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Considering School Nursing

As a school nurse, you walk proudly with one foot in nursing and the other in education.

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At some point in your career you have may well have considered school nursing as an option.

Most likely it was when you were scheduled to work Thanksgiving and Christmas.

The dilemma was whether to work the shifts and devastate your family or complain and live with guilt knowing a colleague's holiday would now be ruined. It was a hopeless, no-win situation.

Thoughts of school nursing then dimmed with the holiday lights and rekindled in June when you struggled with vacation and summer childcare plans. You compromised, rearranged days and thoughts of school nursing faded.

You rationalized and reminded yourself that you made a career choice knowing hospitals did not close for vacations or holidays.
However, that was before children and aging parents. Now you are a different person. Older, wiser, you appreciate that these times pass quickly and cherish every family moment.

Perhaps there is more to your unrest. Do your needs go beyond just wanting holidays and summers off?

Ask yourself:

  • Am I challenged by my work?
  • Am I frustrated by repeatedly patching patients up only to see them readmitted with the same preventable illnesses?
  • Am I convinced education can reduce or eliminate poor health behaviors and hospital admissions?
  • Am I confident enough to work independently?

If the answer to any of the above is "yes," then maybe you should consider the specialty of school nursing-perhaps when you are not swayed by the responsibility of staffing or stressed over balancing your personal and professional lives.

GET THE FACTS: Award-winning school nurse, college professor and author Janice Loschiavo (back row, far right) poses with students in a recent School Nursing I class at William Paterson University, Wayne, NJ.
ON THE HOMEPAGE: Loschiavo with an elementary student in New Jersey where in 1994-95 she was elected the state's Nurse of the Year before competing for the national title. Photos courtesy Janice Loschiavo.

Lessons Learned

Is your perception of school nursing influenced by childhood memories? Do you recall a woman in a white-starched cap who spent her day putting on Band-aids? If so, it is time for you to learn more about the role of the school nurse today.

However, before you can understand the present, first let us reflect generally on the school environment of the past and how school nursing has evolved in the U.S. When the U.S. first began to emerge as a nation, children were educated at home, if their parents were literate, that is; many were not.

The Tenth Amendment to the Constitution, passed in 1792, gave educational responsibilities to the individual states. Progressive states quickly mandated school attendance and placed all children in age appropriate classes, and by the year 1900 most states had school attendance laws.

These new requirements were mot only major steps forward in public education, but also revealed two major facts:

First, schools are breeding grounds for illness. Communicable diseases became rampant and nurses were now needed not only for first-aid and recordkeeping but also to control the spread of infectious disease by reducing absenteeism. 

Second, children have different needs. Once assembled, it became clear some students were not capable of functioning in a regular classroom. Language was a learning barrier for the immigrant population and conditions of neglect and poverty impacted the child's ability to learn.

Impact of Special Needs Children

Historically, schools and teachers were ill equipped to handle the child with special needs.

In the beginning, virtually none of state attendance requirements apply to children with special needs. Sadly, parents typically had to choose whether to keep the child home or place him in an institution; sending him to school was not an option.

Spurred on by the Civil Rights Movement of the 1960s and with increasing recognition that virtually all children were capable of learning, parents united and demanded that services be provided.

Book Review

Fast Facts for the School Nurse: School Nursing in a Nutshell.

Read a review of award-winning school nurse Janice Loschiavo's book.

By the early 1970s, with the nation's attitude toward inclusiveness progressing, children with disabilities increasingly were allowed to attend school. Still, most were taught apart from the mainstream classroom, they were placed in self-contained classes or special facilities.

It took until mid-1970s for lawmakers to look closer at the growing number of children with special needs and to recognize that students could learn from each other. Studying side-by-side, all children benefited by learning acceptance and compassion.

The Individuals with Disabilities Act of 1975 would guarantee access to public education for all students regardless of the severity of their condition or number of medications and treatments they required. Federal money was made available to states for teacher training, barrier free buildings, related services and extra classroom personnel.

