Have you ever heard a nurse pass judgment on a colleague and say that another nurse isn’t a “real nurse”? Have you noticed some nurses looking down on those who choose to be school nurses or work in home health, dialysis, assisted living, medical offices, or ambulatory surgery?
Judgmental attitudes by one group of nurses against another don’t do anyone any favors, but such thinking is all too common.
So, given that there are still nurses who think in such old-fashioned ways, what then constitutes a “real nurse” anyway, and how do we know when a nurse is the real deal? (Hint: they’re all the real deal.)
That’s Not “Real” Nursing
When we’re in nursing school, it often seems that everyone and their mother has their sights set on “sexy” specialties like trauma, emergency nursing, and critical care. When a peer talks about having a goal of working in public health, school nursing, elder care, home health, community health, or some specialty that isn’t highly technical or soaked in adrenaline, some may scoff at such a notion.
“School nursing? That’s not real nursing — all you do is put band-aids on boo-boos and give kids aspirin for headaches.”
“Home health? Do you want to go from house to house checking blood pressures and filling little old ladies’ med boxes?”
“Why would you want to do public health? That sounds so boring.”
Looking down on nurses who don’t want to follow the straight and narrow path of the more fast-paced or complex acute care areas is an all too common way of thinking about others’ choices. When a nurse isn’t inherently drawn to the ICU or the ED, some nurses may be quick to judge that nurse for being lazy, not smart enough, or simply not a “real” nurse.
For those who think that school nursing is just band-aids and aspirin, think again: kids come to school with trachs, vents, complicated medication schedules, brittle diabetes, and all manner of chronic illnesses.
School nurses have to think on their feet, sometimes manage multiple schools, and also tend to the medical needs of teachers and administrators. And in rural and underserved areas, the school nurse may be a student’s primary connection with the healthcare system, not to mention parents.
In home health, patients can come home with complex surgical wounds, including a wound vac, IV antibiotics, and other medications administered by a programmable IV pump.
Home health nurses may also encounter patients receiving TPN and other complex situations necessitating expertise and highly skilled care. And when a home health nurse is out in the field, that nurse is all alone — there are no colleagues, doctors, or specialists to lean on with questions and concerns.
The home health nurse is by nature autonomous and independent and can face life-or-death decisions without the benefit of others to confer with.
According to the American Association of Colleges of Nursing (AACN), approximately 55% of nurses work in general medical and surgical hospitals. So, where do the other 45% of nurses work if this is the case?
When it comes to “real” nursing, there’s nothing fake about home health, public health, ambulatory care, community health, or school nursing. All nursing is real, and those who think otherwise are gravely misguided.
No nursing specialty or area of practice is more worthy than another. Under our big nursing tent, all nurses are welcome, and whatever each nurse chooses to do for a living is a valid choice.
When you hear another nurse talking negatively about another nurse’s valuable contributions to society, you can rest assured that that nurse’s opinion has no merit, and every colleague’s career choice has its role to play within a noble and highly respected profession.
Kimberly McClintick, MSN, RN, the children’s school health coordinator at Children’s Hospital & Medical Center in Omaha, Nebraska, embarked on a mission in 2018 to elevate the experience of school nurses across the state.
Through surveys and conversations, she discovered a crucial need for mentors, particularly in rural communities, where school nurses often find themselves as the sole healthcare provider for an entire district. The lack of support and guidance can leave these nurses feeling overwhelmed.
McClintick was determined to bridge this gap and revolutionize the support system for school nurses and teamed up with Andrea Riley, BSN, RN, children’s school health liaison, to create a groundbreaking initiative–the Nebraska School Nurse Mentor Program. The program pairs seasoned school nurse mentors with newer school nurses.
The CDC recently recognized the Nebraska School Nurse Mentor Program as a remarkable Healthy Schools Story of Achievement. Daily Nurse honors Kimberly McClintick as the Nurse of the Week for her work to enhance school health in rural communities and helping to increase new nurses’ confidence in their work with the 12,5000+ students in rural school districts in Nebraska.
Since its inception during the 2020-2021 school year, the School Nurse Mentor Program has seen resounding success. It has already made a significant impact with 83 mentees and 25 mentors from 70 school districts across the state. An impressive 76% of mentees reported a notable increase in confidence and proficiency, resulting in a heightened ability to fulfill their roles effectively.
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
It’s back to school time again, which means school nurses are preparing for the year ahead and the challenges and opportunities a new school year will bring.
