case. It might depend upon whether you are in the teachers bargaining unit or not. Being part of the most powerful union in the country is not a right for nurses, it's up to the local district whether nurses belong, and including them is often something that must be bargained at the local level. Generally speaking, if you work for a district in which the nurses are in, the pay and benefits are better than if they aren't.
Benefits in education tend to be better than those for nursing in general, at least in my area of the country. The average pay for a school nurse with 15 years experience was recently reported to be about $36,500.
Trying Out School Nursing
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. It's 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 in my own small home town in New Hampshire 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 in the past 25 years or so 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. It's not uncommon for parents to drop their child's medication off at her house on their way in to work in the morning (kids are not allowed to transport their own medications). And by the way, she's also the cheerleading coach, the Red Cross Instructor, the puberty educator, and the coordinator of the holiday food baskets.
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. Not long ago I assessed some suspicious-looking spots in the canned goods aisle of the local grocery store for a mother who said, "Oh! Gerri, I am so glad I ran into you, I just saw these spots on her neck and wondered if she has chicken pox! Would you take a look?"
School nurse jobs are not generally plentiful.
But that's not to say that it's hard to break in.
Agree to sub and you can work full-time starting next week., for the number one need for school nurses are subs to whom they can confidently entrust their kids so they can stay home and be sick in peace themselves. Subs, you see, get "sub pay" which is uniform across the district in many cases. Sub teacher, sub aid, sub custodian, sub nurse....it might be a mere $50 a day. You do it to try out school nursing and get a foot in the door, you don't do it for money. Many school nurses started as subs.
Subbing lets you try it out, become a known entity, evaluate a particular school as a potential place to work, allow kids and administrators to see how well you perform under pressure, and network with other school nurses, who will recommend you (or not) when an opening occurs.
One great school nurse I know began her career by subbing for me. On her first day, someone sprayed pepper spray in the cafeteria, and there were six simultaneous asthma attacks, plus a dash of panic, a few distraught staff, and a lot of upset parents to deal with. She managed the whole episode with such aplomp (this is where experience comes in) that my own principal happily supplied a recommendation when she applied for a school nurse opening in another town.
Beacuse of liability issues, volunteering in a school nurse office may not be allowed, but shadowing or an internship may be an option in some schools. Contact the school nurse directly, and she will let you know if it is something she can do, and how to go about arranging it.