Supporting Students with Seizures in the School Setting

Seizures in the School Setting:

Information for New School Nurses

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During the 2025-2026 school year, I responded to two grand mal seizures just 24 hours apart.

Before I arrived, my staff had already begun implementing the student's Seizure Action Plan because they knew exactly what to do.

That's the goal. Good seizure preparedness isn't just about what the school nurse knows—it's about making sure everyone is prepared before an emergency happens. - Elisabeth The School Nurse LLC

Seizures can be one of the most intimidating emergencies school nurses encounter, especially when you're new to the role. The good news is that preparation makes all the difference.

By developing strong systems, educating school staff, reviewing Seizure Action Plans, and using evidence-based resources, you'll be well prepared to support students safely and confidently.

According to the Epilepsy Foundation: 

"Epilepsy is not a rare disorder, 1 in 26 people will develop epilepsy during their lifetime. It can occur on its own or alongside other health conditions of the brain. What happens during a seizure may look different depending on who is experiencing them. However, seizures are usually stereotypic, which means the same things or behaviors tend to occur in a person each time they have a seizure." 

 Understanding Seizures and How They Affect Students

Students with seizure disorders may experience different types of seizures, from brief episodes to more complex situations. It’s important to recognize the signs and know how to provide support. When a seizure occurs, your calm, quick response will set the tone for the entire school community. Staff and students often mirror the school nurse’s reaction, so staying composed will help reassure everyone involved.

Know the Seizure Action Plan

Each student with a seizure disorder should have a Seizure Action Plan in place. This plan outlines what steps to take during a seizure, including emergency medications, whether emergency services should be contacted, and how to ensure the student’s safety. Review plans regularly. 

Review each student's Seizure Action Plan before the school year begins and anytime changes are made. The more familiar you are with the plan before an emergency occurs, the more confidently you'll respond.

If a Seizure Action Plan is not in place, follow your school's policy and procedure guidelines to respond appropriately.

Educate School Staff

Teachers and staff may not have the same medical knowledge as you. As a school nurse, part of your role is to educate them on what to do during a seizure, how to keep the student safe, and how to call for additional help. Consider providing brief refresher training each school year—even for experienced staff.

General Seizure First Aid – Stay, Safe, Side

• Stay with the student and time the seizure.
• Safe – Keep the area clear of hazards.
• Side – If possible, turn them on their side for safety.

(If a seizure lasts more than 5 minutes, follow the Seizure Action Plan or call emergency services.)

State-Specific Laws and Policies

It’s also important to be aware of state-specific laws and policies that may impact how schools manage seizure disorders. For example, in Illinois, the Seizure Smart School Act requires schools to have Seizure Action Plans for students with epilepsy. It also mandates that schools designate "Delegated Care Aides" who are trained to assist in implementing these plans, ensuring that students receive the appropriate care and support they need during a seizure. Be sure to review your state’s specific laws to ensure compliance and best practices.

Don't Reinvent the Wheel

When educating staff, there's no need to reinvent the wheel. Many districts already have seizure protocols in place. You can also use reliable online resources to save time while ensuring your school staff is well-prepared. Here are a few helpful options:

• The School Nurse on Teachers Pay Teachers: Offers a set of "Teacher Tips" for educating staff on various seizure diagnoses.

• The Epilepsy Foundation: Provides a FREE Seizure Action Plan template, nurse (with CEs) & school staff trainings and other super useful tools.

• NASN (National Association of School Nurses): Offers resources specifically designed to help school nurses manage students with epilepsy.

You don't have to create every seizure resource yourself. Many excellent organizations have already developed evidence-based training materials, action plans, and staff education resources. 

By using these resources, you’ll ensure staff are informed and prepared to support students with seizures in a timely and effective way.

Supporting Students Beyond the Seizure

A seizure lasts minutes—but supporting a student lasts all school year.

