The Transformative School Nurse

Leading a School Health Team: With Heart, Humor & a Whole Lot of Patience

There’s something incredibly rewarding about leading a school health team. When things are running smoothly, you’re helping create a safe, supportive environment for students, families, and staff. And when they’re not running smoothly? You’re still somehow expected to be a clinical expert, a communication strategist, and a peacemaker… all before lunch.

Whether you’re working with unlicensed assistive personnel (UAPs), office staff, or floaters who think “medical clearance” means the parent said it was okay — your ability to lead with heart and keep students at the center is what makes you, well… you.

When There’s No Nurse in the Building… But the Phone Still Rings

Many families don’t understand the difference between a nurse and a UAP — and that’s not their fault. But it can lead to confusion and frustration, especially when communication doesn’t go as expected.

For example: A student gets hurt at recess. A well-meaning staff member with limited health training makes the call home. The parent thinks they’re speaking with a nurse. Cue frustration when the explanation feels off, or decisions don’t align with what they expected.

You know what happens next:
You're now the “lead nurse on damage control.”

But here’s the thing — this is where quiet leadership shines. Not with blame or frustration (even when it's justified), but with calm, empathetic action.

Support the Student. Guide the Team. Reassure the Family.

In the moment, it’s tempting to explain everything that went wrong. But true leadership often means stepping in, resetting the tone, and guiding the conversation toward what will happen next.

• Support your team without shaming them — they may not have the training, but they likely had the best intentions.

• Model calm, clear communication for the family. Listen fully, explain thoughtfully, and refocus on the student’s needs moving forward.

• Bridge the gap — whether that’s creating a care plan, clarifying protocols, or gently reminding others not to play health professional when they’re not.

Let your example lead the way.

Growth Comes from Reflection (Not Perfection)

Your team may not get it right every time. Office staff may misstep. Families may be upset. It happens.

What matters is what happens next:

• Use these moments to reinforce best practices.

• Help your team grow their confidence and clarity.

• Gently redirect when others fall into the blame game — because finger-pointing doesn’t support student wellness.

You are not just the clinical expert — you are the calm in the chaos, the heart behind the protocols, and the person making sure everyone feels supported, including the staff you lead.

✨ Keep Leading, Even When It’s Quiet

Leadership in school nursing doesn’t always come with a title. But it shows up in how you handle tough moments, how you lift up your team, and how you keep students at the center of it all.

Some days it’s exhausting. Other days, deeply fulfilling. And most days? A little of both.

So if you’re guiding a team through all the wildness that is school health — keep going. You’re doing important, transformative work. And even when it feels like no one notices… you’re making a difference that ripples far beyond your office door.

Supporting Students with Sickle Cell Trait: Improving Care and Awareness

While sickle cell disease (SCD) rightfully receives significant attention due to its severe health complications, including pain crises, organ damage, and anemia, the focus on SCD often leaves sickle cell trait (SCT) under-recognized and under-researched. SCT typically causes no major health problems and does not require the same level of medical intervention, leading to a perception that it is insignificant. However, this emphasis on SCD, combined with a lack of clear guidelines for managing SCT and ongoing research into its potential complications, creates a situation where children with SCT may not receive the attention and preventative care they need, leading to it being potentially undertreated and possibly resulting in serious health outcomes.

Misunderstanding the Symptoms and Risks of SCT

Sickle cell disease (SCD) is caused by inheriting two sickle cell genes, resulting in a high percentage of sickle-shaped blood cells—typically about 60-90%. Many people are unaware that sickle cell trait (SCT), which involves inheriting only one sickle cell gene, still leads to a small percentage of sickle-shaped cells in the blood—typically about 20-45%. Although this percentage is lower, it can still cause potential complications under certain conditions, such as physical exertion, dehydration, or high altitudes. While rare, these conditions can lead to complications such as increased risk for infection, muscle breakdown (rhabdomyolysis), kidney issues, bleeding and increased pressure in the eye (glaucoma) following eye injury, and even sudden death with extreme exertion.

The Need for Specific Guidelines for SCT Management

Unlike SCD, where there are more well-established guidelines, there is no universally adopted protocol for managing children with SCT in physical activities or school settings. As a result, each school or healthcare provider might take a different approach. Some children might receive accommodations for rest or hydration, while others might not. This highlights the important role of school nurses in identifying students with SCT and facilitating communication and collaboration among the family, healthcare provider, and school staff to develop an individualized health plan. By working together, they can ensure that the child receives appropriate accommodations tailored to their needs.

