NUR 460 Capstone

Practicum Log

Name_____Ashley Selby_____
Practicum Agency______N/A Virtual Student_____________________
Department, Unit, or Division Location ____________N/A Virtual Student__________________
Preceptor_________ N/A Virtual Student _______________
Please use this form to provide a thorough, ongoing documentation of practicum experiences and how they helped you meet the
CCPOs/PGCs. For each practicum experience, regardless of practicum option* please complete the following information. You may
add rows as necessary to document your experiences. Students must complete a total of 45 practicum hours. Students may submit the
form periodically throughout the progression of the course.
Date and Objectives Met Detailed Description of Experiences Hours
Times (CCPOs and/or
PGCs
5/29/2022 CCPO 2; PCG 1,3 Online discussion/talk with Sonia Rivas, BSN. Sonia was a school nurse for Belton 1.5
1738 - 1900 ISD for 3 years that left in 2019. We discussed her roles and job duties both in the
elementary school and middle school as well as drills in the school associated with
school shootings. In the elementary school she stated that she did not participate
much in student development, she mostly did administration work regarding staff
and student’s health records for vaccines, etc. She stated that in the middle school
she was more informed of situations that was going on and stated that there were
two drills per semester where the schools would go on total lockdown and the
teachers and students would practice turning off the lights and hiding. She stated
that her involvement during the mass shooting training was very limited and that she
really “didn’t do that much”. She stated that she was designated to train staff
members on “stop the bleed” and had to train UAPs in regards to medication
 administration like EPI pens and insulin injections for diabetes.

Sonia stated that coming from the ER to a school nurse position was “different” and
stated that she felt like she was not using her assessment skills as often as she liked.
During our discussion it made me think about how school nurses are required to do
a lot of paperwork to keep up with district and state regulations. To me, it seemed
like the job required a lot of “secretary work”
6/01/2022 CCPO 5; PCG 3 Research on school nurses and their job duties/functions. Researched different 3
1200-1500 articles via EBSCO regarding school nurses and the roles they play in student
development.
06/14/2022 CCPO 2,3; Today I spoke with Jaclyn Ritter, BSN who is a school nurse for Bayview 1.5
Elementary in North East, MD. Jaclyn is the only school nurse at Bayview with a
PCG 1,3,6,7
student population of around 460. She has been working for Bayview for 3 years.
1100-1230

Jaclyn stated that her duties at Bayview included making sure there were care plans
for students who had medical needs and needed daily medications such as
asthmatics and children with diabetes. Like Sonia, she has to have a Dr’s order to
give medications. However, per Jaclyn, she has to have a Dr’s order to give OTC
meds as well d/t Cecil Co. policy. A majority of her day is seeing students with
minor medical needs, headaches, stomach aches, etc. Whom she states “are usually
trying to get out of class”. She stated she only had 9 kids in the 2020-2021 school
year that required daily meds, however, that didn’t mean her day wasn’t busy as she
would see an upwards of 50+ kids a day with minor complaints. If she notices
anything suspicious or a student says something that is alarming she notifies the
school counselor and notates it in the student medical record.

When discussing obstacles and hardships Jaclyn stated how the hardest thing is
 limited time and resources. Since everything is required to have doctor and parent
sign off, it’s hard for her to treat students “on the whim” when they have complaints
since everything needs a doctor’s order and parent sign off. Communication barriers
are another issue when it comes to getting parents to follow through on follow ups
and to sign permission for her to administer medications and her time spent on
documentation was “endless”.

It was interesting to hear Jaclyn’s perspective compared to Sonia’s in regard to

duties and feelings of being a school nurse. Even though Jaclyn usually saw a large
number of students daily, she thoroughly enjoyed her job.
06/09/2022 PCG 3 I researched Texas laws regarding mandates for school nurses (which there are 2.5
none) as well as researched more articles regarding school nurse roles via EBSCO
1200-1330
and google scholarly articles.
06/20/2022 PCG 3 Researched articles on EBSCO host and Google Scholar for more articles regarding 3
school nurses and their roles with mental health. Started to work more on the layout
1530-1830
of my artifact.
07/09/202211 PCG 3,6 I spoke with Sonia and Jaclyn via online/chat about my project and my 3
1145-1315 idea/direction I was going with my project. Since Sonia felt like she was always
doing administrative work and Jaclyn felt like her days were always busy I started to
think about incorporating my project more on nursing ratios and the effects it has on
1800-1930 students. Both stated that they had good relationships with their students, however,
they were always busy and felt “super stressed” all the time.