As school nurses, we help students succeed by:

• reviewing Seizure Action Plans

• educating school staff

• coordinating emergency medications

• communicating with families and healthcare providers

• promoting inclusion and reducing stigma

• helping students safely participate in school activities

That feels more like your current writing style.

Closing Thoughts

Every school nurse hopes they never have to respond to a seizure emergency—but every school nurse should be prepared.

Preparation begins before the first seizure occurs by building strong systems, educating staff, reviewing Seizure Action Plans, and using trusted resources.

The more prepared you are today, the more confidently you'll respond tomorrow.

HERE IT IS!

              

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The School Nurse’s Guide to Setting and Keeping Professional Boundaries

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Tips to Setting & Keeping Professional Boundaries for School Nurses

One of the biggest lessons I've learned over the years is that being a great school nurse doesn't mean saying "yes" to everything.

Early in my career, I wanted to help everyone. If someone asked, I said yes. If there was another task that needed to be done, I tried to fit it in. Like many school nurses, I thought working harder was the answer.

Over time, I realized something important.

Setting professional boundaries isn't about doing less. It's about protecting your time, energy, and clinical judgment so you can continue providing excellent care to the students who need you most.

Healthy boundaries don't make you less caring—they help you build a long, rewarding career in school nursing.

5 Key Tips for Setting and Keeping Professional Boundaries

1. Know Your Role

• Make sure staff and administration understand your role as a school nurse.

• Set expectations on what falls within your scope of practice—and what doesn’t.

• Politely redirect requests that don’t align with your responsibilities.

Too often, school nurses are expected to take on extra tasks simply because they’re available. Clearly communicating your role helps prevent being pulled into non-nursing duties.

2. Protect Your Time

• Establish clear working hours and avoid responding to emails or calls outside of them.

• Let staff know when and how they should contact you for non-urgent matters.

• Take your breaks and lunch—your time to recharge is just as important as anyone else’s.

Many school nurses struggle with stepping away, but setting limits on your availability is crucial. If you’re always available, people will always expect you to be.

3. Learn to Say No (Without Feeling Guilty!)

• Recognize that saying no doesn’t make you unhelpful—it makes you more effective.

• Use professional but firm language when declining extra responsibilities.

• Offer alternative solutions if appropriate, like directing someone to the right resource.

Saying no is often uncomfortable, especially in a school setting where teamwork is key. But protecting your time and energy ensures you can focus on the students who need you most.

4. Protect Your Emotional Energy

• Be mindful of becoming too personally involved in student or staff issues.

• Keep your interactions professional and avoid taking on emotional burdens that aren’t yours to carry.

• Protect student privacy by following FERPA and HIPAA guidelines.

It’s natural to care deeply about your students, but setting emotional boundaries prevents compassion fatigue. You can support students while still maintaining a healthy separation.

5. Advocate for Yourself

• Speak up when your workload becomes unrealistic.

• Request policy support from administration regarding boundaries.

• Connect with other school nurses for guidance and encouragement.

Remember, advocating for yourself isn't selfish—it's one of the best ways to protect the future of school nursing in your building. 

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Final Thoughts: Boundaries Help You Thrive

Looking back over my career, I can honestly say that some of the best decisions I made weren't about becoming a better clinician—they were about learning to protect my time, my energy, and my role as a school nurse.

You don't have to solve every problem.

You don't have to carry every burden.

And you certainly don't have to do everything alone.

The students who need you tomorrow also need you to take care of yourself today.

Healthy boundaries aren't a luxury—they're part of becoming a successful school nurse.

More DOASN blog posts about professional boundaries:

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Why School Nurses Need To Be Invited

Pull Up a Chair: Learning How To Invite Yourself to the Table

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As a school nurse, you are the healthcare expert in your building. You see students daily for everything from minor injuries to chronic illness management, mental health concerns, and social-emotional struggles. But despite your expertise and firsthand knowledge, you may find yourself left out of important conversations about student health and well-being. If you’re waiting for an invitation to join these discussions—you might be waiting a long time. It’s time to learn how to get your invitation and pull up your own chair.

