Issue No. 7 — The Work You Actually Do

Clinical Corner is here.

I won't make a big thing of it — but I will say this: building this newsletter has reminded me why I became a school nurse in the first place. Not because it's easy. Because it isn't.

School nursing is one of the most clinically complex, professionally isolating, and genuinely underestimated specialties in all of nursing. We manage medically fragile kids, make high-stakes decisions alone, train staff who forget everything by October, and somehow still find time to hand out the occasional ice pack.

That last part is the joke everyone else makes. We know what the job actually is.

What I'm building here — slowly, intentionally — is a place where school nurses are treated like the professionals they are. Where the clinical work is taken seriously. Where this specialty is seen not as a stepping stone or a fallback, but as the destination. The job that the best nurses choose on purpose.

We're just getting started. But I'm glad you're here.

— Megan 🌸

Welcome to the first real issue of Clinical Corner — practical, evidence-based topics written for the nurse who already knows what they're doing. Let's get into it.

The Epinephrine Hesitation Problem

You already know epinephrine is the first-line treatment for anaphylaxis. That's not the issue. The issue is the pause before you give it.

The research is consistent and uncomfortable: delayed use of epinephrine has been identified as a significant feature in several reports of fatal food anaphylaxis, and is perhaps the risk factor most amenable to modification. In other words — it's the thing most likely to go wrong, and it's the thing most within our control.

So why does hesitation happen?

A few reasons show up repeatedly in the literature. In 38.5% of reported school anaphylaxis cases, epinephrine was not used as the first-line treatment — antihistamines were given instead, despite their lack of efficacy in anaphylaxis. Some of that is training. Some of it is the fear that the reaction might not be "bad enough yet." And some of it is an unsubstantiated perception that epinephrine itself is dangerous.

It isn't. There is strong existing evidence that delayed epinephrine administration is associated with worse outcomes, including increased mortality.

The clinical reality is this: fatal reactions typically progress to respiratory or cardiac arrest within 5–30 minutes of exposure. Antihistamines work on a completely different timeline. By the time a Benadryl is doing anything, the window for epinephrine has already mattered.

The framework worth internalizing:

If the presentation is consistent with anaphylaxis — give epinephrine. You can always explain a precautionary injection. You cannot undo a delay.

This framework should always be applied in the context of your individual student's emergency action plan and your district's protocols. Clinical Corner is for educational purposes only and does not replace individualized medical guidance.

References

Let's talk about pens.

Not in a serious way. In a "you deserve something that actually works and maybe comes in lavender" way.

If you haven't tried the Pentel EnerGel RTX, you're missing out. Fast-drying gel ink, smooth write, retractable so you're not losing a cap somewhere in the health office chaos, and it comes in enough colors that you can absolutely justify buying the multipack. Nurses who use them tend to be loyal to them in a way that borders on personal.

Find them on Amazon here.

And while we're here — what's your pen of choice? Ballpoint or gel? Hit reply. This is important research.

Last issue I asked: what's the first thing you do when you walk back into your health office after summer?

One response stopped me:

"I make a cup of coffee, close my door, and sit in my chair for exactly five minutes before I let anyone know I'm there. I take stock of what survived the summer and remind myself why I do this. Then I open the door."

That's it. That's the whole ritual. And I think most of us have a version of it.

This week's question — and it's a real one:

Have you ever hesitated before giving epinephrine? What went through your mind?

Hit reply. This is the conversation worth having.

Until next time,

— Megan 🌸

The School Nurse Dispatch is published every Wednesday by The School Nurse Collective.
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