Tricks of My Trade
In my travels and discussions with other school nurses I hear time and time again "My office is so busy. I can not get a minute to even pee". I have worked in two offices in my tenure as a school nurse. In my first role I was a support nurse to the Certified School Nurse who managed two schools. I was there to support her in her absence and cover the office. On an average day, we saw 75-90 kids. If you do the math in a 6.5 hour day that is a kid every 4 minutes and we all know they do not come one at a time. Some kiddos would wait for 20 minutes to be seen for a band aid. I was only there in that office two days a week and in no position to make a change.
In my new school I came into similar numbers. I was the Certified School Nurse in my own building and after my first year, definitely in a position to make some changes. But to make change, you need time.
That very wise Principal who told me to get out and meet people also reminded me of the golden rule of leadership. It takes three years to make a position your own. Year one, stick with the status quo and only change what urgently needs changing. Use that year to develop relationships and trust with the kids, families and staff. Year two, start to make small changes, continue to build the relationships with your clientele and introduce one or two new initiatives. Year three is yours. By now you have the trust of the kids, staff and the families (if you have laid the ground work). This is the year to truly make your practice your own.
So year one, I started the "Walk About". My Guidance Counselor and I grabbed our morning cup of something and set off. We developed those relationships with the teachers and paraprofessionals. They felt comfortable and able to share concerns about students or themselves. We had authentic, vulnerable conversations. I coached a Run Club with the kids, got in the dunk tank at back to school bash. I called parents often and shared with them concerns but also successes. I became part of the school community and a resource for those I worked with.
Year two, I had the support and direction of the Principal to reduce the number of children coming to my office. He was concerned about the amount of time the children where spending outside the classroom in my office missing academic time. I discovered a document online from a fellow school nurse. I can not find who she was to give credit here (so if anyone knows her speak up :)) but it changed my office. Because of the relationships I developed with my teachers I could put into practice the "Tips to Keep Kids in Class" document, band-aids in classrooms and "The 5 B's". I basically gave permission to the teachers to troubleshoot the majority of complaints requesting to come to my office. I explicitly told them, if a parent called or emailed to complain that they did not send a student to see me, refer them to me. This gave me an opportunity to have a discussion with these parents to either explain the importance of self care and coping strategies or bring to light avoidance behavior. We are six years in and the calls have nearly stopped. I still call the frequent visitor's parents to discuss reasons they seek me out 6+ times a month, but the complaints have stopped. I also armed the recess monitors with band aids as well. They can easily treat a superficial abrasion and allow the kiddo to get back into play. Obviously, serious blood finds its way to my office. I also do not allow ice packs on the playground, so when the children learn that they have to sit out, they are miraculously healed. Lastly, ice packs are always leaving the office to be used in class. I do not have them sit for 15 minutes in my office to ice. This cuts down on using my office as an escape. The culture was beginning to change. Office visits were averaging 40-50 visits a day.
Year three arrived and I could feel the shift. This was my practice and it was time that I critically evaluated the work I do. As School Nurses we are expected to work within a scope of practice and utilize evidence based care. As defined by the National Association of School Nurses (NASN), School nursing is a specialized practice of professional nursing that advances the well‐being, academic success and life‐long achievement and health of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety including a healthy environment; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self‐management, self advocacy, and learning (2010). I spent the year advancing my training in a doctoral program. I pulled reports from my EMR and started to evaluate what and who were my frequent visits. It was a telling year. Research had been published that addressed somatization in school aged children. The underlying theme was STRESS. Stomachaches and headaches comprised 60% of my visits with only 3% being reason for dismissal home. Our kids where stressed and did not know how to help themselves.
My next entry will introduce a program my guidance counselor and I developed and began to implement in year four. Office visits are way down. I have averaged 15
kids a day in this first month of school. Stay tuned to how that happened.