In recent years, the roles and responsibilities of school nurses have evolved. Traditionally, school nurses are tasked with administering first aid and caring for students’ physical health. Still, we are seeing demand for school nurses to manage a broader definition of wellness, including physical and mental health. The new focus is the overall well-being of every student.
Plus, they are now helping more than just the students. The CDC says, “School nurses promote a healthy and safe school environment. School nurses care for the entire school population—students and staff.”
Mental health concerns are high for students, parents, and teachers. Mental Health America’s 2023 Youth Data survey reports that 11.5% of youth, totals over 2.7 million, have severe mental health issues. Since students spend so much of their waking hours at school, designated individuals must be on campus to help them with mental health-related issues.
However, 77% of counties in the U.S. lack school behavioral health professionals, as The National Council for Behavioral Health reported. Meaning in some cases, school nurses have had to fill in the gaps in services.
School nurses can play a vital role in early intervention since mental health challenges can sometimes manifest with physical symptoms and behavioral changes. This is especially common in children and teens. School nurses can be trained to recognize these warning signs and work hand in hand with school counselors (if available) and the student’s teachers and family.
Fully certified nurses can administer medication and treatments to ensure the student remains healthy and can attend classes. The nurse can also liaise with the student’s parents, teachers, and potentially even pediatricians to ensure all the student’s needs are met. Additionally, school nurses can help teach students how to manage their health, especially in secondary school settings, independently.
In some cases, a school nurse could be the first to notice an unknown health concern with a student, ensuring they get outside medical attention if needed. They are the all-around, on-site medical staff.
Health Education
School nurses not only help students with immediate health concerns but can also educate students on various health and wellness topics such as proper nutrition, substance abuse prevention, hygiene, and puberty.
This type of education is crucial to help students better understand their health and wellness and encourage them to make healthier choices. By promoting healthy behaviors, school nurses are contributing to the overall well-being of the student population.
Staff Wellness Programs
With the growing emphasis on staff well-being in the education industry and beyond, school nurses are also tasked with implementing employee wellness programs. The programs often focus on initiatives around physical health and stress management, including helping with access to general and mental health services and encouraging active and healthy lifestyles with fitness challenges, nutritional eating challenges, mindfulness seminars, and more.
These programs are becoming more critical for improving staff retention and productivity, decreasing employee absenteeism, and decreasing healthcare costs. And ultimately, supporting the well-being of the staff, by extension, helps keep the well-being of the students.
Financial Benefits of Nursing Programs in Schools
Besides these occupational benefits, nursing programs can also have financial benefits for the school and its families and staff. A solid nursing program in place was found to reduce medical care costs and productivity losses for parents and teachers in a study of the cost-benefit of school health services in a Massachusetts school district.
In other words, school nursing has broader benefits than just keeping students and staff healthy, and it’s increasingly important for school districts to have nursing professionals on staff.
We foresee that the school nurse’s role will continue to change as our society’s overall expectations for school services and education shift.
The role of school nurses often has the reputation of being a treater of injuries for rambunctious kids. But they have a more profound impact. Nurses in educational settings contribute to kids’ physical, personal, and social growth. One of the most important ways this is evident is in how school nurses influence the development of students’ health literacy.
Health literacy isn’t just about understanding information on wellness matters. Instead, it is discovering information, acting on it, and advocating for oneself to improve quality of life. Therefore, it is vital to encourage these abilities in children from an early age, as it impacts how they navigate wellness issues throughout their school years and into their life beyond the classroom.
Let’s take a closer look at school nurses and their vital role in developing children’s health literacy.
Providing Relevant Knowledge
Among the key components of health literacy is the ability to gain and use information about medical and wellness matters. This allows patients, no matter their age, to make informed decisions about their lives and care. School nurses have a significant impact in helping children develop in this area by providing general health knowledge and offering the most relevant guidance to help them thrive.
This is a result of the fact that the role of a school nurse sees them being front-line workers in children’s day-to-day lives. This means they tend to have a more nuanced understanding of their communities’ wellness challenges, concerns, and trends than other healthcare professionals. They can, therefore, offer a relevant range of tailored healthcare information to children and parents alike to empower them to navigate these components.
Indeed, this closeness to the community also means school nurses have the opportunity to address local wellness misinformation trends. For example, children are likely to be subjected to rumors and poorly researched opinions from their peers and parents, which can impact their understanding of specific health issues. School nurses can counter this by identifying common challenges and helping children find and use more credible sources of information.
Building Trust
Trust is vital to effective relationships between patients and medical professionals. When health literacy is in place, this can help patients to be better advocates for their needs and develop trusting, collaborative connections with a range of healthcare providers. The earlier this component can be in place, the more valuable it is to patients and communities. School nurses play a crucial role in children’s early development of such connections.
