School Nurse Savvy
It's still early, but Ashley Palmore's cell phone is already chirping.
She’s en route in her blue Nissan Rogue to one of the ten schools in San Diego County where she oversees a team of nurses fanning out to tend the needs of kids with medical complexity—everything from type 1 diabetes to IEPs, 504s, and feeding tubes—so they can get through their school days healthy, without incident, and primed to learn.
As a nurse manager in Rady Children’s Hospital’s school health division, Palmore and her team parachute in daily to assess, medicate, and deploy emergency care, in constant consultation with parents, doctors, and educators. Theirs is a new breed of school nurse: experienced, credentialed, driven by evidence-based practice, and primed to engage—especially if they perceive a way to improve care for kids.
“I always tell people, ‘The best thing about nursing is you’ll never be bored.'"
Rady Children's Hospital nurse manager Ashley Palmore (BSN ’06)
Just don’t confuse them with the on-site unlicensed caregivers who staunch nosebleeds, tend stomachaches, hand out ice packs, and diagnose lice. When teachers at Palmore’s schools tell pupils to “go to the nurse’s office,” she always corrects them.
“I’ll say, ‘Do you mean the health assistant’s office?’” laughed Palmore. “Yeah, it drives the teachers crazy, but language is important.”
In California, all credentialed school nurses are BSN-educated; many, like Palmore, have or are pursuing MSN degrees, and boast expansive experience and training. To them, working as a school nurse isn’t a quiet retirement role or one tucked away in an office oversaturated with tissues: it’s an out-front, cutting-edge set of skills for nurses at the apex of their careers.
After early-career stints as a night shift labor and delivery nurse and as the nurse lead in a family medicine clinic (“Where I first learned a little bit of everything,” she said), Palmore worked with rural school children across remote stretches of Hawaii as a healthcare consultant. As a result, she is, today, a school nurse out to change the way school nurses are viewed. Constantly assessing literature, open to change and critique, and up for challenge and collaboration, Palmore’s always on the lookout for evidence-based innovations.
“School nursing is really an independent nursing practice,” she said, “because you’re giving the highest level of care in the school setting, and people rely on you a lot.”
Being a jack of all trades positioned her perfectly for her current role, a robust fusion of leadership, organizational psychology, mentoring, and good, old-fashioned gumshoe. “We’re the ones seeing kids for six or more hours a day, so sometimes those things that present as non-specific complaints—headache, stomachache, anxiety—position us well to ask the right questions, such as, ‘Is anything different going on at home? Did you eat breakfast?’ rather than reaching for medication,” she said.
It’s the same practicality that fed her during her undergraduate years at UVA and that has compelled her ever since. To Palmore, COVID-19 birthed a confidence and flexibility on which she and her colleagues are still capitalizing.
“I’m a different nurse every day,” Palmore said. “Every day, you learn something, or discover that the way you do things doesn’t work, or you are forced to rethink things, or new research comes along. It’s why nursing careers are journeys: getting challenged, asking questions, digging in. It helps you figure out where to turn for the next place you’ll go.”
It’s why her phone’s always on. Why she constantly meets with her nursing staff and parents, zips over to provide a second opinion, and advocates for consistency between states when it comes to standardizing requirements for nurses working in schools.
“I always tell people, ‘The best thing about nursing is you’ll never be bored,’” she said. “Time flies when you’re having fun, right?”
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