Having been raised in a family of nurses, I learned early on that seeking advice from a nurse is one of the best ways to understand what it takes to be a good doctor. I am currently a Broad-Based Training doctor, a programme that involves six months of working in paediatrics, medicine, general practice and psychiatry. As part of my training, I have allocated time to shadow health care workers in these specialities.

I decided to use this time to shadow my mum, Michelle McAvoy, a school-based nurse at Sullivan Upper School in Holywood. Having worked in paediatrics, general practice and psychiatry, I knew that spending time with a nurse in a school could offer a unique perspective on all three.  

The school nurse is often thought of as the school matron, whose main role is to send children home sick and put plasters on their knees. While this is part of the job, what is often not recognised is the immensely challenging, complex and holistic work involved in being a school-based nurse, often as the only full-time health care professional in the school.

Nurse McAvoy’s day involves arriving early to school, and she has a brief period to prepare for the day. This involves liaising with teachers who have concerns about people, calling parents to get updates on children she has seen and ensuring that her documentation is up to date. The day proceeds as if she is a GP for pupils (and the occasional staff member). She will assess, triage and treat a huge number of conditions, from headaches, period pains and gastroenteritis to mental health and pastoral issues.

Watching Nurse McAvoy approach each child with compassion and respect, ensuring they felt they were being listened to and their problems being appropriately addressed, showed me the high level of communication skills needed to work as a school nurse. Nurse McAvoy works as an independent practitioner who needs to decide where the best place for a child is and whether their issues need to be escalated. My mum has stories of treating acid burns, cardiac arrests, fractures and degloved fingers, ensuring she needs to keep her pre-hospital clinical skills to a high level.

I also spent a day with Kerry Tinman, the school nurse and counsellor at Bangor Academy School. One of the most challenging areas that I witnessed both school nurses facing was the presentation of mental health problems among pupils. A pupil in one of the schools had escalating patterns of anxiety that were preventing them from attending classes. They agreed to a crisis plan in which the pupil would come to the nurse’s room at times of anxiety. Often, these five minutes of calm allowed a space for the pupil’s self-regulation to help them attempt to return to class. Again, the school nurse picked up on the increased frequency of these events and helped guide pastoral staff and parents in deciding on the possible next steps. Without the presence of these nurses, I believe the students would lose a vital space to express their concerns and a trusted individual they can confide in, with the assurance that they will be taken seriously.

School-based nurses are also involved in teaching. While shadowing, I saw them participate in career talks, health and social care teaching, and learning for life and work classes. These nurses are an asset to pupils considering a health care career. Nurse McAvoy advised her pupils who are considering applying for medicine to find out what makes a good doctor: ask a nurse!

The main takeaway from my week working with nurses appointed in schools is how integral they are to the wellbeing and development of school pupils. While working in a busy acute assessment unit in Glasgow, I mentioned to another Northern Irish doctor that my mum was the nurse at Sullivan Upper School. Her face lit up, and she told me my mum was a school legend. I saw this firsthand while shadowing at Sullivan. I saw the trust and enormous affection pupils and staff had for their school nurses, demonstrating the necessity of appointing nursing staff in a school setting. While often overlooked in their contribution, the work they do in schools is a credit to the nursing profession.