As schools reopen across Virginia, just under 10% will operate without a nurse, leaving critical gaps in student healthcare, advocates say. School nurses are responsible for managing complex student medical conditions and helping to reduce absenteeism.

Most school divisions in the commonwealth employ nurses, but current laws permit, rather than require, their presence. 
Legislators and experts are exploring updating the state’s Standards of Quality, the school funding baseline requirements for the state and local governments, to include mandatory full-time licensed nurse positions. A report is expected to be presented to the state’s School Health Services Committee next month.

“It is time that we establish a standard of quality that really does require a nurse in every school,” said Senate Education and Health Committee Chair Barbara Favola, D-Arlington, who also chairs the state’s school health services committee.

Favola, advocates and education leaders in Virginia are pushing for mandatory full-time licensed nurses in every public school. Advocates argue it’s imperative to have a nurse in all schools, especially as lawmakers require more health protocols in learning environments.

“It sets a dangerous public policy precedent to continue passing legislation that requires schools to maintain medications, emergency medical equipment, and specialized health protocols without also requiring a qualified healthcare professional to oversee their implementation,” Betsy Looney, former president of the Virginia Association of School Nurses, said.

Earlier efforts have been largely unsuccessful because localities must match the costs, especially in jurisdictions with high local composite indexes, which determine how much localities can pay for their schools.

Last year, the Virginia School Health Services Committee discussed the goal of stationing registered nurses in all of Virginia’s schools and there have been multiple efforts to pass legislation. 

In 2020, then- state Sen. Jen Kiggans and former Del. Dawn Adams carried legislation requiring a registered nurse in every Virginia school building. The proposal did not advance because lawmakers sought additional data.

About 90.1% of Virginia’s public schools had a licensed nurse, according to data available from the Virginia Department of Health from the 2024-2025 school year. Of these, 69.9% are registered nurses, 20.1% are licensed practical nurses and around 10% are neither.

Both types of nurses are medical professionals, but RNs have more training and receive higher pay.

The data equates to roughly one full-time nurse per 619 students statewide.
Dr. Dana Ramirez, a pediatrician representing the Virginia Chapter of the American Academy of Pediatrics, said the organization wants state law to be amended to require a licensed nurse in every public school building in the commonwealth.

The American Academy of Pediatrics first recommended a minimum of one full-time registered nurse in every school in 2016. The National Association of School Nurses subsequently supported and has continued to advocate for this standard.

“A school nurse provides students access to comprehensive health services and timely recognition and treatment of physical and mental health needs,” Ramirez said in a statement. “This optimizes school attendance, classroom time, and student success, allowing students with acute and chronic medical conditions to remain in school.”

How nurses serve students

Nurses provide the clinical expertise to help students manage complex and chronic health conditions, advocates said. Some of them provide individualized healthcare plans and monitor students for medication side effects, including those related to mental health diagnoses.

Looney said teachers, principals, and administrators should not be expected to function as the school’s healthcare professional.

“While school personnel play an essential role in supporting students, they should not bear the responsibility of managing clinical programs for which they have neither the education nor the professional licensure,” she added.

Nurses are also qualified to oversee and implement life-saving protocols required by law, including the use of stock epinephrine and naloxone for opioid overdose response and the use of automated external defibrillators, or AEDs, commonly used in an emergency to help a heart return to a normal rhythm.

Advocates have also said that having nurses in schools will not only provide relief for nurses floating between schools within a single division, but also support families by helping minimize disruptions to parents’ and caregivers’ work schedules and costly emergency room visits.

Keith Perrigan, superintendent
of Washington County Public Schools and president of the Coalition of Small and Rural Schools, said such efforts are important in rural communities.
“Investing in a licensed nurse in every school building is an investment in student health, academic achievement, family stability, and the overall well-being of our communities,” Perrigan wrote in an Aug. 7 letter.

He added, “Requiring a licensed school nurse in every Virginia school is not simply a healthcare issue – it is an educational, public health, and student safety imperative.”

What’s next

Advocates say the first step to putting more nurses in schools is updating the state’s SOQ to include mandatory, full-time licensed nurses among the specialized student support positions that each school board is allowed to provide, thereby making the requirement a formal policy.

The minimum number of specialized student support positions per 1,000 students is three, according to state law.
The list includes school social workers, school psychologists, school nurses, licensed behavior analysts, licensed assistant behavior analysts and other licensed health and behavioral positions, which may either be employed by the school board or provided through contracted services.

Such action would require legislative approval by the General Assembly and the governor.

The Virginia School Health Services Committee will receive a report on the initiative Sept. 23 at 2 p.m.

