A Day in the Life of a School Nurse

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Parents should be able to send their children to school and be assured they will remain safe, healthy and ready to learn.

WCSD nurse Cara Rudolph evaluates a young patient.
WCSD nurse Cara Rudolph evaluates a young patient.

In honor of National School Nurse Day on May 7, we celebrate and recognize school nurses in our community and all they do to protect our children.

We asked Cara Rudolph, a school nurse in Washoe County, and a certified nurse practitioner, to share a recent day at work with us, which involves much more than just dealing with bumps and bruises.

6 a.m.
The alarm goes off and it’s easy to hit the snooze. After a few back stretches, I get up and start the day.

7:45 a.m.
Generally I arrive at school before the office staff which allows me time to plug in my laptop, look at my to do list for things I want to accomplish at school today and check my mailbox and email. There are lots of emails from teachers with updates about students who have been hospitalized and diagnosed with complex medical problems. I make notes to myself to contact the parent and develop a safe plan for the child once their doctor releases them to return to school.

8:15 a.m.
Team meeting with the MTSS team (Multi-Tiered System of Support). The team looks at testing and class performance. I see my role as the one who asks if a student’s struggle may be due to vision or hearing problems, prior medical history or diagnosis, inattention (like ADHD) or even small seizures. If the teacher reports that the student is struggling with reading, then I make a note to screen the student’s close vision and eye tracking. Specialized vision screening is not only state-mandated, but is integral to the role of the school nurse.

9:30 a.m.
I recently screened 11 children who were having difficulty with reading fluency (how smoothly they read across the page). In my mailbox I find two reports from eye doctors regarding students that I have previously screened. I review the reports and interpret the information for the teacher and we discuss possible ways to help the student work past their vision issues.

I know how important good vision is to a student’s academic success. As a school nurse, I also work with the families of students to ensure they complete any necessary vision screenings and treatment, as well as serve as a resource to connect them with financial assistance programs that are available to them, if needed. Because I belong to NASN (National Association of School Nurses), I can request “VSP vouchers” to use for children who meet the guidelines. Eye doctors across the country who participate in the program will see a child for an eye exam and determine if glasses are needed at no charge. It’s great that there are so many community resources and I am happy that I am in a position to help connect families with the assistance they need.

And with school-aged children, unfortunately accidents are expected. The clinical aide at school and I discuss a child who was injured while running and required some stitches last week. I had concerns about possible head injury and concussion, but since I wasn’t at the school when this happened, I reviewed the symptoms of head injury with the clinical aide over the phone. Today I plan to stop in to check on the student.

10 a.m. to Noon
I review permission forms for students who will be participating in an overnight field trip. Many students will need to take their daily medications while on the trip. With proper permission notes from their parents, some students can self-administer the medication. Some parents prefer that a teacher administer any medications. In that case, I train the teachers how to safely administer and document the medications, and how to spot potential side effects.  And while I hope it is never needed, I also review “code blue procedures” should a child be injured or become seriously ill on the field trip.

Noon
Lunchtimes would typically be spent administering insulin to students with diabetes and providing gastrostomy feedings to students who can’t swallow in the usual way. But today, my nursing colleagues are taking these procedures for me.

Lunch recess brings in children with playground injuries. The clinical aide provides routine illness or injury care every day but today there are five who come to the health office at once, so I pitch in to help. One child has a scraped right knee, another has a twisted ankle from running on the field, and a kindergarten student has a bloody nose. The clinical aide handles more scrapes on elbows. Unfortunately bumps and falls are also common. Thankfully we have standard procedures to monitor the students and identify any concerns. In any type of injury that may results in a concussion, I monitor the student for 20 minutes, observing closely for signs of confusion, nausea, vomiting, dizziness and headache. Because symptoms of concussion can develop over several hours, we always notify parents when head injuries occur and send home a “head bump notice” so the parent knows to continue to check their child after school.

While I don’t have students with diabetes or other complex nursing procedures at the school I’m working at today, many of my colleagues do and the lunch hour is very hectic for them.

Under the state laws that mandate nursing practice — The Nevada Nurse Practice Act — a licensed nurse must administer all insulin unless the student is capable and responsible enough to give his/her own shots or manage their insulin pumps safely without help. Nurses throughout the district are typically driving between two-to-three schools each day to cover those types of medical procedures.

12:30 p.m.
Lunch with the lower grade teachers is a great event. They are such a committed group of teachers that I truly try to sit down for a moment to eat rather than eating on the run.

1 p.m.
I job-share the school nurse position at my other school and today my colleague and I collaborate about a student that had blood work this week to check for diabetes and discuss how the management of his blood sugar checks and insulin administration, if diagnosed, may be impacted by his other health issues and fear of needles.

1:30 p.m.
I check on the student who received stitches last week — healing nicely.

1:45-3 p.m.
I try to squeeze in peeks at more emails and send home a parent questionnaire for a health history to be completed for two students who must be assessed for the Special Education evaluation process. My role is to perform a physical exam and health assessment for children referred for Special Education. I love to visit with the students as a part of that. To lower their anxiety, I usually start by asking them a few questions about what they like or dislike about school, what are the hardest subjects for them, who are their friends and if they ever feel bullied.

When the School Nurse completes the Special Education health assessment, they also review of the medical history provided by the parents as well as other school records that are documented in the health file.  As part of this process, school nurses may also obtain height and weight, calculate BMI status, check distance and close vision as well as tracking, assess hearing and visualize the ear drums for any signs of infection, listen to the heart and lung sounds, and check pulse and blood pressure. The nurse will make sure the student is compliant with immunizations and make any necessary referrals depending on the findings.

I am part of the educational teams at my schools, as all school nurses are. At minimum, all school nurses have a bachelor’s degree in nursing and are certified to practice school nursing by the Nevada State Department of Education. The fact that I have a Pediatric Nurse Practitioner certification is definitely a plus.

3:30 p.m.
I meet with a student’s mom and dad to discuss the results of my assessment and other testing that has been completed over the past three weeks. The behavior survey from the teacher and dad indicates severe attention problems. Because Attention Deficit Disorder (ADD) can only be diagnosed by a doctor, the team recommends that the family take the student to his doctor to discuss the results of the testing. I share my professional knowledge and insights with the parents and the team regarding the pros and cons of medication for children with ADHA, but make it clear that the decision about diagnosis and medications is in the hands of their doctor.  My role is to encourage the parents to check out current information that exists about behavioral management as well as medication.

5 p.m.
This meeting went longer than anticipated, which means I missed my Jazzercise class again. It’s a good thing I can aim for tomorrow’s class.

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