, ,

This is actually a pretty good sum up of a typical day: 

Major issues that nurses deal with include asthma; childhood obesity and diabetes; students with allergies, both food and environmental; drugs, both prescription and recreational; disaster preparedness; crisis management; school health documentation for local governments; head lice; immunizations; mental health; oral health; visual health; school wellness policies; violence and bullying.  Nurses also provide health education to students, including sex education, nutrition, substance abuse prevention, bullying and much more.


Here are some comments from nurses about what they face all the time:

 *Growing stress levels and mental health issues among students of all ages.*

“I have 10+ kids visit the clinic in an hour on test days.  Vomiting, anxiety attacks, stomach and head aches; it’s all stress.  And we, the adults, are putting that stress on them.”

“Our school has a lot of undocumented Hispanic students.  The week following President Trump’s election, the counselor and I were swamped with numerous suicide threats, anxiety attacks, stomach and head aches — at an elementary school!  A 2nd grader asked his teacher, ‘Will we be sent back?’  Kids soak up their environment.  They aren’t clueless.  They know what’s going on much more than we can imagine.”

*Growing insomnia among students, perhaps due to staying on computers and mobile phones.*  

“I often call parents inquiring why their child may be falling asleep in class.  I ask ‘Have they been sick?  How late do they stay up?’  The parent can’t answer these questions.”

 *Parents who micromanage their kids and tell nurses how to do their jobs.*

“We get reamed out for not providing information to parents about their children but there are confidentiality laws that preclude us from telling them everything. Parents don’t understand that.”

“I have parents who call the clinic daily asking me to check on their student.  They say things like, ‘She had a stomach ache last night,’ or ‘Her toe was hurting this morning.’  Like I have nothing better to do than to check on trivial issues.”

 *Parents & teachers who think kids can take care of themselves.*

“I have teachers constantly tell me, ‘Oh, I don’t need to remind them to take their medicine.  They should know by now,’ or ‘I don’t need to help them with their inhaler, right?  They know how to do it?’  Most adults don’t even know how to use their inhaler properly, let alone a 9 year old child.”



 *Parents who don’t tell the truth on health forms.*

“We send home health history forms to all parents and get them back blank.  Nothing about the condition or medication.  And then a child has a seizure or you find out they’re diabetic.  You’re operating blind, which would be ok if the student was choosing to withhold that information but they aren’t.  It’s the parents.  They are putting their own child at risk.”

“Sometimes you see the same handwriting on a form for the parents and the physician.  Or it may be written in a way a doctor wouldn’t, with misspelled words and without a dose.  It’s obvious the parent wrote it.” 

*Parents & staff who don’t understand the constraints of a nurse’s job and who ignore the advice of the nurses.*

“They will say, ‘What do you mean you can’t give them Tylenol without authorization from the doctor. Every other school does it.’ No, they don’t. We can’t give meds that aren’t approved for certain things. Herbs. Sunscreen and bug spray have drug labels on them. We can’t dispense them without permission.”

“It happens every year. We tell the parents allergy season is coming. Be prepared. Its coming. And then the kids come in and their eyes are swollen and they are sneezing and coughing. And the parent says, ‘Well, it wasn’t bad when they left home this morning.’”

*Questionable parenting.*

“Kids rat out parents all the time.  I ask how late they stay up and what they’re doing.  They say 2AM, watching TV because mom is with her boyfriend.”

“I will call parents asking for a completed vision referral or to explain the seriousness of a medical situation.  They just don’t care.  But if I fail to call them concerning a bruised elbow from basketball practice, they act indignant.  So you don’t care that your kid is 200 pounds in 5th grade but you’re mad that he bruised his knee playing football and you didn’t get a call?”

*Students who lie and parents get mad at you.”

“Students will go home and tell parents, ‘The nurse wouldn’t give me my inhaler.’ The next morning you have an angry parent in the office, spouting off how irresponsible you are.  Come to find out, the student never came to the clinic that day to ask for their inhaler.  The parents never apologize.”

'My teacher sent me. She said to tell you I'm just not myself.'

 *Students who need to be educated about their own conditions.*

“They get inhalers but don’t know how to use them. Nobody has taught them so I do.”

*Parents who tell students to use the nurse as a resource, not understanding our job duties, then students tell the nurse what to do.*

“I have students come to the clinic all the time with general ailments and no fever.  When I tell them to go back to class they protest, ‘My mom said if I wasn’t feeling good that I could come to the nurse and I could go home.’ ”

*Working at more than one school because every school doesn’t have a full-time nurse.*

“Look in Virginia. By law Virginia schools have to stock epinephrine [which treats severe allergic reactions] but they don’t have to have nurses so secretaries are learning how to administer it and making the decisions.”

 *Problems from delegation of responsibility to teachers and other adults in the school on field trips.  Nurses are responsible for decisions made by others because it is done under the auspices of the nurse’s license to work.*

“You can explain over and over how critically important it is to administer medication correctly and how to manage a student’s care but… they just don’t care.  They don’t consider it their job so it’s not their priority.  There are registered nurses who I wouldn’t trust with a saline syringe; can you imagine handing a lay-person a vial of insulin with the hope that they do everything correctly and don’t accidentally kill a student?!”

*Helping adults in the building with their medical issues.*

“Teachers come into the clinic on a regular basis; I need my blood pressure checked, do you have neosporin, should I take this medication?  My favorite is when they stick out their arm, revealing an obscure rash, and ask ‘What is this?’  I just want to say to them, ‘You know I’m not a doctor, right?’”

*Having to think through worst case scenarios.*

“I consistently deal with CPS issues.  It can be difficult having a teacher ask you to assess a bruise — does this look like a fingerprint or just normal ‘play’ type bruises?, do you think this student is abused?, what’s this cut mark from, does it match the student’s story?  You’re playing detective with very little training to do so.”

“I was in a meeting where the teachers were feeling guilty about limiting a student’s diet.  It was a life and death situation; if the student eats enough protein, she will die.  Finally I interjected, ‘Look, you can have a hungry student or a dead one.  Your choice.’  If you don’t scare them, they won’t listen. ”


Nurses are primary care providers for a great number of kids. They have no one in the school who is trained in the same way for consultation, making it a lonely job.  There is a great deal of freedom, however, a freedom that is hard to consider giving up if/when you ever return to the hospital setting.