I am a school nurse AMA

[Nicebitofsquirrel]

I am an NHS school nurse, not to be considered with school first aiders.
Our service takes over from health visitors once children start attending school.

How many schools do you cover?

Is safeguarding a big part of your job?

What do you do aside from vaccinations?

I cover 14 primary schools and 2 secondary schools. I have a community nurse who works with me.
My job is mostly safeguarding meetings and working with families involved with social care. Both of us do a lot of work supporting children with emotional health issues that don’t meet the camhs threshold, or from children who have attended drop in at secondary schools. I also put in care plans for children with complex health needs attending schools and ensure schools are sticking to them. The community nurse holds clinics and sees children for continence, weight, sleep, picky eating, low level mental health issues, hygiene, behaviour etc.
As it happens we don’t do the immunisations, these are done in school by a separate team.

Thanks - didn't realise your role was like that at all!

Do you prefer primary or secondary? What is your opinion of CAMHS? I have heard terrible things about them not being fit for purpose etc.

When you have a meeting or informal conversation about a child / safeguarding do you always have to record it even if is just a quick chat ?

Do you really exist?
I've never seen a school nurse in the whole 7 years of my DC attending primary school!

How much training do you have on conditions like type one diabetes?

I prefer working with the secondary students, as you can really make a difference to them if they are having emotional health difficulties such as self harming and poor self esteem. CAMHS are different in all areas, but all of them are severely understaffed and have huge waiting lists. It is really hard to get a referral accepted to CAMHS so our team tend to do as much work as we can, as if CAMHS can see other low level things have been tried with no progress they are more likely to take the referral.

All meetings and conversations about a child are recorded into their record, or should be! It is helpful if the child comes into the service at a later date that you have this historical information.

CosmicOwl we are a referral service so if you have not needed us we wouldn’t have seen you! We are not based in schools but in NHS buildings and we travel to schools in the community. We do attend new starter events for reception children if we have capacity, but we have always been woefully understaffed compared to health visitors.

As registered nurses we already have a good knowledge of conditions like diabetes, but children with diabetes in our area have a named specialist paediatric diabetes nurse, we do get involved and work with these children such as if they are not taking their meds or insulin, and for healthy eating, but the specialist nurse would be doing the liaison with school and care plans.

Thankyou for that. I was told that informal chats about safeguarding concerns didn’t need to be recorded formally ! I did think it sounded odd

Who does the referring? Do you support children with SN or as that seen as more specialist so not your role?

It must be hard taking on a counselling role when it’s not your background. Do you feel
supported enough in doing this?

hadithadenough
We have electronic records. If it’s a conversation regarding safeguarding it will go into a different area of the notes which isn’t accessible to other health services who may access the record, to protect the child’s confidentiality. In other words, it’s not there in the notes for everyone to see.

What age would you start getting concerned about a child wetting the bed every night?

Referrals come from parents, older children self refer, schools, GPs, minor injuries and A&E, paediatricians, social workers, family workers, lots of places. Parents have to be aware of a referral, what it contains and consent to it if it is coming from another agency.

We do support children with SN and signpost to other services if they are beyond our skills. We work with SN children on all issues I mentioned above such as conitnence, sleep, healthy eating etc, and also work with schools and parents together. Quite often there are TAC meetings for SN children which we attend.

I am quite happy taking on a counselling role as we receive lots of training from CAHMS and can access CAMHS for consultation and advice at any time we need. It has become easier with experience, having a drop in can mean a young person will disclose to you they are suicidal or self harming, and it is good to pick up these issues early on.

I'm amazed. Both my children have SN. They have difficulties sleeping, eating, one has continence issues, and one has school related anxiety. We have TAC meetings every 3 months. I've still never seen a school nurse or even knew of your existence! Perhaps it varies by area?

We work with children who are bedwetting from age 5 as that is the nice guidelines, but I wouldn’t be really concened until after age 7.
9 times out of 10 children are bedwetting because they are not drinking enough during the day and going to the toilet too frequently, meaning their bladder is weak and poor capacity.

cosmicowl
Maybe it does vary by area, but we see SN children exactly the same way we see NT children and usually they follow the same treatment pathways although you do have to make adjustments, such as sensory issue for instance, for each individual child. To not do this would be discrimination and we are very mindful in our area of the lack of support for SN children and try to support parents as much as we can within our remit.
You could ask the school how you get a referral or you could google school nurse team in your area?

Just want to say thank you. I work closely (sw) with school buyers and know most of them quite well. They in my experience are the most readily available service and appear able to jump straight in when I have health issues with my case loads. My school nurses are highly experienced, tough, hands on, extremely caring and understanding with our clients and I couldn't manage without them x

Queenofthedrivensnow
Thank you
It’s nice to get some positive feedback, we do tend to be a catch all for lots of referrals that would have gone elsewhere before services started disappearing!

What is your opinion on childhood obesity? I went to a sports day a few weeks ago and some foundation children were so “large” ( won’t use the word fat) they couldn’t run.

As you may know, we deliver the NCMP (National Child Measurement Programme) and year on year we are seeing more overweight children (we don’t refer to children as obese). It’s not fair on the children, some of them can barely sit cross legged, they have difficulty getting uniform to fit, they have difficulty participating in physical activities and get teased about their size as well as storing up joint and heart problems for the future. We also are starting to see secondary school children with tupe 2 diabetes, which is a real worry.

You would be amazed at the abusive telephone calls we get from parents who have received a letter telling them their child is in the unhealthy bmi range and instead of wanting to address it, they just want to have a go at us! We don’t even send out the letters, public health do - we just collect the measurements.

It’s an ongoing problem, contributed to by Lots of reasons.
I believe it needs addressing in a more holistic way than just blaming parents, we need to look at wider environmental factors.