Today's School Nurse

School nurses still perform first aid procedures, do screenings, monitor immunizations, keep health records and control infectious disease. The nurse remains the health specialist in the building in an inclusive, multifaceted role.

The school nurse has hundreds of patients including all students, staff members, parents and building visitors. She is the first one summoned in any building emergency. This includes the injured student, ill staff member, grandparent collapsing with heat exhaustion, an abusive parent, the custodian with chest pain or visitor who has a seizure in a voting booth.

Working independently and within their State Practice Act, the school nurse implements the nursing process and assesses, diagnoses, sets goals, plans actions and evaluates every health issue presented.

Some students need daily standing and emergency medications to remain in school. Asthma, ADHD, anaphylaxis, diabetes and seizure disorders all require specific medications in specific situations. Nebulizer treatments, catheterizations and blood sugar testing must also be done.

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The school nurse serves as the link between the home and school. Once a diseases or illnesses is diagnosed, the physician's orders are interpreted for the parent, teacher and student. A plan is devised so the child's day has as few interruptions as possible. Every child must feel welcome in the school community in order to succeed academically, emotionally and socially.

In order to remain current and maintain the high standards of the profession, many school nurses belong to local, state and national organizations for both teachers and school nurses. Some school nurses conduct formal classes, but all teach about health to students, staff and parents or even as a guest lecturer. Some states require a bachelor's degree and certification as well.

Schools are mandated to be part of a number of multidisciplinary teams, e.g., the institution's Child Study, Crisis Intervention, Intervention and Referral and 504 Accommodation Teams. This presence at the table insures that students receive continuity of care and have their rights protected.

Why Not School Nursing?

Certainly, what you are doing is important. But, look at the larger picture. With your commitment to wellness and nursing background, you can find greater challenges by making a much larger, long-range contribution to the delivery of healthcare.

As a school nurse, you walk proudly with one foot in nursing and the other in education. By combining both professions, you have the opportunity to educate children about risk factors leading to illness. And if you raise the level of wellness for just one child, you will raise the level not only within the school, but also the community and ultimately the nation.

Janice Loschiavo is adjunct professor at William Paterson University, Graduate Nursing Division, Wayne, NJ, and the Education/Nursing Division at Caldwell College, Caldwell, NJ. She is author of the book "Fast Facts for the School Nurse: School Nursing in a Nutshell." 

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I have been a school nurse for 26 years. I have worked at the elementary, middle, high and at a special school for students with behavioral issues. I have worked in many other specialty areas (part time) from Intensive Care, Shock Trauma, Home Health, Geriatrics, and I currently part time as a House Supervisor in a Rehabilitation Hospital. It is the one specialty that I have never grown tired of. In 18 months, I will retire with a nice pension and benefits and I have had the ability to be the parent to my three children that I had always wanted to be. I spent a summer with them as a Camp Nurse, traveled through Canada in a Mobile Camper and had time off that matched their schedule to enjoy watching them grow. My youngest is now 24. The job has its stressors and there are days that press you to the limits, but if I had to redo my last 30 years of nursing over, I would surely see school nursing as the largest part of those years again.

Robert Mehl,  RNFebruary 02, 2013
Baltimore County, MD

I've thought about school nursing for many years, but the comments about the stress and poor pay as well as having to have a masters degree is crazy. Also,they let unlicensed personnel do way too many things, and the nurse is responsible for their mistakes. No way!

Carla Mallard-Kusek,  RNFebruary 02, 2013

A fine article to introduce one to the specialty so many of us love. Not only does the certified school nurse heal and educate...he/she advocates and conducts research for the future. The school nurse has to have a passion for this specialty for survival.

Jeanne Kiefner,  Conference Planner,  American Healthcare InstituteJanuary 30, 2013
Cherry Hill, NJ

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