One of the benefits school nurses have over other medical professionals is the nature of their place in children’s lives. They are a familiar and friendly part of regular school interactions. Children can also independently choose to go and speak to the school nurse when they have questions or concerns. Not to mention that they attend appointments without parents or teachers present, meaning they are speaking perhaps more openly than they would otherwise. Each component contributes to developing children’s confidence in professionals and taking charge of their wellness.
That said, it’s essential to understand that this trust is often hard-won. School nurses must be prepared for the challenges of interacting with that demographic to play a role in children’s health literacy. Working with kids requires patience and empathy, as they’re still growing emotionally and socially. Not to mention that school nurses may need to kneel, bend over, or sit on the floor to communicate at the kids’ level, which can make them feel more comfortable.
Overcoming Anxiety
One of the hurdles to health literacy is the propensity for healthcare anxiety. This is where patients have fears surrounding being in medical environments or interacting with professionals. Unfortunately, children can be particularly susceptible to this. When not effectively addressed, it can lead to patients delaying getting medical attention or information they need, which may exacerbate matters.
School nurses have a chance to help identify and mitigate this trait in children. This isn’t just reassuring kids that medical professionals are there to help and guide them. There are common symptoms that can suggest medical anxiety is in place, such as skipping appointments or experiencing a racing heart. School nurses can be mindful of the presence of these in students and note the root causes, like previous negative experiences or misconceptions about specific medical procedures.
School nurses are often able to provide the attention required to address such issues that other medical professionals may not be able to. The fact that the nurse’s office is in the familiar environment of the school can help reinforce that medical spaces are safe. This provides the foundations upon which school nurses can teach children coping mechanisms for their anxiety and provide accurate information about medical care in general.
Conclusion
School nurses are invaluable influencers in children’s development of health literacy skills. Their position in the community enables them to identify key challenges and provide relevant education. They also hold a unique position of trust, which can influence kids’ future interactions with healthcare providers. School nurses have an opportunity to provide the individual support and guidance required to address potentially damaging medical anxiety hurdles. This nuanced role has an early impact on children and the community.
School nursing builds a culture of health and improves health outcomes in their communities. Today’s Nurse of the Week is a school nurse passionate about using the school nursing profession to educate and uplift students, families, and the community.
We honor Dr. Cynthia Samuel, Ph.D., RN, CSN-NJ, school nurse at the University Middle School in Irvington, New Jersey as the Nurse of the Week.
“I’ve had the privilege to collaborate with and serve on various school nursing committees, projects, and events at National, State, and local levels with Dr. Samuel,” says Judith Woop, retired Executive Director and President of the New Jersey State Nurses Association.
Woop says she’s partnered with Dr. Samuel on professional and community agencies such as the National Association of School Nurses, New Jersey Education Association, and American Academy of Pediatrics. She says Dr. Samuel’s leadership speaks volumes.
Woop says Dr. Samuel proudly represents the school nursing community by increasing school nurse visibility and advocacy with community stakeholders and presenting nationally on current school health policy and procedures.
“Dr. Cynthia Samuel embodies today’s Certified School Nurse in New Jersey. Her timely mission is to connect underserved/underprivileged students and families pre-post Covid-19 with needed essentials in the community,” says Woop.
She says Dr. Samuel’s years of experience enhance her ability to successfully transfer her nursing skills into a school practice to care for those in the community she represents. In addition, Dr. Samuel is a visible, reliable, and trusted neighborhood advocate, serving as a necessary community liaison and resource person in today’s unprecedented times.
Woop says honoring Dr. Samuel as Nurse of the Week is the perfect recognition for her tireless efforts in serving her students and community. Adding that Dr. Samuel contributes diversity, experience, expertise, and medical insight that lends richness to enhancing New Jersey students’ academic and psycho-social growth and development.
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life and as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
Nurse researcher and educator Kasey Jordan, RN, PhD knows the stereotypical image of a school nurse – overworked, underpaid and, over the past two years, often on the front lines of controversial COVID policies.
And while those things are true, they aren’t the complete picture, says this Nurse of the Week.
“We don’t always present them as these strong, capable expert professionals that they are,” she said.
The same could be said for nursing in general – or for any traditionally “female” job. But Jordan sees the power in the interpersonal connections that nurses build with their patients and, from that, their capacity to create community change.
“If we’re serious about having better patient outcomes for society, then it’s areas in which the traditional nursing role can lead that really, I think, have a lot of potential to make a big difference. Things from communication to health promotion to what happens outside of that time when people are sick,” she said.
