A typical day in the life of a school nurse

New Mexico Nurse, Jan-Mar 2003 by Weirick, Kathleen

8:00 a.m. A parent brings in a narcotic controlled medication for her son who fractured his arm the day before. The parent is advised that the doctor and parent must sign permission for the student to take prescriptive medication at school. The nurse advises that the student will have limited ability to learn at school while taking a narcotic.

8:15 am. Two students come in to the office to take medications before they start their school day. One student takes Dexedrine to help him focus throughout the school day and keep centered on his work. The next student takes an anti-depressant and Dexedrine to help him as he studies.

8:20 a.m. A student arrives who has vomited and is very anxious about starting her day. A call home to her parent confirms that she was seen twice this week by her physician and is suffering with anxiety. She needs some time to re-group before she goes to her first class. I walk the student to class and inform her teacher of her anxiety as she has been late to his class all week. This student is new to middle school and is facing the many changes in moving to new classes every 50 minutes.

8:30 a.m. I have seven students who help in the nurse's office for one period a day and receive credit toward their school program. My first student has autism and comes in to make ice bags for students. The school has an Occupational Therapist who begins working with this student to find other tasks that can be accomplished with assistance and direction. This autistic student needs repetition of tasks and the opportunity to socialize with others, as they tend to be in their own work and exclude others in their environment. They are often very bright students and can learn to contribute to society. The occupational therapist decides that some errands can be done. Getting drinking water for the day and requesting that a teacher send a student to the nurse's office and some filing and cleaning can be done as well. The OT works with the student to accomplish these tasks.

8:45 a.m. Three students come into the office to tell me that they are not feeling well and would like to call their parents to go home. Parents are contacted, temperatures are taken, and advice is given to the parents regarding illnesses that are currently traveling through the school.

9:00 a.m. The first injury of the day comes into the office. Two girls have been playing volleyball -and they collide and one of the students comes to me holding her nose. I take a look at her nose and think that it might be fractured. Her parent is called and she is taken to the doctor and her fracture is confirmed.

9:15 a.m. I am traveling 3 blocks to go to my elementary school. I have a meeting with parents and the educational team for an Individualized Education Program. The student has specific health needs, which are impacting the educational process. An Individualized Health Plan is designed for the diagnosis of Attention Deficit Disorder and Bipolar Disorder. Medications will be necessary and will be planned into the school day, as well as assessment of how these medications are working.

The staff will need to be educated on how to deal with the mood swings and outbursts during the day. The parent will be taught some coping skills to use at home with the other members of the family. The doctor will need to be contacted and medication prescribed. The educational team will set goals of accomplishment and appropriate interventions for certain situations.

10:30 aim. I drive back to the middle school to enter the nurse's office and see 7 students. Three students have upset stomachs with fevers and are waiting to go home. One student has a nosebleed and is holding pressure on his nose to stop the bleeding. Two have bumped their heads in their physical education class while playing volleyball and are holding ice on their heads. They are assessed for serious head injury and parents are notified of the incident so that they can follow-up at home. We are unable to reach one parent and so a written note is sent home.

ll:00-1:00 Ten students come in for their medications. My Health Assistant and I try to eat our lunch, give out medications, take care of sick students and students who come in with injuries. Meanwhile parents are returning calls from the students and are coming into the office to sign out for their students.

1:00 p.m. The Assistant Principal calls me to her office. She has a student who has been caught with cigarettes and two lighters. They are confiscated and a punishment is assigned. This student has surrogate parents and needs some limit setting both at home and at school. The students know when they are breaking school rules. In School Suspension is assigned and the student is given materials to read and report on regarding smoking and drugs. The student has difficulty writing, so I will meet with the student at the end of the day and we will discuss his reading assignment.

1:30 p.m. All of our current immunization records have been entered. I print a report and find that 177 students are not within the state immunization requirements. Some are students with no records at all. Some are 8th graders who need Tetanus/diphtheria boosters. The majority are 7th grade students who need a series of Hepatitis B shots. It will be necessary to contact all 177 parents and to dis-enroll these students until immunizations are current.