This month’s Featured “Get to Know Nurse” Sheila Caldwell, took her background in hospital patient care and case management into the school setting as a school nurse in New Jersey. I asked her how she decided to become a nurse and how she became interested in caring for an entire school’s student population.
MP3 Audio Podcast
Jamie: In this month’s episode, Nursing Notes Live goes back to school with a look at school nurses. This month’s featured Get-to-Know nurse, Sheila Caldwell, took her background in hospital patient care and case management into the school setting as a school nurse in New Jersey. I asked her how she decided to become a nurse and how she became interested in caring for an entire school’s student population.
Sheila, tell us a little bit about what got you started in nursing, how you decided to become a nurse and your career path through school that led you here.
Sheila: Okay. When I was a young girl, my mom was a social worker. She would always tell me that she had wanted to become a nurse but, financially and schooling-wise, she wasn’t able to do such. She guided me into that path of when I would see her out working and helping people and doing different things, I kind of said to myself I knew I wanted to do something in to the medical field but a little bit different than what she was doing as a social worker. I wanted to just make sure that I went into the direction of medical health in that fashion. She had told me she had been named after a nurse from years back and it really keep my interest and I did like the health sciences as far as when I was in high school and things and that was the career path I took. I started out as an LTN and one that really likes to enjoy education and things. I, then, as I was working on the Med-Surg floor, decided I wanted a little bit more and I wanted a little bit more. I went on to acquire my Associate degree of Registered Nurse. From there, still yearned for more education and decided to pursue my Bachelor’s tracking through intensive care and various other areas of nursing within the hospital realm and on to case management within a hospital. I ended up on a pediatric floor and that really interests me to track people from the beginning to the end and even at home with setting them up for their healthcare and tracking them to the system and then empowering them, the families of these children on this particular floor. Then from there decided, “Okay, I want to become a school nurse.”
Jamie: When you got to be a school nurse, have you worked in the same school throughout your career as a school nurse?
Sheila: No, I haven’t. I’ve been in a couple of different type of settings at schools. I’ve been in what they call in New Jersey, an “Abbott district school,” which are considered schools that are in the lower socio-economic area and schools that are in non-Abbott districts. I’ve gone through a couple of different schools and seen a couple of different ways that school nursing works throughout the state. It’s really a little bit varied but it’s based on the needs. Communities, as we all know, throughout the country, the needs are different based on the region or the area that you live in. The focus of the school nursing conditions that children have and families have is going to change.
Jamie: One of the things that fascinates me about school nurses – I have kids myself and I’ve developed very close relationships with the nurses in the schools where my children have attended in – it’s this melding of not just pediatric nursing but primary care nursing and a flavor of public health nursing as well. Would you like to talk a little bit about that?
Sheila: Right. Well, coming from the case management background, as a school nurse, you are working actually in a very similar role but in the community setting. You are the person that interacts with the parents, sees what the parents may need and have to do - maybe they don’t have insurance, maybe you’re helping them along to get them insurance, maybe you’re helping them along to get them other local community resources for them and even their children that will help them along the way. It integrates a little bit of everything. You’re pulling a lot of partners in the area to help you with the students and the families and it really is something where you can on-goingly watch and monitor and help them through the system of healthcare and for wellness. We want to empower families and the students to be able to address their own health and wellness needs. As the country right now is going through all this turmoil with healthcare itself, we need to be more empowered and know what is going on, how to access it, and what to do about it as any individual.
Jamie: You talked about how varied school nursing is, what do you see as a challenge that all school nurses face?
Sheila: One of the biggest challenges right now is based on probably the ratios that you are seeing of school nurses to students. Now, in New Jersey, they do virtually require at least one school nurse to a district, at least one. Usually there’s actually one to every school. There’s other states where there’s a nurse that may have greater than 4,000 students for one school nurse and then there’s even other states that don’t even have school nurses. So understand the need for healthcare for this young people because usually and, in very high cases, especially Midwest and that type of thing, the school nurse is the only healthcare professional that is being in this child’s life or in this family’s life. So the highest challenge is getting to understand from, even the educational side, your role as a school nurse and how much you can impact, getting these children well and having families be well and for wellness and health in order to attain the educational expectations that are for them.
Jamie: You talked about educational aspects. Of course, nurses are always involved heavily in patient education. It’s a key part of our educational process, to learn about that. But you really become very involved in health education in general as well as helping individual students learn more about their individual issues.
