School nurses know the drill: you need a day off, whether for illness, a family emergency, or one of the other million things life can throw at you on a school day. But finding a substitute school nurse feels like searching for a unicorn - elusive and impossible - which poses a real risk to student health and safety. Why are these professionals so hard to come by, and what can school nurses do to navigate this challenge? 

The Dilemma

The critical shortage of school nurses stems from a complex interplay of factors, including:

• The overall nursing shortage - The demand for nurses across all sectors is high, leaving fewer available for school settings.
• Pay disparities - School nurses often earn less than nurses in hospitals or private practices, and substitute school nurse pay rates can fluctuate widely, making it difficult to attract qualified substitutes.
• Lack of awareness & appeal - School nursing is a critically undervalued profession, often misunderstood and overlooked in healthcare.
• Unique skill set required - School nursing requires a unique combination of clinical expertise, communication savvy, public health knowledge, and an ability to work independently, which many healthcare professionals may find intimidating. Furthermore, substitute school nurses are subject to varying credentialing requirements across districts and states, creating additional barriers to entry.

The Consequences

When a qualified substitute isn't available, the health and safety of students can be compromised:

• Medication errors - Errors, such as missed doses or incorrect administration, are more likely when non-nursing personnel handle medications.
• Delayed recognition of emergencies - Non-licensed personnel may not recognize the early signs of a medical emergency, such as respiratory distress or hypoglycemia.
• Increased absences - Without a school nurse properly assessing students, non-nursing personnel are more likely to send students home unnecessarily, leading to lost instructional time.
• Risk of liability - Allowing unlicensed individuals to provide nursing care can create legal liabilities for the school district.

The Solutions

While systemic changes are needed to address the root causes of the shortage, school nurses can take proactive steps to improve the situation in their schools or districts:

• Demonstrate school nurse impact - Present data and anecdotes to leadership and families, highlighting the positive impact of school nurses and the risks of not having a nurse on site.
• Advocate for competitive pay - Work with your administration to ensure that substitute school nurses are paid a fair wage that reflects their education, experience, and the importance of their role.
• Recruit creatively - Reach out to nurses who work in other healthcare settings, such as emergency departments or ICUs, who may be interested in occasional substitute work.
• Partner with staffing agencies - Seek out agencies that can provide qualified substitute nurses.
• Orient substitutes thoroughly - Provide comprehensive orientation for substitute nurses, including information on school policies, procedures, student health needs, and access to health records. Additionally, NASN recommends preparing a detailed substitute folder with essential information, including emergency contacts, medication lists, health plans, and school maps.

While finding school nurse subs may feel like searching for a needle in a haystack, it's a challenge that must be overcome to safeguard student health. Thinking outside the first aid kit and advocating for change can turn this 'Sub-mission Impossible' into a 'Sub-cess' story!"