Hydration and Physical Activity Management

Proper hydration is widely considered important for children with sickle cell trait (SCT), particularly during physical activities such as running a mile outside in hot weather. Dehydration has been identified as a potential trigger for sickling, and inadequate fluid intake could theoretically increase the risk of a pain crisis or muscle injury. However, the specific thresholds at which hydration and fluid intake impact SCT versus sickle cell disease (SCD) are still not fully understood, as research on SCT management is more limited compared to SCD. As a school nurse, collaborating with the child’s healthcare provider, you can help implement accommodations, such as ensuring students have access to water before, during, and after exercise, and encouraging regular hydration to minimize potential risks.

Supporting Students with SCT: Educating for Health and Advocating for Research

School nurses can play a vital role in educating students about sickle cell trait (SCT), emphasizing the importance of hydration, recognizing signs of exertion-related pain, and encouraging the practice of taking breaks during intense physical activity. By fostering this early education, school nurses can help students develop healthier habits and a greater sense of responsibility for their own wellness, which can significantly reduce the risk of complications later in life. 

Despite these efforts, there remains a critical need for more research on SCT and its long-term effects, particularly in relation to physical activity and exercise. Increased awareness among the health community, educators, and parents is essential, as many children with SCT may not receive the attention or accommodations they need. By advocating for more research, improved screening, and better understanding, we can ensure that children with SCT are supported and that their needs are addressed. This is a call to action to spread awareness and ensure that SCT is not overlooked in the conversation about child health and wellness. Let’s create an environment where students with SCT are supported, informed, and prepared to take care of themselves, ultimately promoting long-term health and well-being.

Call to Action

The role of school nurses and healthcare providers is critical in raising awareness, educating families and staff, and ensuring proper accommodations for children with sickle cell trait (SCT). By advocating for more research, early intervention strategies, and individualized health plans, we can create a safer environment for children with SCT and help prevent potential complications. Let’s work together to ensure these children receive the care and attention they deserve—before complications arise. 

A Silent Struggle in Schools: How a School Nurse Can Make a Difference

Did you know that there is a common phobia in children that can lead to chronic absenteeism, increased anxiety, and negatively impact academic performance? More importantly, did you know that if you, as a school nurse, identify this issue early and implement interventions, you can prevent this from becoming progressively worse over time? In fact, the problem can be minimized or even eliminated just based on your approach!

What is this phobia that has such a significant long-term impact, yet can be effectively managed and potentially prevented through early intervention? It’s Emetophobia, or the fear of vomiting. Some studies suggest it affects about 7-9% of school-aged children. It’s more common in girls, but can affect both, with the typical age being around 8-9 years.

Triggers for this phobia can include witnessing another child vomit or vomiting themselves. Children who already have anxious tendencies are particularly vulnerable. Once a child witnesses vomiting or experiences it themselves, they often develop an extreme fear of vomiting. This, in turn, leads to stomachaches, nausea, frequent visits to the nurse’s office, a fear of eating at school, and even school avoidance altogether. In some cases, anxiety can escalate to the point where the child forces themselves to vomit (often appearing as spitting up), which only reinforces their fear.

Schools typically have a vomiting policy—similar to "students who vomit must be picked up and cannot return to school for 24 hours." This can inadvertently reinforce to the child that something is seriously wrong, increasing their anxiety and contributing to a cycle of absences. This cycle might look like the child staying home, returning to school, vomiting (or spitting up), being sent home again, and the cycle repeating itself.

The Power of Early Identification: How School Nurses Can Break the Cycle

It’s important for school nurses to identify this issue as early as possible, as early intervention can significantly reduce the long-term impact. Children with this condition may begin to avoid places associated with vomiting, such as school or the lunchroom, which can affect their social and academic experiences. This can also extend to families, leading to lost work, increased stress, and potential disruptions in daily routines. While the situation may seem concerning, it's essential to remember that phobias like this are common among children and, with the right support, can be managed effectively.

The Difference Between Early and Late Intervention

Over the years, I’ve had the privilege of witnessing the transformative impact of early intervention. For example, I’ve worked with several students who, with early identification and intervention, were able to make significant progress. While it was often an effort to implement the necessary interventions—such as providing reassurance, working closely with parents, and offering additional support—these students were able to overcome their fears. In fact, most of them fully recovered, returning to school without the fear of vomiting dictating their lives.

On the other hand, I’ve also witnessed the struggles of older students who were not identified early. These students often had a history of chronic absences, misunderstood their condition, and had developed school refusal. In many cases, their parents were overwhelmed by the ongoing struggles. The long-term impact was not only the fear of vomiting but also issues with anxiety, avoidance behaviors, and strained relationships with both peers and staff. These students faced much steeper challenges because the issue was not addressed early, and the negative cycle became harder to break.