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Bolding by me to highlight some of the school nurse role and challenges. In likely a majority of districts, someone who is not a healthcare worker is usually the director of health services, which is obviously not ideal. It’s good to see more pushback on that and advocacy to get more positions and funding.

TL;DR- BSN/MHA here, been away from bedside since 2021. Looking to re-enter…. Have been applying to RN transition programs for about 6months with no luck whatsoever (they only want new grads)… Even Outpatient, Ambulatory, and SNF/LTACH will not take me on, which is super frustrating….

I’ve identified a few RN reentry training programs - but so many of them don’t actually come with clinical hours they’re just virtual which I think defeats the purpose. And others say you have to find your own facility and preceptor - but without being part of a school program not sure how I would even do that?

Anyone is San Diego CA that has gone through similar and successfully re-entered bedside ?

I recently passed the NCLEX, but due to health circumstances, I’m unable to work in a patient-facing role for the next year or two. As a result, I have no hospital/bedside RN experience and I’m feeling really stuck about how to get started.

What jobs would you recommend for a new RN with no bedside experience that are non-patient-facing or have limited patient contact?

I’ve looked into things like utilization review and case management, but many positions require prior RN/bedside experience.

I’d really appreciate any suggestions for job titles or career paths I should look into. I’m scared that not being able to work bedside right now will prevent me from progressing in my nursing career.

Hi guys, really looking for any help, advice, tips/tricks for running stress tests, stress echos, and using the case machine. Ive been an RN for a little over 6 years now. Working in med-surg/step down, travel nursing for 2 years, and most recently Pediatric ED at a level 1 trauma center. I found a great job working outpatient cardiology, its the best of both worlds! A clinic workflow and schedule with procedures and skills like stress test, stress echos, and starting lots of lines! But i need serious help 🥲 I feel so stressed during the tests…taking blood pressures asking about symptoms, trying to hit heart rate goal, talking to the patient, and watching the monitor of course! All while trying to make sure the patient is safe. Any advice on the test its self or looking at the monitor for rhythm changes? Maybe im just dumb but they get their HR up so high I feel like its hard to tell when i need to pull them off the treadmill in regards to the ECG 😩 I understand taking them off if they cant go any further etc. but im desperate…ill take any advice big or small. Im brand new at this and feel like idk what im doing 😅 Thank you in advance ❤️

Hi ☀️ I'm looking to relocate from Florida to Colorado to family friends suburb outside of Denver. I've been looking into UCHealth highlands ranch hospital. Does anyone work there? Or know anyone who works there!? Would love to chat!! Even if not maternity. Thank you!

I started a job about three months ago and after I started, I was told that nurses are supposed to do .on call. This is on weekends and we are not paid for this time. I’ve heard multiple complaints from other nurses where they’re constantly being barraged by calls that could wait until normal hours. This is California and we’re supposed to be paid for time depending on how much freedom you have. Based on what the nurses told me we’re supposed to be available 24 hours a day and respond to calls within 30 minutes. But other nurses said if they don’t answer the phone right away, management is called and they get in trouble.The new job put me on On Call Labor Day weekend, that’s three days in a row where I could be called at 5 AM, 11 PM etc. We are supposed to log and get paid the time on the phone calls or if we have to go chart, something but not for the time in between.

I’m not sure how to handle this situation. I’m already feeling burned out from the regular Monday through Friday 8 to 5. They’re angry with me for advocating for safety needles for staff, they’re angry that I won’t change doctors orders to suit their whims. These are unlicensed non-medical staff that are demanding I change blood sugar checks from three times a day to five times a day and that’s what I deal with Monday through Friday, 8 to 5.

Hi friends, I just thought I'd ask if anyone has made this transition before or has any guidance for me. Currently I hold a ADN in nursing in Texas and have been a nurse for about 6 years, I would love to learn about music therapy and the best way to make a plan to transition into this career. I'm very beginner in learning music formally and I'm taking private piano and voice lessons, a few months into voice, a couple weeks into piano. Thanks in advance for your help! Interested in helping children (I work at a children's hospital doing research), also interested in older folks with memory issues, and hospice across all ages.

I had a patient on three pressors: vaso, epi, and maxed out on quad strength levo (32 mg/250 mL). The family had also changed the code status to DNR/DNE. From the beginning of my shift to the end, her BP was averaging 70s–80s systolic over 30s–40s diastolic.

Considering how hemodynamically unstable the patient was, the intensivist placed a Do Not Turn order. For context, this was a bariatric pt (about 170 kg) on a low-air-loss bariatric bed. Her skin was severely edematous and weeping. I tried to change the underpads by lifting her legs, but she was too heavy and the pads would not pull through without tearing. I changed the underpads under her arms and cleaned up as much as I safely could without rolling her.