Sheila: Yes, definitely. You have to teach. You teach, you mentor, you guide, you facilitate, you do a little bit of all of those things. You’re doing it for the faculty. When there are children that are diabetic or have other health conditions that they’re not familiar with, that we have to familiarize them with. Then you’re talking to the student and dealing with the student on different levels so the student understands what the needs may be based on their age, and the parents as well. So you have to kind of work with it all and pull it all together educationally. You’re getting little bits of education to everybody to get them to understand where their little piece of the puzzle fits for that student or that family.
Jamie: You talked about Midwest. I remember reading, oh, maybe a year or so ago, the state of Idaho had – because the teachers are giving medications to kids when they don’t have school nurses handy. They mandated that there had to be an RN in every school and they had a five-year phasing period. I think a year or two ago I read an article that said that 60% of the counties in Idaho were filing for extensions because they were unable to fill those positions because either they were unable to compete with local hospitals for nursing staff or just the nursing shortage in general. Is this a problem everywhere?
Sheila: I don’t necessarily foresee it as a true problem everywhere. I think what has happened is a lot of nurses are looking at a lot of different areas that you can go in to other then school nursing. We want to draw them into the school nursing world. School nurses, it is a wonderful area to work in. Now, what I foresee is that some nurses do believe that as far as their salaries go and things maybe they’re not getting the salary the same as a nurse working in a trauma unit at a hospital or something of that nature, but the rewards are different and the job role is different and you have to look at it. School jobs are not totally year-round in most states. So if you really broke it down into how the numbers actually work out, your salary probably is basically the same but it’s based on maybe that 180 days as it is like in New Jersey that children have to go to school as opposed to maybe another state. Whereas if they’re working in a hospital or a clinic or occupational nursing or industrial or something of that nature, you’re working – you just get two weeks a year as a vacation and you’re working longer. So a lot of school nurses compensate by working some other jobs during the summer as well or week-end job or something of that nature. The biggest draw is to get nurses in because they think that it’s not a fulfilling job as well. Like I say from the financial one and they do believe - it’s not about the Band-Aids anymore. It is about so much more in the school nursing realm. It’s about helping full families address the needs that are there and look at what’s going on in healthcare now and in the future. Look at how health information systems are now being integrated into schools and how we can be very important in that whole data collection process for public health and community nursing that can help to mold things that go on. You got to think back. Way back when this school nursing was kind of even thought about by that Lillian Wald. Her whole concept was she saw that there were high absentee rates in the country. She apparently went to Europe to see their model and saw that they did have a nurse in some of these buildings and brought that concept back to the United States. After some trials here in the US, she determined that, “Hey, look, the absentee rates are going down. We are able to impact the community and ultimately the country by having a nurse in the schools.” It’s really an area that can have one of the biggest impacts to our nation. Even today, look at – now we are fighting with obesity issues, diabetic issues that are rising beyond disbelief, asthma issues. We see that our government wants us to really take a look at that and one of the biggest places that can be of - the best place to be a part of this are at the school nursing levels.
Jamie: It really is the future. We talked about this. We see teachers talk about it. “The children are our future.” We say that all the time but really as a school nurse, you have an amazing ability to influence that future positively for not just one single child but for an entire population in your community.
Sheila: Correct. Students will listen to you. They see you as someone who is that comforting person, also that person that can teach them about the health path and wellness path that they should take. They look to you for that guidance and that information. We can be there for them as school nurses. It’s definitely an area that they really embrace. There are many people that if you spoke to them today, they can tell you one little story, a tidbit story, “Hey, how my school nurse was a part of my life” or “What that nurse did for me that” – even till today, they could be 20, 30, 40 years old, and they’ll tell you what that nurse meant to them.
Jamie: Do you see school nurses as being an ambassador to encourage students to maybe become nurses someday?
Sheila: Yes. When I’ve had children in the, mainly, the middle school ages in my office, I kind of let them see and hear what types of things I do. Obviously, I’m not giving personal information about other students and that but they will ask questions. They want to know what is it you’re doing and how do you do it. You do let them know that – yes, you’re doing the screenings. Yes, you’re collecting some other data. Yes, you’re giving an asthmatic child a nebulizer treatment. You’re assessing. You’re doing all those stuff. But the ultimate goal of it is to let them know that there are so many other facets to this. You’re working with the families. You’re integrating in community resources into the lives of these other students, this middle school-aged children especially – and even younger. I’ve had a few even younger that, you know, they wanted just touch the stethoscope and want to know, “Hey, how does this work?” You start letting them know and even play with this type of equipment a little bit to get them familiar with - that this is what it’s about. It’s really great to get them started at that young age and get them stirred in that direction. Because everybody has to take a career path at some point and, you know what, if you can introduce them within that age range of the elementary to middle school ages to their area of school nursing, it’s a good thing. It’s really a good thing. You want to, if you can, take the time with this young people to get them to at least be aware of what the role is about.