7/10/2022 CCPO 2, 3; PCG 1, Online discussion/chat with Melissa Watson, BSN. Who was a school nurse of 3
1430 -1730 3, 6, 7 Pflugerville ISD for 14 years. During my long discussion with Missy, an old
colleague from the children’s hospital ii have worked at and friend, we discussed
her role as a nurse in a large school district here in the Central Texas/Austin area as
well as her frustrations and limitations with school nursing. During our discussion
she explained how she was the only school nurse in an elementary school with 960
students. She talked about having to train staff members to be UAPs and had to
entrust them with giving insulin and epi shots to students when she was not around.
This was something she never liked as she always felt like her license was at risk.
Missy told the story about how another nurse in her district was sued by a mother
after a cerebral palsy student developed a pressure sore after the teaching assistant
whom the nurse assigned care to, didn’t turn the student enough. Missy stated that
one of the biggest obstacles/problems she sees is the inability to do much when
students need medical attention and they aren’t able to treat them or do much as you
would like in an ER due to legal issues and fear of being sued.

We also discussed Texas House Bill 496 which is a traumatic injury response
protocol for all schools in Texas to have bleeding kits stationed in every school and
all staff and personnel to partake in Stop the Bleed training. Missy stated that she
was trained with Williamson County EMS and then once certified was in charge of
training staff members. She stated despite the training, she still saw those who
weren’t medical professionals uncomfortable with the idea/ thought of using that
training. Missy also stated she had no say in who she trained regarding it and even
her UAPs that she trained was usually designated by the principle of the school,
giving her no say in who she felt was fit to medically treat students in her absence.

I also discussed with Missy my paper and the direction I was going with it. I
originally wanted to do something about the school shooters and nurses but after
talking to Sonia who said she didn’t have much to do with it in her school and
Jaclyn said they hadn’t had significant training in almost two years relating to stop
the bleed I was on the fence. From Missy’s experience, she was involved in more
training than Sonia and Jaclyn, especially with triage and incident command
training, however, she stated that in her 20+ years as a nurse, she never saw nurses
actually being utilized to their full potential with all the training they mandated. She
stated they were almost always the first people to be escorted off of properties when
mass causalities at schools happened and were never allowed back in.

She stated that the biggest issue she felt in school nursing was “not enough time”
she stated she was always busy and felt like her license was always at risk due to the
ethical dilemmas school nurses face with the large amount of children they treat and
some of the parents they deal with. She stated she left being a school nurse after the
cerebral palsy child’s mother wanted the child to be transferred to Missy’s school.
She stated the issue wasn’t caring for the child, but was that the mother stated that
she wanted no staff involvement in care except for the administration of Diastat.
Missy stated that the nursing director for the district worked out an agreement with
the mother in regards to this without Missy’s input or involvement. Scared for her
license, Missy asked for legal documentation about this matter and wanted it
notarized to protect her license since the mother was notorious for threatening legal
action against staff members. Missy feared that it she followed the mother’s
wishes/action plan without it being notarized/legally signed and it came back that
she did nothing despite her skills and training as a nurse, it could be used against
her, especially since this was almost a DNR matter with no actual legal
documentation. The director did not want to what Missy asked, despite the
principles of her school fighting for her, so she left.

After talking with Missy about all of her experiences and from just what I learned
with Sonia and Jaclyn about action plans and having their hands tied regarding their
autonomy and fully treating students; I decided to focus my paper on the ethical
issues school nurses face and how the lack of school nurses in schools have an
impact on students’ well-being and mental health tying the most recent Uvalde
 school shooting.
7/11/2022 CCPO 1, PCG 3 Researched metal health training and school nurses the EBSCO host. 4
1000 - 1400 Continued to write my paper and formulate ideas.
07/12/2022 CCPO 1,2; PCG 3 Worked on my artifact and ideas associated after a work shift. Started to base my 2
artifact on the paper I was writing.
1930-2130
7/13/2022 CCPO 2, 5, 6; PCG Tonight I dedicated researching and reading articles about nursing ratios and 5
1700-2100 3, 4 staffing in schools. To my surprise it took a little bit of time and effort to find the
right information/data on the subject. I found an interesting report from the Texas
Center for Nursing Workforce that focused on the 2019-2020 school year and data
collected by the Texas Education Agency (TEA). According to the TEA, there are
1,200 school districts and 9,000 campuses in Texas. Only 824 districts and 4,893
campuses had school nurses listed by the TEA. The range of students per school
nurse ranged from 1250 to as high as 3000 in some areas. The report also had a
breakdown of the distribution of school nurses in each school age group. According
to the TEA, 51% of school nurses worked with elementary grade groups.