Why You Need to Be at the Table

School nurses play a vital role in student well-being, yet they’re often left out of important conversations simply because others don’t realize the depth of their expertise. By advocating for a seat at the table, school nurses can break down silos, strengthen collaboration, and ultimately provide better care for students. If you wait for an invitation, you might miss the chance to make a real impact! Learning to pull up your own chair ensures that the health perspective—especially in areas like mental health, safety, and student support—is represented.

Many school-based committees and initiatives focus on student health, safety, and well-being, yet school nurses are often overlooked when these groups are formed. Whether it’s a suicide prevention team, a student support committee, a truancy meeting, or a crisis response team, your input is critical. You are uniquely positioned to recognize patterns that others may miss, such as students with frequent somatic complaints tied to anxiety or those showing signs of self-harm. You understand how health conditions impact learning and can bridge the gap between medical and educational needs.

By inviting yourself to these conversations, you:

• Prioritize student health – Your perspective is essential in discussions on mental health, safety protocols, and emergency preparedness.

• Strengthen collaboration – Working alongside teachers, counselors, and administrators helps create a more comprehensive support system for students.

• Advocate for your role – The more visibility you have, the more others will understand the depth of your expertise and the importance of school nursing.

• Improve student outcomes – Your voice can shape policies and interventions that directly impact student health and success.

How to Invite Yourself

If you discover a team, committee, or initiative that aligns with your role and passion, take the initiative to join. Here’s how you can approach it in a way that feels natural and professional:

1. Express Interest with Curiosity

Instead of focusing on why you weren’t invited, frame it as wanting to support the initiative:

"I recently learned about the suicide prevention group, and I think it’s such an important initiative. As the school nurse, I’d love to contribute and collaborate. I often see students who may be struggling—whether through frequent health office visits for stress-related symptoms, signs of self-injury, or other concerns that are shared with me. I’d love to support the team’s efforts. Would it be possible to receive calendar invites for future meetings so I can join?"

"I had an idea that might help give us a more complete picture of the students going through the MTSS process—adding some input from the nurse’s office to the problem-solving form. Things like known medical conditions, a quick summary of nurse visits, or participation in programs like XXX could really help us understand the bigger picture and how it impacts their school experience. Let me know what you think. Thanks so much!"

"I’d love to join the truancy meetings to help provide insight from the health office. I often see students whose absences are linked to health concerns—chronic conditions, anxiety, or other barriers that may not be immediately obvious. Including this perspective could help us better support them. Would it be possible to be added to the meetings? Let me know what you think—I'm happy to chat more!" 

2. Highlight Your Unique Role

You bring a different (and valuable) perspective:

• You see students with physical complaints that may actually be rooted in emotional distress.

• You often have private, one-on-one conversations with students who may not open up to teachers or counselors.

• You can help identify patterns in health office visits that might indicate a student is struggling.

3. Keep It About the Students

People don’t know what they don’t know, and that includes understanding the full scope of a school nurse’s role. Many assume we’re just here for bumps, bruises and daily meds, without realizing that we’re trained to assess both physical and mental health concerns, recognize patterns in student behavior, and provide critical input on issues like attendance, chronic illness, and mental health. Because of this, school nurses are sometimes unintentionally left out of important discussions—not out of intentional exclusion, but simply because others don’t realize the depth of our expertise.

It’s completely natural to feel a little hurt when you realize you weren’t included in a team or meeting that aligns with your role. But instead of dwelling on the oversight, it helps to frame your involvement around how you can support students. A simple, proactive approach—like expressing interest, highlighting your unique perspective, and emphasizing collaboration—can open doors. In most cases, once others understand what you bring to the table, they’ll welcome your participation.

This shift in mindset not only helps you gain a seat at the table but also strengthens your presence as a key player in student support teams. If you wait for an invitation, you might miss the chance to make a real impact!