Putting a Plan in For Student Success

Once the condition is identified, the next crucial step is to help the school staff understand the situation and implement a plan. Communication and securing staff buy-in are key to the plan's success. It’s important to explain the nature of the issue, the interventions being put in place, and the long-term benefits of supporting the child in this way. First and foremost, reassure the parent that their child will not be sent home unless they have additional symptoms of illness. If the child vomits or spits up at school, it’s essential for staff to assess the situation and, if no other signs of illness are present, the child should remain at school. Educating the school staff about the potential long-term consequences—such as school refusal, absenteeism, negative impacts on academics, and the development of social phobias—can help prevent these outcomes and keep the child on track. By ensuring that staff understand the importance of the plan and how their support directly influences the student's success, the intervention has a much higher chance of being effective.

Early Action, Lasting Impact

Early intervention is crucial in addressing the fear of vomiting (emetophobia) and preventing it from affecting a student's educational journey. By identifying the issue early, school nurses can take proactive steps to create a supportive and understanding environment. This early support helps children feel safe and confident, allowing them to continue attending school without the fear of vomiting dictating their actions. Through open communication with parents and collaboration with other school staff, nurses can ensure that students receive the resources they need to manage their anxiety. I’ve seen firsthand how timely support can transform students’ experiences, enabling them to overcome these fears, regain their confidence, and thrive academically and socially. When we intervene early, we provide students with the tools to build resilience, improve their mental health, and enjoy a fulfilling educational experience. Every child deserves the opportunity to succeed in a supportive, understanding environment, and early intervention is the key to making that a reality.

What Happens When a School Nurse Gets Sick?

School nurses are an essential part of the school community, spending their days caring for others. They are there to comfort ill or injured students, monitor chronic health conditions, and respond to medical emergencies, often with calm and compassion. For many, it’s not just a job – it’s a calling. However, in the midst of caring for others, self-care often takes a backseat. It’s a reality that school nurses, like anyone else, are human and susceptible to illness. So, what happens when the school nurse gets sick?

While it may seem like an odd question, the absence of a school nurse can have a significant impact on the entire school. That’s why it’s essential for nurses to prioritize their own well-being – both to recover when they’re unwell and to ensure that the school’s health services continue seamlessly in their absence.

Establishing a System for Absences: The First Step in Self-Care

One of the most important ways for school nurses to take care of themselves is by setting up a system that makes self-care possible. Nurses are excellent planners, with sharp attention to detail, and these skills are essential when it comes to creating a framework that supports their absence. However, this is often not given enough priority. It’s time to change that.

Planning for an absence should go beyond simply having a substitute on call. It involves creating a comprehensive system that ensures the school can function smoothly even when the nurse is not there.

Additionally, training other staff members ensures there’s a safety net in place. If there is higher medical need in your building than at another within your district, keep that nurse informed about students with significant health needs so they can step in and cover your building while the substitute is placed in theirs. Alternatively, equip them with the necessary knowledge to remain in their building and assist with the substitute’s questions, easing the substitutes mind and ensuring a smooth transition during your absence. 

Finally, ensuring that there is an adequate substitute pool is critical. Having a reliable list of trained and qualified substitutes who are familiar with the school’s protocols can prevent the chaos that might arise when there’s no one available to step in.

Giving Yourself Permission to Rest and Recover

Nurses are known for their dedication to their work, often sacrificing their own health and well-being to help others. It’s common for school nurses to skip lunch breaks, stay late after school to address lingering issues, and give their all to the students in their care. However, when a school nurse is sick, it’s essential to allow themselves the time and space to recover.

It’s easy to feel guilty about taking a break, but rest is not only beneficial – it’s expected. As the saying goes, “Put on your oxygen mask first.” In order to continue caring for others, nurses need to care for themselves first. This means taking the necessary time off to heal and rest without guilt or hesitation.

Navigating the Aftermath: Coming Back to a Full Plate

When the school nurse returns to work after being sick, they often find themselves facing a mountain of tasks. There may be missed protocols to address, upset parents or staff to calm, and a backlog of paperwork to catch up on. It’s easy to feel overwhelmed by everything that needs attention. But it’s important to remember that this is perfectly normal, and it’s okay to take it one step at a time.

Start by taking a few deep breaths and focus on tackling one task at a time. Remember, it’s okay to let others step up and help when needed, and sometimes, people will surprise you by rising to the occasion in ways you didn’t expect. Allow yourself to trust in the systems you’ve set up, and embrace the support from others.

Don't Give Up on Self-Care

Most importantly, never give up on the idea of self-care. It’s easy for school nurses, like so many caregivers, to get caught in the cycle of giving without thinking of their own needs. But self-care is not selfish – it’s necessary for sustaining the work you do. By prioritizing your own health and well-being, you’ll be better equipped to care for your students, your school, and yourself.

