School
Nursing
Mary 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 followups 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 healthrelated 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 Jobs
Ask 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 Focus
Highlight 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 References
School 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 LUCK
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