Don’t Wait for Permission

Too often, school nurses hesitate to step forward because they assume they need an invitation or worry about stepping on toes. But advocating for yourself isn’t about pushing in—it’s about making sure that student health is not an afterthought. Schools function best when all key stakeholders are involved, and school nurses are absolutely key stakeholders.

If you see a seat missing at the table, don’t be afraid to pull up your own chair. Your students will be better for it, and so will your school community.

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School Nurse Must-Know: Allergy Preparedness Schools

Allergy Emergencies: Are You Prepared?

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Essential Allergy Preparedness for School Nurses

Allergies are one of the most common chronic health conditions school nurses manage. While many reactions are mild, every school nurse should be prepared to recognize and respond to anaphylaxis quickly and confidently.

Preparation begins long before an emergency occurs. Strong systems, clear communication, staff education, and access to emergency medication all play an important role in keeping students safe.

Whether you're preparing for your first school year or reviewing your current procedures, taking time to evaluate your allergy preparedness can make all the difference when every second counts. 

How Should a School Nurse Respond to a Life-Threatening Allergy?

Allergy emergencies can occur suddenly and without warning. Developing practical systems before an emergency happens helps ensure students receive prompt, effective care when they need it most.

As you review your school's procedures, ask yourself these questions:

• Does your district require an allergy action plan? Verify if your school requires a formal allergy action plan or medication authorization for students with severe allergies.
• How are students with severe allergies identified? Develop a system for safely identifying students at risk, ensuring privacy while keeping key personnel informed.
• How will you gather additional health information? Consider using a standardized health history form to collect essential details from parents and update records as needed.
• Are students allowed to carry their own emergency medications? Check district policies regarding self-carry and self-administration of epinephrine, and educate students on their responsibilities.
• Who needs to be trained? Identify staff members who should be trained to recognize allergic reactions and administer epinephrine, including teachers, coaches, and cafeteria staff.
• How will staff receive training? Determine the best method for educating staff on allergy signs, symptoms, and emergency medication use. Hands-on demonstrations and annual refresher sessions can be valuable.

Having a well-defined allergy response plan not only helps ensure a coordinated approach in an emergency but also fosters a safer school environment.

Notifying School Staff About Student Health Concerns

Effective communication with teachers and staff is essential to ensuring that students with life-threatening allergies receive the support and care they need. Clear, consistent messaging helps staff recognize allergic reactions, understand emergency protocols, and respond appropriately when seconds matter.

Utilizing email and student management systems like Skyward can streamline the process of sharing critical health information. Consider these best practices:

• Email Notifications: Send targeted emails to teachers and key staff outlining students’ allergy action plans, emergency protocols, and any necessary accommodations.
• Digital Health Records: Upload allergy action plans, medication authorizations, and emergency procedures into Skyward or your school's health management system to ensure easy access for authorized personnel.
• Teacher Tips: Provide staff with quick-reference guides that summarize key allergy information and response steps, helping them feel more prepared in an emergency.
• In-Person Follow-Ups: Encourage teachers to reach out with questions or concerns and offer brief, in-person training when necessary.

By integrating digital tools and direct communication, school nurses can ensure that all staff members are informed, confident, and ready to act if an allergy emergency arises.

Remember, every district has different communication systems. Whether you use Skyward, PowerSchool, Infinite Campus, email, printed health alerts, or another student information system, develop a consistent process that ensures the right people receive the information they need while protecting student privacy.

Why Notify School Staff?

As school nurses, we often assume that others have a basic understanding of medical conditions, but that’s not always the case. Teachers and staff may not recognize the signs of an allergic reaction or know how to respond in an emergency.

One of the easiest ways to improve allergy preparedness is by collecting accurate health information before an emergency happens.

A comprehensive health history helps identify students with known allergies, previous reactions, prescribed medications, emergency action plans, and any accommodations they may need during the school day.

If your school uses Google Workspace, consider creating a digital health history form to gather and organize this information before school begins.