School nurses as “change-makers”
The possibilities inherent in nursing have inspired Jordan ever since she accidentally ended up in a nursing class in high school in rural Georgia.
“In high school, there were vocational classes that we took with all the other classes, and I wanted home ec, but I got stuck in health occupations against my will. Well, it stuck, and it really resonated with me,” Jordan said. “I ended up including those classes as part of my program of study, and I did an apprenticeship program with a local family practice and just never looked back.”
Even with the limited work that a high school apprentice could take on, she felt a meaningful engagement with patients and saw the role that the nurses played in their patients’ health journeys.
Jordan went on to study nursing with the expectation that she would be a bedside nurse, but by the time she finished her program, she knew she wanted to be in public health. Her first nursing job was in the cardiothoracic unit at Duke University Hospital to gain experience. Then she worked at the health department for a time before taking a job in the emergency department so she could complete an internship while earning her master’s degree.
Through the public health department, she spent a year and a half as a school nurse in Durham, North Carolina, at five alternative schools, each geared toward a different student population that needed extra attention.
“Every school had its own flavor,” she recalled.
Yet she also started to see constraints in the system.
One small example: The alternative schools were well-connected to mental health and behavioral resources for the students. But Jordan saw that some students weren’t having truly basic needs met, like good nutrition, decent sleep and adequate physical movement. Jordan approached an administrator about this, and the answer was, “Well, there’s no grant funding for that.”
“It was like, there’s all these high-level treatments that are so valuable. But then there’s also these basic processes that are so impactful on our outcomes. And it was sometimes harder to work on those things,” she said.
In both public health and school nursing, Jordan found herself surrounded by “incredibly smart people with great ideas” who faced numerous obstacles in bringing those ideas to fruition.
“That core challenge is really what led me to go back for my Ph.D. and what, in different ways, I’ve tried to explore since then,” she said.
Now an assistant professor in the College of Nursing at MUSC, Jordan focuses on innovation management. She especially values how school nurses and other health care providers find ways to develop resilience in communities and address disaster risk.
“What I’m most excited about is nurses and health professionals finding ways to make our communities more resilient to disaster. School nurses are incredible change-makers, and so are our students,” she said.
For instance, students in the accelerated Bachelor of Science in Nursing classes are learning the change-making skills that school nurses often learn, by necessity, on the job, Jordan explained.
Innovative projects the ABSN students have tackled recently included a podcast geared toward mental health challenges during the pandemic and support for educators to understand how COVID-related changes could affect student health.
School nurses play key role in community resilience
Jordan noted, too, that local disaster response requires flexibility to adapt to specific circumstances, and that’s where she’s interested in seeing who’s doing what.
“If you consider disaster response, there’s this piece of improvisation that is in it. It’s such a fascinating area, and school nurses have been on the ground improvising to meet these needs,” she said. “It’s really inspiring – and important to understand.”
“So much of responding to disaster is locally driven,” she continued. “So understanding what professionals in community spaces need is important.”
Jordan said she loves seeing school nurses who understand how comprehensive the role can be and are pushing expectations of what they’re there to do.
“One of the amazing gifts of school nursing practice, because you are outside the traditional system, is there is so much freedom and independence,” she said.
On the other hand, that requires skills that nurses don’t necessarily come equipped with. Unlike nurses in a health care setting, school nurses may need to be more entrepreneurial to “sell” innovations related to health.
“School nurses really have to build their teams and raise whatever kind of capital is needed – social or financial – to see their changes move forward,” Jordan explained.
While there’s general agreement that addressing health and physical needs will ultimately help with academic outcomes, Jordan said, the rub is the school nurses actually have to negotiate to get what’s necessary to address that health. That’s where those skills of teambuilding in a multidisciplinary environment come into play.
“There’s good evidence that school nurses are a great return on community investment, but I think there is more to tell about the community resilience they are building that is outside the traditional expectations of what school nurses have done,” she said.
In follow-up to a previous study she conducted, Jordan is currently looking at how school nurses are leading resilience-promoting change in school settings.
Since coming to South Carolina, Jordan has been working with the South Carolina Association of School Nurses to determine what subject areas need more research to help nurses in schools. That’s how she came to do an analysis of continuing education needs for school nurses, which led to her examining how school nurses are leading resilience-promoting change in school settings.
Throughout her journey, one fascinating thing that she has discovered is that innovation can come from anywhere.
“There’s not a single profile of an innovator,” she said. “It’s something that happens in all parts of an organization. But definitely there are skills we can learn to make it more effective.”