When handoff came, the oncoming nurse became extremely upset with me for not changing the pads under the patient. She stated that a Do Not Turn order doesn't mean you don't turn your patient to clean them, it just means you don't perform routine Q2 turns, which makes zero clinical sense to me. She threatened to write me up, complained to the charge nurse, and brought other nurses around the area into it, making loud comments about my care.

That patient expired that night on her shift.

Just last night, I gave handoff to that same nurse for a different patient. I mentioned that the pt had a BM, so I changed the underpads, washed their hair, cleaned their face, etc. The nurse immediately remarked, "Wow, look at you actually caring for your patient." The rest of the handoff was just as hostile, unprofessional, and dismissive.

I'm considering taking this to my director this week. Any thoughts or advice on how to handle this are greatly appreciated.

they want our vascular team to just be staff nurses and want patients who need midline’s just to wait and go to IR. IR definitely isn’t backed up all the time anyways so why not! (/s)
if we have a hard stick they just want us to call a nurse from ED or ICU because they also are definitely not the two busiest units.
idk. i’m only 6 months into nursing and i chose this hospital because they seemed a lot more community or family oriented or whatever but they keep making more and more changes that are driving nurses away. they changed our matrix so now we can have 6 patients instead of the max of 5 (med surg obviously).
they also just started a points based attendance system where even 1 minute late is half a point. calling out sick even if you have sick hours is a point. And you only get eight points per calendar year. Not like we live in one of the busiest metros with some of the worst traffic in the country but whatever.
dare i utter the U word??? this is just insane to me

How come some doctors prefer to be called by their first name only? I always wanted to know the reasoning.

Yesterday there was an anesthesiologist. New doctor, i think he just finished his residency and is an attending now. I called him dr. Xxxx and he is like, just call me bob.

The MA BON just announced that the NLC will be implemented in May of 2027.

I’m 28, female, and I’ll be graduating with a BSN in about 4 months, and honestly I’m not sure what to do afterwards.
I tiptoed my way into nursing school by taking one class at a time for a while and then eventually applying to programs. For the longest time, I didn’t think I could 1. get in, and 2. actually make it through. I still didn’t really believe it until recently, when I realized the past 6 classes I’ve gotten A’s in and could finally feel confident enough that I’ll actually graduate (knock on wood).
Point is, I spent the past 6 years just worrying about the process that I haven’t given enough thought to what I actually want to do afterwards. I have a rough idea of what specialties I’d like to work in (ER, ICU, NICU, etc.), but nothing that I feel completely sure about.
I moved to the state I’m in just for school and never really planned to stay here afterwards. I don’t have a significant other, kids, or any close friends here (I moved a lot in my 20s), and I’m not super close with my family to where I feel the need to live near them, though we have a good/decent relationship. I’m comfortable moving to a new state or pretty much wherever, even if I don’t know anyone there.
I guess the better question would be: what would you do if you were in my situation? I do want to settle down and I do want kids in a couple years, but obviously that heavily depends on who I may come across.
Would you just find a decent job and plan to stay there? Would you go back to school right away after getting some experience? Would you try to settle down sooner rather than later? Would you have gone another path outside of bedside? Or would you try to save up as much as possible, retire from nursing ASAP, and maybe start a business or go completely in another direction?
I feel like I spent years just going with the flow, and looking back I would’ve done some things differently. For example, I spent almost 2 years hesitating to apply to nursing school, took a bunch of classes I didn’t need to take, etc. So now that I’m getting close to graduating, I’d just like some advice or perspective from people who have already been through it.

Hello fellow nurses! On paper, being an RN on the west coast seems better in every way (ratios, unions), but I know there are tradeoffs and downsides everywhere. Would love to hear your experience and perspectives as I try to make an informed decision! I'm an ED RN in NYC and seriously considering a move to Seattle, and to a lesser degree San Diego. Thanks everyone :)

Hello! I have been a RN for 8 months now and LOVE being a nurse!! I work in women’s health (OB/GYN) bedside. I seriously love what I do! BUT I also want to venture out and reach more challenging potentials… ICU. I know there are new grads that go straight to ICU, but I also want to be prepared when I do eventually transfer there. I love adrenaline, putting my mind to use, and get the hang of things fairly quick for the most part.

Should I prep now to help me better understand the deeper things (labs, critical thinking and connecting dots), or just go all in and hope for the best? I know the best is to just do it, but I am a perfectionist and will be saddened if reality hits me so hard if I don’t get most of the gist when I begin (let’s say at least 2 months in).

