Away from the Bedside: School Nurses
- Sara Bergenholtz
- May 31, 2023
- 5 min read
I could never be a school nurse.
A lot of nurses have been trying to move away from the bedside over the last few years. It's no secret, in fact I am certain there are national publications and politicians and organizations galore that have spoken on it at length. Every one of these nurses, provided they are RNs, are eligible to be members of WSNA although taking positions away from the bedside typically means leaving the tender embrace of the labor organization and it's contracts. WSNA is, always, a professional organization and a ANA affiliate and it is this side of our organization that those away from the bedside remain members of.
School nurses have their own professional organization separate from WSNA (doesn't every branch of nursing?), in Washington it is known as the School Nurses Organization of Washington or SNOW. Their mission statement reads "SNOW supports school nurses in the delivery of health services designed to improve the health and academic success of students. (August, 2011)", and their website is full of the types of resources one would expect to see from a professional organization.
While perusing the site I learned something interesting, although not required by law many school districts require their nurses to become certified as an "Educational Staff Associate". This certification requires not only an unencumbered RN license, but a BSN as well. It's not optional, which is far more than any hospital I can name (I've never seen it outside of the "preferred" category). This certification, in turn, allows the school nurse to make as much as the teachers.
Has anyone taken a look at teachers contracts and pay scales? They aren't great. Even with the bump the certification gets them, most BSN prepared nurses in this role would be making considerably less than their brethren in acute care.
And they would be taking on a great deal more risk as well.
I am not an expert on this role, by any means, yet I've talked with enough of those in the role that I know there is more than a little conflict with school administrators who think they are qualified to direct how a nurse performs his or her duties. I know, too, that there can be a lot of conflict with parents/families when it comes to the care provided or withheld. We all know by now that even in the hospital, where nurses are most prominent and have the greatest amount of institutional support, we are always seen as an easy target. Alone, surrounded by non-healthcare providers, with no doctor in sight I cannot imagine it would be any better as a school nurse.
In fact, I think it could only be worse. This year at legislative day in Olympia we were joined by a nurse who works in one of our Wenatchee schools. She was there to advocate for HB1608, which would have provided standing orders to school nurses for emergency medications such as epinephrine. As we know, these nurses are perfectly within their scope to administer this medication if ordered, but she explained that the Wenatchee school district, like many school districts, could not find a provider willing to write such an order. This leaves school nurses in a precarious situation where they must depend on the family of a student to bring their own medication and they must hope that every person with a life threatening allergy or medical emergency has already been diagnosed and provided the appropriate medication.
Because if someone needs that life saving medication and they have it on hand (sometimes they do, saving unclaimed and expired medications for just such a scenario) and give it without an order (I'm told they have and do) they not only risk their license by acting outside their scope of practice, they open themselves to civil liabilities should there be any adverse reaction or outcome related to the medication they administered. An unliscenced educator would be at lest risk giving a medication in that situation than an actual nurse.
I suspect it was both ignorance and the funding attached to the bill that killed it, either way die it did.
So, we have nurses who must want to work in schools, with children, who have higher educational requirements than those of us in acute care, less resources, more risk and get paid far less to do the job.
I should say here that I know those of us who work away from the bedside tend to be paid less than those who do as a disturbing matter of course. Wage differences based on state, region, and cost of living I can understand. Yet I am somehow always surprised that the simple fact of working outside of the hospital setting automatically makes a nurses skills less valuable. Obviously no one else can do the job or they would have someone else doing it.
We all know that nursing is a subdivision of specialties, and those outside of the hospital or no less specialized than those within. I would argue that those outside of the hospital setting are more specialized than those within it. I can float to a different unit than that on which I make my home and can have an understanding of my scope of duties and the needs of care. I cannot walk into a school without specialized training and understand the scope, the legal complications, and the expected duties without an extended period of orientation.
Can you?
Somehow we've accepted that these roles are less than (perhaps harboring the unworthy thought that they aren't really nurses because they aren't in the hospital) and so have left them to fend for themselves.
You know what it seems like they need?
A union.
I won't pretend to have a solution to this one, the situation no doubt includes inter-union relationships and politics with decades of history that I know nothing about. It does seem though that if we believe that nurses are best represented by nurses in one setting why should we believe that to be any less true in other settings?
It may well be that bringing the school nurses under the wing of our union isn't something we can do. The national labor relations act (NLRA) defines the minimum number of staff necessary to establish a union is seven. I don't know if there are schools in Washington that even employ that many nurses, which definelty throws a wrench in the works. Even if we aren't able to cover them with a collective bargaining agreement, we can and should work with SNOW to more adeptly and effectively advocate for them.
With the majority of our members working in acute care it is perhaps natural that we should focus so strongly on the needs and issues of acute care nurses. Although, just as we can adapt to better serve the nurses in smaller facilities, we can and should adapt our tactics and priorities to support those in other settings.
I'm going to keep saying this. What is good for one nurse is good for all nurses.
I could never be a school nurse because I don't think that I could accept the risks they face, could deal tactfully with school administrators or parents in a setting that automatically reduces my credibility and authority as a healthcare provider. It shouldn't, but it does. People react differently when we are surrounded by the trapping of our profession. The frustrations they must face when dealing with a lack of resources and support would be my undoing.
If we are an organization that supports all nurses in Washington State, then perhaps it's time to stretch our wings, think outside of the box, and do so.
Finis
Washington Office of Superintendent of Public Instruction: School Nurse
School Nurse Organization of Washington
School Nurse Salary in Washington
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