I am embarrassed to tell you that before I became the School Health Advocate for District IV in Department of Health, my only reference to school nursing was way back when I was in school. The only reason I ever went to the nurse's office was to get Midol® for my cramps or a Band-Aid® for a cut or scratch. Not being a nurse at the time, I didn't pay any attention to anything else the nurse ever did.
Boy, have times changed. We are working hard to get a nurse in every school. One of the reasons for this is that they are really needed. Did you realize that nurses now have students on ventilators? That they have to do catheterizations routinely on many students? That nurses give out thousands of doses of psychotropic medications in the schools daily, and that doesn't count the other medications they give? That they do more paperwork in a day's time than most nurses in hospitals do? That they do vision and hearing screening on their students? That they have to keep up with the immunization records of the kids to make sure they are up to date on everything. Of course, there is the constant visit of children in the office for everything from headaches, stomachaches, hurts and bandage changes along with blood sugar checks on the diabetics. There is the monitoring of the food choices those diabetics make, so there is consultation with the food service people to help them understand that some things cannot be given to the diabetic even if the child does want it for lunch. Then there are those kids with food allergies that require constant monitoring and education of the school personnel if the child inadvertently eats something they shouldn't and goes into anaphylactic shock. Where do you put that Epi pen so that everyone has access to it, but the kids can't get hold of it? Being there for the kids who need to talk and assessing their needs is vital for a school nurse. Assessment, Assessment, Assessment, is what it is all about. I meet very few school nurses that do not have great assessment skills. What are those spots, anyway?
Educating staff is an ongoing issue with school nurses. Making them aware of what can be happening to that little diabetic that keeps going to sleep in class, or what to do if someone has a seizure. That doesn't count the health classes they get to do when it comes to STD's and Pregnancy issues. Of course the nurse, in most schools, has to be very careful not to get caught actually teaching sex education for fear of offending the parents of those little darlings that couldn't possible be having sex.
School nurses are governed not only by the Public Education Department, but also by the Department of Health. Often times these two entities do not go together. PED doesn't want anything to interfere with the test scores of the students, and don't always correlate scores with the health need of those students.
There is also that other population of patients that school nurses take care of; the teachers and parents. Teachers pop in on a regular basis to have their blood pressure checked or to ask medical questions about themselves and family members. And, it is not unheard of for a family member of a student to drop by to get answers about something including the siblings still at home.
School nurses deal with every thing from head lice to suicides. They take care of students with asthma receiving nebulizer treatments, ostomy care, eating disorders, neurological issues, endocrine disorders, cardiovascular diagnosis, dental problems and of course the students with ADD/ADHD.
There is a whole group of school nurses out there that work part time in schools because nurses are not a high budget item in some of the smaller schools. These nurses do all of those things cited, but do it one or two days a week. Some of them do two or three schools a week in different locations to give health care to those kids in small communities.
Yes, the school nurses get the summer months off, but don't you think they deserve the time for all the work they do? Next time you see a school nurse, tell her thank you. I am so grateful they are dedicated to the children in our school system.
The school nurse sometimes is the only provider these kids see for health care.
I get tired just thinking about all they do, don't you?
Jan Jordan RN, MSN
School Health Advocate
DOH/PHD District IV
Roswell, New Mexico
Copyright New Mexico Nurses Association Jul-Sep 2005
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