Remember, being a school nurse is a marathon, not a sprint. You deserve rest, time to recharge, and the space to recover when you’re unwell. It’s time to recognize that taking care of yourself isn’t just beneficial for you—it’s beneficial for everyone who relies on your expertise and care. So, set up a system that allows you to take the time you need, trust in the support around you, and, above all, never underestimate the power of self-care.

The Importance of Spreading Awareness About the Role of School Nurses

As a school nurse, one of my most important tasks is not just tending to the immediate health needs of students but also spreading awareness about the vital role we play in the educational environment. I believe this awareness can lead to better health outcomes for students and more effective educational experiences for everyone involved.

One story that illustrates why raising awareness about our role is so crucial happened during the pandemic. As many school board meetings moved online, I took the opportunity to listen to discussions from different communities. I wanted to gain insight into how other districts were handling the challenges of the moment. What I heard in one meeting, in particular, left a lasting impression on me.

In this meeting, board members were debating whether or not they needed a school nurse. One board member, an intelligent and highly educated individual, asked, “Why do we even need nurses in our schools? Our students are healthy. We have a healthy population.”

While I wasn’t exactly shocked by the comment, it sparked something in me. This kind of thinking is part of the reason why some administrators and school boards don't fully recognize the value of having a nurse in the school. It's easy to assume that if students aren't visibly sick, there’s no need for a nurse. But that’s where the importance of awareness comes in.

Why We Need School Nurses

There’s a fundamental difference between simply being healthy on the surface and truly being healthy in a way that supports academic success. The role of the school nurse goes far beyond addressing the occasional scraped knee or cold. In fact, many of the health conditions we manage in schools are not immediately visible.

Not all students’ health challenges are outwardly obvious. Some children live with chronic conditions like asthma, diabetes, or even conditions that are less known, such as sickle cell disease, cystic fibrosis, or childhood cancers. Others might have heart conditions, blood disorders, or kidney issues. There are also many students facing mental and behavioral health challenges that aren't immediately apparent but can significantly affect their ability to learn and succeed.

The Ethical Responsibility of School Nurses

Another reason why school nurses often remain in the background is the nature of our work. Confidentiality is one of the cornerstones of nursing ethics, and school nurses must balance the privacy of student health information with the need to share critical information with staff. This delicate balance can sometimes make it harder to raise awareness about the full scope of our role. We must respect privacy, but we also must make sure that those who need to know are informed about how best to support the health needs of students.

However, even with these ethical constraints, I believe there are ways to effectively spread awareness. It’s about finding the right channels to communicate the importance of our work, without compromising confidentiality. This could mean offering general information about common health conditions in the school population or educating staff on how to recognize signs of health issues early.

The Benefits of Increased Awareness

I have made it my mission to increase awareness about the role of school nurses, and I believe this effort brings several important benefits. First, it leads to better communication and collaboration between nurses, teachers, administrators, and parents. When everyone understands the scope of a nurse’s role, it’s easier to work together to meet students’ needs.

Increased awareness can also improve job satisfaction for school nurses. When others in the school community recognize the impact of our work, it’s more likely that our contributions will be valued. This can lead to a stronger sense of purpose and fulfillment, which benefits everyone.

But perhaps the most important outcome is that increased awareness results in better health and educational outcomes for students. When health conditions are identified and addressed early, students are less likely to fall behind in their studies or struggle with absenteeism. This improves their chances of academic success and helps them thrive both in school and in life.

Ultimately, spreading awareness about the role of school nurses is not just about elevating our profession—it’s about creating a healthier, more supportive environment for all students. When we invest in student health, we’re investing in their future.

School nurses often collaborate with healthcare professionals, where there’s a shared understanding of health promotion and medical terminology. However, the dynamic shifts when working with school staff, such as teachers and administrators. In these situations, school nurses may feel outnumbered or disconnected. But finding common ground is essential, and the key to successful collaboration lies in one powerful tool: curiosity.

A curious nurse doesn’t shy away from a teacher’s request due to differences in approach. Instead of getting frustrated when a request doesn’t fully align with the nurse’s role or scope of practice, a curious nurse digs deeper, asks questions, and seeks to understand the situation more thoroughly. This approach can lead to better outcomes and, ultimately, more effective support for the student.

For instance, when a teacher suspects or insists that a student might be struggling with a mental or behavioral health condition, a curious nurse takes the time to ask insightful questions: What specific symptoms are being observed? How long have these symptoms been present? Could an underlying health issue, like a tooth abscess, be affecting the student’s behavior? By exploring all possibilities, the nurse ensures that all angles are considered before jumping to conclusions.

Collaboration in school nursing isn’t just about exchanging information—it’s about working together for the best health and educational outcomes. When nurses approach each situation with an investigative mindset, they offer better care and support for both students and staff. By asking the right questions and communicating openly, school nurses build stronger relationships with their colleagues, leading to a more integrated approach to student wellness.