Jamie: And you mentioned, of course, elementary, middle and, of course, high school as well. Really school nursing encompasses many different roles across that spectrum. So if you enjoy caring for younger children, you got that opportunity. But if you enjoy educating young adults and trying to be a mentor in that way, you have that opportunity at the high school level. So there’s a broad spectrum really available for school nurses to have an influence in many different ways and practice their nursing in many different ways.
Sheila: Yes, that’s so true. I do know a few nurses. Now I currently am not at the high school level but I do know some nurses that do some like, what they might call, whether it’s like a mentoring nurse – meet-the-nurse type program at their level in high school where it’s set up almost like a class where maybe once a week, they kind of sit down with that nurse and have a conversation during her lunch hour if she has a few moments. It’s a tough call to say if she’ll have a few moments but if she has a few moments and gets to know her and gets to know about the job. Now I do that myself too but I say as they say I’m at a younger level and sometimes, obviously, the children are in the school to learn and they’re there for their education but sometimes life lessons are sometimes better for them to understand as we say when we want to guide them for a professional role.
Jamie: Are there conflicting views between the goals of, for instance, a school system versus your goal as a healthcare professional? Is there ever an issue with that?
Sheila: Oh, sure. There are times when we look at that - from the educational side, we know that it’s about passing grades. It’s about all of this since the “No-child-left-behind” had come into play that we see that we’re looking at numbers, numbers, numbers of grades for students. And it has to be about a little bit more than that because if you’re not healthy, you’re never going to get that education. You can’t pass that anxiety level if you can’t pass over that anxious issue and that too even be able to take a test or if your mind is focused on “Oh, I have the stomachache” or “I have this headache” or “I have other issues going on at home.” You can’t get pass that. So there are goals that the nurse wants to do that are totally contrary to what education wants to do from the start. Often the goal, as we all know, is to empower the children to be healthy and well so that educationally they can function but at the start of it, you have to look at and delve deep into what this children are bringing to the table when they walk in that door every day. Maybe their parent just lost his job, maybe there’s something else going on. If you really think about it about a good 30%, if not more, of what school nurses do is in that mental health realm. It’s just giving the children somewhere to go, someone to talk to and we kind of can then piece together and figure out what’s going on, what are the dynamics are. Whether it’s from the household or from what’s going on the classroom or from what’s going on on a playground; whether it might be like bullying or something of that nature that are playing a part in why this child is struggling with school. So it sometimes does conflict because we want to address those issues and then we can say, “Okay, now we can send you back to your classroom, back to your class or whatever or talk to your parents or talk to a counselor or talk to the principal or whoever it may be that then you can go on to your classroom and succeed.”
Jamie: It really fits into that holistic nursing model of - we have a psychosocial aspect, we have a physical aspect. It really brings in all of these various natures of a person’s being and health aspect to really help them become the best that they can be. You talked about bullying and some of the mental health issues that go along with, heck, going through puberty. Nobody ever wants to do that again. It’s like in the nursing school life but…
Sheila: Yes, right. With middle school, that’s a tough one. Like I said, right now, I’m not at that middle school level but when I was there, it was very challenging to speak to those because the emotions are flying left, right, sideways, up and down. The kids are just not settled in what’s going on hormonally and you want to bring in and discuss with them what’s going on in their lives and how their bodies are changing as much as allowed and why this is happening and why now. The eyes are focusing on the opposite sex and things like that but you have to bring them down to that level of understanding and so they can learn. It’s very challenging but middle school and puberty they really are something.
Jamie: Well, Sheila, it’s been great talking with you. Before we go, would you like to share any advice for somebody thinking about moving in to school nursing – an existing nurse perhaps even a nursing student that thinks this might be an option for them as a career path?
