School Nursing Can Be...

A. Mundane and routine
B. Challenging and limit testing
C. Frustrating and aggravating
D. Humorous
E. All of the above

A. Mundane and routine: Yep, school nursing can be both of these things. Day in and day out there are a lot of band-aids and ice packs that get distributed for the typical scrapes, bumps and owies that children suffer. There is also a lot of temperature checking and re-assuring and shooing back to class, day in and day out.

B. Challenging and limit testing: But on occasion there are situations that come up that challenge my assessment skills and decision making. In the past few weeks I have had to call 9-1-1.

First was an elementary boy who has a cardiac history of SVT (supraventricular tachycardia). When I was called to assess him his heart rate was 115. He was complaining of crushing chest pain. He had already been quietly resting for 15 minutes with no relief. I have at my disposal a stethoscope, a blood pressure cuff and a pulse oximeter. That's it. Those are all of the fancy tools I get to care for kiddos in school. So a thorough assessment becomes very important. In this case, the boy's color was good but he was uncomfortable. He kept saying how much his chest hurt. And then he develops this weird cough, which he describes as feeling a tickle in his throat. Not knowing this kiddo (did I  mention he is a student at a school I am not assigned to? I just happened to be the nurse on-call for that school) and with his parents unreachable (unreachable parents are a HUGE frustration factor when facing these kinds of situations), the decision to call 9-1-1 was made. The paramedics came, hooked him up to all of their fancy machines, saw that his heart rate with a sinus dysrhythmia, still couldn't reach a parent or emergency contact, and loaded him into an ambulance to take him to the hospital for further evaluation.

The second 9-1-1 call was for a middle school student who reported to the health room with a blood pressure of 194/138. That's not good. I had her rest and rechecked her blood pressure after 15 minutes. While waiting for the 15 minutes to pass, I tried to reach the parent. The student tried multiple times to reach the parent. The assistant principal tried several times to reach the parent. NO PARENT AVAILABLE. UGH! 15 minutes later and the student's blood pressure is now 140/100. Now she is complaining of impaired vision, dizziness and tingly. OK. 9-1-1 to come do a further assessment because remember all I have is a blood pressure cuff, a stethoscope, and a pulse oximeter. Again the paramedics come, hook the student up to all of their fancy tools, discover she has significant orthostatic changes in BP, and load her onto a gurney to take her to the hospital.

C. Frustrating and aggravating: Besides not being able to get a hold of parents when their children are sick, there are other frustrating aspects of being a school nurse. As a school nurse I am responsible for monitoring immunization compliance. I spend several hours a month reviewing records, sending out notices, making phone calls, and doing all I can to make sure that students meet the state standards for immunizations. But making phone calls and sending out notices is about all I can. It is up to administrators to enforce the law. And quite frankly, immunization compliance falls way down the list of priorities for administrators.

The sh*! only hits the fan when there is a potential of disease outbreak and the administrators discover that many children are at risk and will have to be excluded if there is an outbreak.  Then all of  the sudden it becomes a priority. This is what happened recently in a large neighboring school district. The head shed people finally decided to hold school administrators feet to the fire regarding immunization compliance and a huge effort was taken to get students caught up. The district went from having 5000 students out of compliance to 98! That is an amazing change. And do you know what else happened? Instead of praising the school nurse who is the coordinator of school health for her efforts to bring immunization clinics to schools to get those kids in compliance, the district is firing her. FIRING HER! She has become the fall guy for the negative press that surrounded the large out-of-compliance rate even though school nurses, as I previously mentioned, have absolutely no authority to enforce immunization laws. Oh I am SO MAD over this injustice.

D. Humorous: Fortunately there are enough humorous moments to compensate for the frustrations, aggravations, challenges, and mundane tasks. The humorous moments definitely help keep me going. Things such as pea gravel in ears (seen more cases of this than I ever thought I would), funny little kids and funny big kids are daily bright spots in my job. The other day an 8th grade girl came to see me. She said she had a rash on her chin. I looked at her chin and she did have lots of little dots on the underside of her chin, but it looked more like she had rubbed up against something rather than a rash. So I asked if she played softball and had slid on the ground. No. How about dancing and sliding on the floor? No. Well it looks like your chin rubbed against something and ruptured lots of little blood vessels. Oh, I did have a cup stuck there for a couple of minutes. Congratulations, you gave yourself a hickey. Spent the rest of the afternoon chuckling over that.

E All of the above: So as you can see, school nursing fits all of the above descriptors. And as difficult as B and C can be, those are things that make sure there is never a dull moment. But thank heaven they don't happen on a daily basis.