A day in the life: nursing at a special school for pupils with learning disabilities

Special school nurse Fran Dodd shares her working diary in a school in Northumberland for children with severe, profound and multiple learning disabilities, including autism

• Role provides assurance, support and advice for children, parents and carers
• Ensure regular medications and vaccines are administered appropriately and with due care
• Provide practical training and support to educational staff, especially during the COVID-19 pandemic

8.15am Monday mornings always bring a lot of anticipation as each week can be completely different, especially with the ongoing challenges brought by the COVID-19 pandemic. I’m a lone worker providing nursing care to children and young people with some complex health needs and disabilities in school.

My role is important in helping to keep children safe and well in school, and providing reassurance, support and advice to parents and carers.

8.30am I have lots of emails with queries from parents, school staff and other NHS professionals, and tasks to prioritise. Last Friday, a four-year-old child was absent from school following a prolonged seizure, which resulted in her admission to hospital. I can only imagine how scary this has been for her and her family, so I call her parents.

She’s okay now, which is a relief. I check that the child’s community paediatrician has been informed of the hospital admission and had contact with the family.

8.45am I have a request from the community immunisation team who want to attend school to administer the human papillomavirus vaccinations to pupils. It’s vital children don’t fall behind with their vaccinations, otherwise we could see a re-emergence of other serious illnesses. I work with the school staff and immunisation team to arrange this and ensure COVID-19 safety measures are followed.

Having external visitors is still worrying for the school. It’s my job to provide health guidance and reassurance to the children, their families and the educational staff.

9am The pupils are now arriving thick and fast. As always, the day begins with a rush of information and supplies being brought to my room. If I’m not organised for the day by this point, it can get stressful. A parent calls for advice about how to get their child a vision test. Then a teacher brings some antibiotics for a child that need to be given today.

However, there is no pharmacy label on the bottle detailing who the medicine is for, or a consent form from the parent. I ring the child’s mother who provides all the information I need. We also discuss the child’s anxieties about taking the medicine. I reassure her and then speak to staff to adapt the pupil’s timetable to include her medication.

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9.30am A teaching assistant rushes into my room to ask me to review a child with COVID-19 symptoms. The staff are worried and need support and reassurance. In full personal protective equipment (PPE), I review the child in the isolation room. The boy is six years old and appears scared and anxious, as well as flushed and hot.

I speak calmly and softly, trying to soothe him. His temperature is high. I arrange for a teaching assistant to stay with him for support while I contact his parents to arrange collection. The parents are anxious and don’t think the child will comply with a lateral flow test. I speak to the head teacher and we agree a school postal test can be used. I successfully swab, process and register the test. It was a difficult job to swab him, but I managed.

‘I have found remote consultations difficult, particularly in terms of communicating effectively and assessing non-verbal cues and body language’

10am Regular medications begin now. The first is for a pupil with severe autism and attention deficit hyperactivity disorder (ADHD). I administer methylphenidate: this is the most commonly used medicine for ADHD and the most common control drug I hold in school. It belongs to a group of medicines called stimulants, which work by increasing activity in the brain, particularly in areas that play a part in controlling attention and behaviour.

I administer two medications to another pupil with a cerebral palsy diagnosis, who is able to tolerate her medications orally.

10.10am A child with severe autism has something lodged in his left inner ear. I have to put on my PPE before I can examine him and I can see some debris, but I am not sure what it is. I gently attempt to remove it, but am unsuccessful and the child is getting distressed.

I feel slightly upset with myself that I couldn’t help the child with this problem, but I’ve tried my best and I don’t want to make this worse. I contact the child’s parents to request they take him to hospital, then comfort him as he’s still upset and doesn’t like going to hospital.

10.30am I now have time to organise the school clinic with the community consultant paediatrician who will attend school next week. One effect of COVID-19 has been the rise in remote consultations. During lockdown periods a lot of my communication with parents and carers has been via telephone or video consultation. These have proved useful for us to help limit the spread of coronavirus and in terms of access and convenience for parents and carers.

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However, I have found remote consultations difficult, particularly in terms of communicating effectively and assessing non-verbal cues and body language. I appreciate being able to work once again more closely with families and consultant paediatricians in school. Face-to-face consultations are beneficial to obtain a full picture of the children and young people’s physical, emotional and social well-being.

11am I turn my attention to a request from the children’s emotional and mental health service for vital signs observations to be taken of two children in school who are taking non-stimulant medication. I speak with school staff and arrange this for later this week. Children being monitored by me will need to understand and feel safe with me checking their blood pressure, heart rate, height and weight. These tasks often aren’t as simple as they sound and need patience and care.

‘Due to the numerous different diagnoses and differing complexities of the pupils in school, I need to be flexible and adapt to children’s individual needs’

11.30am–1.30pm Midday medication administration begins. These include medicines administered by subcutaneous injection, via low profile gastrostomy button and orally. Due to the numerous different diagnoses and differing complexities of the pupils in school, I need to be flexible and adapt to children’s individual needs. After this, I finish my documentation on the health records of the children I have seen this morning.

2pm The afternoon gives me the opportunity to provide practical training and support to educational staff. Training staff members and care support staff is a large part of my role and something I enjoy doing. It provides me with a great deal of job satisfaction being able to see their confidence grow from my support. Today I’m providing training and support on blended diet via gastrostomy.

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3pm My final job for today is to complete a health report for a child’s annual education healthcare plan review. I contribute to these plans for children and young people who have complex health needs; significant emotional needs; who are transitioning to adult services; on child protection plans; or with looked-after status. Collating health information involves reviewing the child’s health records and hospital letters, and liaising with health professionals, educational staff and parents. Once I’ve checked parents are happy with the content, I send it to my manager for quality assurance checking before sending on.

3.30pm Pupils are now leaving school. I complete my documentation and equipment and medicines’ safety checks. I make a list of the things I haven’t had time for today that I will need to do tomorrow. I reflect on my day. Although it’s been busy, I know I’ve provided safe and professional nursing care to pupils in school and support to parents and education staff, which makes me feel proud and fulfilled.

Fran Dodd is special school nurse for Northumbria Healthcare NHS Foundation Trust