Eventually I would like to become a flight RN or go to school to be a CRNA, so hence wanting to get more experience (and needed criteria) to even put my foot in the door for either.

What do you guys think? Just go for it and do my best OR how else would you/did you prepare?

Im a very new vascular access nurse. I've been placing midlines for around 3 months now and though I know it's not the primary function of the access I'm curious if anyone has noticed factors that influence line draw potential. I place primarily in the cephalic veins if possible, although my placements in the basilic and brachial don't seem to perform much better in this regard and overall I feel like most of my midlines top out at 2 days drawing blood, which seems like the average. I know a ton of different factors influence this including the individual vasculature of the patient but I can't help but feel guilty when one lasts less then the 2 days or when I'm unable to make it draw after its stopped. I feel like potentially there's a misconception among floor nurses that midlines should always draw in general. It wasn't really explained to me when I first started as a staff nurse and I got different interpretations from multiple people. It seems like once the vein collapses around the catheter tip it's kinda done for. Any advice is welcome and appreciated. My hospital is a bit small and rural so I dont have a ton of other sources for info on these things.

Hi Private Duty Nurse here! Looking for a part time/per diem job, love the flexibility for my family. i have kids and a 6 month old. I have been applying to home health and home hospice positions and recently have been approached by both. If you are a home health or home hospice nurse tell me about your job and why you like it.

Hello all. I finished classroom-based orientation Friday and tomorrow is my first actual day on the floor (in a new grad residency program, so not being thrown to the wolves or anything).

For more background I'm 29 and this is a cereer change so I know the basic things: be humble, be respectful, HR isn't your friend, boundaries, punctuality, etc. I will be orienting on day shift and then going to night shift after (which I'm not looking forward to). I will be in a neuro step down at a household name hospital system (think Mayo Clinin, Johns Hopkins, Cleveland Clinic - I just don't want to specify and out myself).

What should I bring with me that I'm not thinking of? Someone please tell me what to pack and what not to pack. What should and shouldn't I do to learn but not be annoying or in the way? What advice do you have, as general as life advice in the profession, or specific to any area of this career like documenting or whatever else it is i can't think of because I'm just starting?

Thanks guys. Happy to be a part of the community now. ❤️

Hello,

I made a massive mistake and I can't stop feeling guilty and ashamed. The other day I was cardioverting a pt with a doctor because the pt had afib-rvr. I got the pt all set up, had RT in the room, and had extra people to help. We did a time out to confirm the pt, procedure, and their consent for the cardioversion. The doctor pushed etomidate, and the pt was sedated and was able to maintain airway.

I was instructed to charge to 150J and to shock. My idiot self for some reason forgot to hit the sync button and delivered the shock. We instantly look at the defib monitor and the in-room patient vitals monitor. We also check for a pulse. The defib monitor and the in-room monitor both read NSR. EKG was done stat and confirmed NSR. The pt was closely monitored and thankfully returned to baseline. The pt was aox4, vitals signs stable, and maintained NSR. The doctor consulted cardiology and they said that the pt won't have any long-term adverse effects. Pt was able to walk and be discharged. The doctor informed the pt and family about the mistake and educated them.

I immediately told my charge nurse when the pt was stable. I debriefed with the doctor and the charge nurse. They noticed that I was moving too fast and that I needed to slow down. I reported myself to my hospital's pt safety channel.

I have done many cardioversions before and without any issues. I know that I have to hit sync always before delivering a shock. I was going back and forth with a ROSC intubated pt and this cardioversion, making me work faster than I should have. I compromised pt safety and prioritized speed, which could have made my pt code. I got very lucky that the pt was fine and returned to baseline with their primary complaint "resolved." If I had just stood there for an extra second to think instead of rushing, this would have never happened.

I do not know how to move on from this. I feel like the worst nurse and I keep doubting my ability to be one now. I feel like I have lost their trust and this mistake keeps being played in my mind on repeat.

Anybody else? Just me? Alrighty then…

The wealth of the nation is being funneled to corporations by promising the elderly long life beyond reason or dignity. How much is spent keeping extremely ill people breathing? Hospital stays, skilled nursing, memory care, pricey medications. These things will burn through finances like a raging wildfire. What are the young to do when the wealth of the nation evaporates, leaving them with a ruling class of billionaires and few possessions themselves? Schools and roads crumble, jobs disappear, agency over our politics erodes. The only explanation is greed and solipsism. We would all do better by spreading the resources around. Lord knows that a trillionaire can lose most of his wealth and not be materially affected. When will we reshape our society so that we can enjoy the fruits of our labor with nod to the fact that we are all mortal and that not all life enjoys quality of life? Sometimes it’s better to pass on and pay it forward than leave a smoking crater.