I spent about 2 hours of my time just browsing information like the above stated and
also writing my paper. I focused on trying to get a better outline down on what I
wanted to write after my long conversation the previous day with Melissa.
7/20/2022 PCG 6 Online chat with Melissa Watson, BSN. Today I discussed more of my paper with 1.5
1100-1230 Missy. She and I talked about what my paper was starting to focus more on. After
talking with her and with Sonia and Jaclyn I decided to focus my paper on the
repercussions of not having a school nurse in school and how by mandating safe
ratios could help students more.
7/22/2022 CCPO 1,2,3; PCG Today I researched mental health and took a look into the Uvalde school shooter 6
1, 3, 6, 7 while I was traveling in and out of airports on vacation. A NPR report stated that the
1000-1327 shooter had only completed 9th grade by the time he was 17 and stated that he was
involuntarily dropped from school for missing more than 100 days. Some
information I also found out during my online research was that the shooter was
1600 - 1900 allegedly bullied in elementary school for a speech impediment he had. This then
prompted me to look into more about the schools in the area, did they have nurses?
Did they have counselors? According to some scholarly articles a key role/function
of a school nurse is to identify when a student is struggling mentally. If the shooter
of Uvalde also had a speech impediment my curiosity rose in whether or not he
would have seen the school nurse for additional evaluations or referrals to speech
pathology. Which according to the NPR report, his speech impediment was never
addressed and he was labeled as being “at-risk” in elementary school records due to
an increase in academic struggling. If bullying was known, was there counselors on
staff? From what I found out, Uvalde high school has two nurses, an RN and an
LVN, it also has several counselors. Where he went to elementary school is unclear,
however from research it looked like there is at a family support counselor or the
like in almost every school for Uvalde CISD.

This prompted to then research further articles specifically to school nursing and
school violence. An article I found on the subject was written by a school nurse with
statistics related to different types of violence in school and the school nurse’s
response to them. In the article it talked about how school violence prevention also
requires school nurse interventions. Utilizing a primary, secondary and tertiary
intervention model from the public health perspective can help with organization
and planning in efforts to address violence.

After speaking with Missy and Sonia about each of their experiences and reading
this article as well as others, I started to feel like there is a misconception with
school nursing on how it “should be” and how it “actually is”. Despite all the
literature I have been finding about school nurses playing this “key role” in schools,
 a lot of the experiences shared with me in real-life seems like they aren’t utilized
and valued for their true capabilities.

As I researched this information I started to write more on my paper about how I

could tie in the example of the Uvalde shooter to mental health needs and the role
nurses and counselors could have taken in regards to prevention.
7/24/2022 PCG 7, 9 Today was a big writing day with some more final research/extra help. I researched 4
more articles to support my paper on the importance school nurses play in
1600-2000
improving student health and started to work on my proposal on how making
mandated ratios in schools would benefit the students ultimate well being.
7/26/2022 CCPO 3 Continued to work on paper by writing and editing. Showed my work to Missy and 4
Jaclyn and asked for input and suggests regarding flow of paper and artifact.

1400-1800

07/28/2022 CCPO 3 Finished the final editing on my paper. Edited my artifact and showed Missy, Sonia, 5
and Jaclyn.
1000-1500

*See the examples below on how to use the form.

IN-PERSON Students: Thoroughly document your activities during your practicum experiences.

Date Objectives Met Detailed Description of Experiences Total Hours

and
(CCPOs and/or
Times
 PGCs
1st date CCPO # 4 I attended a meeting of the Ethics Board with my preceptor. Following the 4
meeting, we discussed an ethical scenario unfolding at the agency. This was an
eye-opening experience because there is not a clear solution to the problem. We
explored the nurses role in ensuring that care is delivered in a professional way
within an ethical framework.

VIRTUAL Students: Thoroughly document your work on your project.

Date Objectives Met Detailed Description of Experiences Hours

and (CCPOs and/or
Times PGCs
1st date CCPO # 2 I contacted nurse manager #1 to discuss the survey questions that I had developed 2.5
related to my project. After our conversation, I researched best practices related to
the issue by using EBSCO.