Teacher Tips health cards offer a simple yet effective way to share broad information about medical conditions, including severe allergies. These quick-reference cards give staff an overview of allergy symptoms, emergency response steps, and key precautions. They also serve as an open invitation for teachers to ask questions and seek more detailed guidance as needed.

By proactively educating school staff, we can help create a safer environment where everyone is equipped to respond confidently in an allergy emergency.

Build a Communication System

Every district uses different documentation and communication systems. Whether your school uses Skyward, PowerSchool, Infinite Campus, or another student information system, develop a consistent process for sharing student health information with authorized staff.

If you use Skyward, here's one example of how you can organize allergy information...

ttake advantage of the Health module by attaching digital Teacher Tips  cards under a student’s health records. Follow these steps:

1. Open the student’s profile in the Health tab.
2. Select "IHP" (Individualized Healthcare Plan).
3. Click "Add File" and upload the Teacher Tips document as a PDF.
4. Use the comment box to include student-specific notes or important details for staff.

Using Skyward to document student health conditions is a valuable tool for ensuring that essential medical information is accessible to those who need it. Be sure to add an indicator so teachers are prompted to review any health concerns that may impact their students.

If you're using an older version of Skyward and need guidance, I have a step-by-step how-to guide available HERE to help you navigate the system efficiently. Keeping health records up to date and easily accessible helps ensure a swift and informed response in case of a medical emergency.

This system is particularly helpful for middle and high school students who have multiple teachers throughout the day. Additionally, the Health Condition tab in Skyward can be a useful tool for tracking medical concerns and running reports throughout a school year.

Apply for Free EpiPens

Does your school have undesignated epinephrine available for emergency allergy situations? If you’ve been following this blog, you know that Mylan Pharmaceuticals  & BioRidge Pharma offer schools two free two-packs of epinephrine auto-injectors, along with replenishment doses and training devices, each calendar year. This program has saved schools significant amounts of money while also ensuring life-saving medication is readily available.

While there is required paperwork to complete, it is straightforward. Schools must have a district physician or a local doctor willing to sign an order or provide a standing prescription.

Having emergency epinephrine in every school building can be the difference between life and death for a student, staff member, or visitor. You can find more details and apply for the program HERE.

Final Thoughts

Every school is different, but every school nurse should have a plan for managing allergy emergencies.

Preparation isn't just about having epinephrine available. It includes developing strong communication systems, educating staff, collecting accurate health information, and reviewing emergency procedures before they're ever needed.

The more prepared you are before an emergency happens, the more confidently you'll respond when every second counts.

SCHOOL NURSE RESOURCES

PDF IHP Template

Editable IHP Google Template

Daniel Tiger PBS Episodes

Mayo Clinic- What is an Allergy?

Food Allergy & Research Education

FARE in Schools

FARE Allergy Plan 

NASN Allergies & Anaphylaxis 

Allergy & Asthma Network 

FAACT- Food Allergy & Anaphylaxis Connection Team 

The School Nurse Amazon Allergy Storefront

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Mandated Reporting for School Nurses: What You Need to Know

The School Nurse's Role in Keeping Students Safe

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Mandated Reporting for School Nurses

Recognize. Report. Protect.

As a school nurse, you are more than a healthcare provider—you are also a mandated reporter. While this responsibility can feel overwhelming, understanding your role before you're faced with a difficult situation can help you respond with confidence.

One of the biggest concerns I hear from new school nurses is:

"What if I'm wrong?"

Fortunately, mandated reporting isn't about proving abuse occurred. Your responsibility is recognizing concerns, documenting objective observations, and making the report so trained investigators can determine what happens next.

The Most Important Thing to Remember

You are responsible for reporting reasonable suspicion—not proving abuse occurred.

Many new school nurses hesitate because they're afraid of making a mistake or upsetting a family.

Remember...

You are not responsible for investigating.

You are not responsible for interviewing witnesses.

You are not responsible for determining whether abuse occurred.

Your responsibility is to recognize concerns, document objective observations, follow your state's reporting requirements, and make a report in good faith.