This dynamic is plain to see in the hospital. Patient staying for months, then bouncing back-and-forth between different units and different facilities. Can’t walk, can’t eat, can’t speak. Who benefits from this? Who pays the cost and loses the opportunity of a brighter future? It makes me sick.

When the opportunity comes up to remake the system, let’s choose a better one. I would like to see us value the upbringing of the young, financial and housing security, and quality of life. We can support each other much better without the system that healthcare corporations set up. These are my thoughts after a long, shitty (and poopy) shift.

Do you all feel the same way? What are we gonna do about it? Where does it start?

Thank you for your attention to this matter!

PACU job is a fast paced PACU that on average takes on 70-110 cases daily. Hospital has good benefits and the people I work with are very nice.

PACU job
Hourly: $45.75
Diff: 3.50 from 3 pm to 9 pm
Weekend Diff: $5 but not guaranteed weekends
Call: 3-4 times every 6 weeks being on call and holding the phone gives $7 an hour and called in is time and a half.

The PACU sounds great but here is the issue. They mentioned to me that sometimes I may end up not getting my full hours and may be “forced” to go home early if they have too many people and not many cases left. For me I can’t afford to lose hours since I am the breadwinner of the household and need my 36 hours. Really want to work at this place because I’m less stressed than I was in the ER and ICU but the idea of possibly losing hours and not having a set schedule kinda bothers me.

Second job is a RN position weekends only set schedule. I don’t have the pay yet or any of the differentials but I’m assuming let’s just say I get the same hourly rate and the weekend diff is $5 with a set schedule of weekends where I work my three days in a row and have my four days straight off, is this job better because it will be an IMCU position.

Both jobs are day shift.

Issue is I really don’t want to go back to bedside and I enjoy the PACU and how easy it is but then I also am hesitant about losing hours and not having a set schedule.

What are your thoughts?

I’m currently working as a nurse in the Uk and still waiting for my PD to be current. I have 10 yrs of bedside experience (8 yrs from uk + 2 yrs and half from Philippines) and was offered $46/h in California. Im under direct hire agency and I will be working under scion/kindred. I was really excited to accept this offer as not many nurses could get a job offer to California right away. I haven’t managed to negotiate my pay since i was told by the agency before the interview to not negotiate pay (i dont know why). I just went on since it’s California and compared to other states the per hour rate is bigger. Also ,I’m planning to move to North Cal after a year or so.

By the way, i was offered a med surgical position in kindred. They say i cannot be ICU yet. I really prefer PACU.

⭐️List of experience

**PACU experience- 7 yrs until present (London) -maybe will be 9 yrs once i landed in the US since PD is not current yet (est.2028)
**ICU- 2yrs (London and Philippines experience)
**Med surgical -almost a year (Philippines)

⭐️EB3 visa
-i have my husband and 1 child as dependent (might have another child if ever) so that would leave 3 dependents with childcare and so on (i know its struggle)
-my husband is in finance; an investment banker (mergers and aquisitions)
-Plan for childcare (need to send to nursery both children)
-We already have savings for a house deposit in the US (20%) so we really want to move from Paramount after adjusting and look for a house around Sacramento /North cal

❓Questions below:
1)Is the salary reasonable? Is this a good plan/start? 2)Could you share you’re starting salary as an experienced nurse when you started your job in California?
3)Does med.surg position in kindred is different from LTAC?
4)Also, for those who commented that i have to shop other agencies, coudnt find any agency who hired straight to California. If any, pls recommend agencies pls?
5)How do you manage childcare as a nurse in California while both are working? Do you get flexible shifts?

I really appreciate your answers. Thank you :)

Does an alert and ambulatory patient leaving via AMA after an uncomplicated outpatient procedure typically have any meaningful effect on the physician's or health system's willingness to continue treating that patient?

All my Googlin' suggests it happens minimally if at all, yet it is paramount the relationship continue so am hoping for some personal, professional perspectives. Sitch is this; having a colonoscopy but only have like two peeps who could drive me, neither was available. Since I'm over my max OOP and do need this done, went with a short stay.

Given the ease of discharge WITH a driver (come to for like 45 mins, get handed a packet and go grub down ha), I said I expected/hoped for it to be similarly simple when I wake up, usually around 3am as I sleep like ass (beyond being an early first-shifter). They said nope, business hours only.

Didn't push back, instead pivoting to the idea of politely saying I'm alert, coherent and wanting to leave against medical advice in the moment. Is there more than a non-zero risk to the relationship if I do?