Sheila: I would probably say get out there, talk to some school nurses in your area and just see if maybe some of them might even be able to get you into their office as like a mentoring kind of thing. Maybe you can spend a day with the school nurse. Maybe there’s a program that they have set up or they can even ask their boards of education to allow for you to come in to spend the day and talk with the school nurse. There are many, many different avenues of conferences and different things out there that nurses can go to find out. There are even different organizations and associations that have to do with school nursing that they can go to and see about - if it’s an interest. It’s definitely a career that gives you a whole lot of flexibility as one. It’s one that you’re interacting with, as I say, and we discussed holistically with the child and the whole family to a degree and even getting involved with community partners. It’s a great thing. You do want to kind of start out and have at least a little bit of a base in your basic assessment skills and things of that nature for sure. You don’t want to walk right directly out of a school and say, “Okay, I’m going to be a school nurse,” without having a little bit of background for assessment skills because that’s ultimately one of the most important things. And you have to be able to utilize those critical thinking skills to the best of your ability. It is something that you want to start to really take a look at and move in to. I’ve been doing it for many years so it’s something that you progress with and, you know what, you get on the top of your game by having that skill and by continuing your education. I still even at this point still taking more classes off and on but you have to. It’s an evolving profession that is moving towards betterment for our students and our country. We want to be sure that kids and young people as students of nursing that are interested in school nursing are really looking at. There are so many areas that are important to this. I’m really happy to be a school nurse and, you know what, it’s one of the greatest jobs you can have as a young person starting out after you get those basics that it grows. I just wished more states and places would allow nurses to be everywhere. There should be a school nurse for every student out there at some level. It’s disheartening sometimes to hear, like as we had discussed before, about issues where [things] happen because whether it’s a secretary or a teacher or somebody has – that doesn’t have the skills of a school nurse or a nurse in general who know how to do that full assessment, evaluate, and do these things. You want to be on top of it. You want to know what’s going. It’s a very intense position at times. You get stressed. There’s a stress level. People think it’s just sitting on a chair and you wait for somebody to come in and put on a band aid but it’s not.
Jamie: I remember when I was in nursing school, I was lucky enough to actually – part of our public health rotation – we had to each spend a day with school nurse in a school. I still look back at that as one of the rotations and I wished that had more than just one day because really it opened my eyes and gave me a different perspective of school nursing, spending a day with a school nurse. I was thinking in my area, there are even opportunities to be a substitute school nurse just like you have a substitute teacher. So if you’re a nurse that has some open time in your schedule and you do PRN work in other places, if you’re interested in school nursing, you might be able to find an opportunity to be a substitute and get your feet wet that way.
Sheila: Right. That’s going to depend on the state as we mentioned. Because some states you have to have that school nurse certification before you can even walk in the door. Some states allow you in there – like as you’re saying – just as a general sub. So you have to kind of look around and see what your state allows and that. We have to make our role as school nurses visible to the public, to the administrations of schools and to other school nurses. It’s a job where you actually are very independent in and of itself because you’re like one nurse for all these students plus the faculty and whoever else was in the building. So you have to be able to be a nurse that can function at a level where you’re comfortable with, more or less, acting in an independent role. I’m not saying a totally independent but where you’re acting in an independent role and where the educational forces are really – it’s really tilted scale. You may have 400 teachers and faculty to the one school nurse. So some values and things that you’re thinking about and think that you may want to accomplish from the health perspective are not going to jive as easily into their world. You have to be strong. The best way probably to do all of this as anybody that’s interested in becoming a school nurse or even that is currently a school nurse is to get out there, get the word out about what it is you actually do; what it is to these families; maybe have some programs for families to see what the school nurse; introduce kids to programs. Maybe when it is around like school nurses, they have something where they can be involved. Maybe even have a meeting with your administration or school board. [A night, a form] where they can hear what it is you’re all about and what your job role is. You have to get the word out there. There are many of us out there that are trying to do all this but it is – we’re, per se, the minority in the educational world. So it’s not as easy but you have to stay strong and, you know what, what you should do is acquire some liaisons with an association with other school nurses whether it’s in your county, whether it’s in your state, whether it’s beyond that to the national level, some organizations and associations, so that you don’t feel that all these pressures on you. You have to have some kind of support system for yourself as that school nurse because, as I say, you may be the only one in the building with all these other people and the students and it does get a little bit overwhelming at times but it’s workable, and it’s doable, and it’s really rewarding after the fact.
- End of Interview -
Don’t forget to check out the entire August, 2011 issue of Nursing Notes, featuring school nurses. This month’s Nursing Notes newsletter includes articles focusing on initiatives combating childhood obesity, mainstreamed kids with special needs and a link to our Nursing Notes Newsletter survey.
You can read the entire issue online at www.discovernursing.com and don’t forget to catch our other Nursing Notes Live episode this month featuring a panel of school nurse leaders and how they are working to improve healthcare one child at a time. You’ll find this and our other podcast episodes at www.NursingNotesLive.com, the Nursing Notes by Johnson & Johnson Facebook page, and in the podcast area in iTunes.