What Is Mandated Reporting?

Mandated reporting laws exist to protect children from abuse and neglect. These laws require certain professionals, including school nurses, to report suspected abuse or neglect to Child Protective Services (CPS) or the appropriate local authorities.

Because reporting laws vary from state to state, it's important to become familiar with your own state's requirements before you ever need them. Search your state with this link HERE. 

Recognizing Signs of Abuse or Neglect

As school nurses, we may notice physical, emotional, or behavioral changes that raise concern.

Some common warning signs include:

• Physical Abuse: Unexplained bruises, burns, fractures, or injuries in various stages of healing.
• Neglect: Poor hygiene, inadequate clothing, untreated medical needs, malnutrition, or lack of supervision.
• Sexual Abuse: Age-inappropriate sexual knowledge, difficulty walking or sitting, or sudden behavioral changes.
• Emotional Abuse: Extreme withdrawal, aggression, anxiety, fearfulness, or sudden changes in behavior.

These signs alone do not confirm abuse.

However, they should never be ignored and may warrant further assessment and documentation.

How to Make a Report

If you suspect abuse or neglect:

1. Document Objective Facts

Record exactly what you observed or what the student disclosed.

Avoid opinions, assumptions, or personal conclusions.

Good documentation becomes an important part of the reporting process.

2. Follow Your School's Procedures

Many districts have internal procedures for mandated reporting.

While you should follow district procedures and notify appropriate administrators when required, you do not need permission to make a mandated report.

3. Contact the Appropriate Agency

Reports are typically made to Child Protective Services or local law enforcement.

Some states require a phone call.

Others allow online reporting.

Some require additional written documentation.

Some states require an immediate phone report, while others allow online reporting. In Illinois, for example, mandated reporters must complete and submit a CANTS form after making a report to the Child Abuse and Neglect Hotline (1-800-25-ABUSE) or online at Illinois Department of Children & Family Services. Other states may have similar documentation requirements, so be sure to check your state’s process.

4. Maintain Confidentiality

Only discuss concerns with individuals directly involved in the reporting process.

Your responsibility is to report—not investigate or share information unnecessarily.

What Happens After a Report Is Made?

Once a report has been submitted, Child Protective Services or another appropriate agency determines the next steps.

Depending on the situation, investigators may interview the child, family members, or school personnel.

Because of confidentiality laws, mandated reporters often receive little or no follow-up information.

That can feel frustrating—but remember that making the report may be the first step in getting a child the help they need.

It's Okay to Feel Uncomfortable

Making a mandated report is rarely easy.

Many school nurses worry about:

• Being wrong
• Damaging relationships with families
• How parents might react
• Whether the child will receive help

Those feelings are normal.

Remember that reporting does not mean you're accusing someone of abuse.

It means you've recognized concerns that deserve further assessment by professionals trained to investigate.

Making a report demonstrates your commitment to protecting children—not passing judgment.

Common Fears About Reporting

If you've ever wondered...

"What if I'm wrong?"

You're not alone.

Here are a few reminders.

✔ You are protected by law.

Most states provide legal protection for mandated reporters acting in good faith.

✔ You don't need proof.

Reasonable suspicion is enough.

Investigating is someone else's responsibility.

✔ Failing to report may have consequences.

Depending on your state, failing to report suspected abuse may result in legal or professional penalties. When in doubt, review your state's Nurse Practice Act and mandated reporting laws.

Final Thoughts

Most school nurses hope they'll never need to make a mandated report.

But if the time comes, remember this:

You are not expected to investigate.

You are not expected to prove abuse occurred.

You are expected to recognize concerns, document objective observations, follow your state's reporting requirements, and make the report in good faith.

That one phone call may become the first step toward protecting a child and connecting a family with the support they need.

Additional Resources:

• National Child Abuse Hotline: 1-800-4-A-CHILD (1-800-422-4453)

• State-Specific Reporting Laws (Child Welfare Information Gateway)