Is There a Nurse in the House?
Readin', Writin', Ritalin
By Denise Mann
Sept. 3, 2001 -- WANTED: Nurses with background in mental health, pediatrics, pharmaceuticals, education, public health, and chronic diseases. All applicants must be willing to keep eyes open for potential violent behavior and medication errors. Willingness to work with teachers, parents a MUST.
Well, this is the job description for today's school nurse. Gone are the days when the school nurse dispensed Band-Aids and performed eye tests -- today's school nurse must be the jack and the master of many trades.
There are 47,600 registered nurses employed as school nurses in America's public schools, according to the U.S. Department of Health and Human Services. School nurses are mandated in some states -- Alabama, Arkansas, Connecticut, Delaware, Louisiana, Massachusetts, Minnesota, New Jersey, Pennsylvania, Rhode Island, Tennessee, Vermont, and West Virginia -- but not all.
The National Association of School Nurses (NASN) recommends that there be one school nurse for every 750 children, but a University of Iowa study found that the ratio of children to nurses may be almost twice that nationally. In some states, that breaks down to just one nurse for every 7,000 kids.
"We are seeing some cutbacks in some places and we have seen additions in other places," says former school nurse Judy Robinson, RN, PhD, NASN executive director in Castle Rock, Colo. "Georgia has passed legislation to have more school nurses and Mississippi is using some of the money they got form the tobacco settlement for more nurses."
Still, every district has different priorities, and some may choose to spend their money on athletics, special education, or additional support staff, she says.
From assuring that your child gets the right medication at the right time to making sure that his or her allergies are taken seriously, here's what to do so your children get the best possible care this school year.
Talk to the People at School
For one, "inform educators, principals, and superintendents that school nursing is a priority [and] advocate for support staff for the nurse such as a health aide or secretarial support to check immunization files and help with screenings," says former school nurse Judy Robinson, RN, PhD, NASN executive director in Castle Rock, Colo.
"If the nurse has a large load, parents should make every effort to give that nurse the most complete information about their child's health needs as possible," she says.
If your child has special health needs, stop in and speak one-on-one with the nurse, says Robinson.
That's exactly what Granite City, Ill., mother-of-two Cassy Lynn Barton does every year for her 9-year-old son Matthew.
Matthew is allergic to peanuts, and a peanut allergy can be life-threatening. When Matthew was in first grade, he had a severe reaction from peanut butter morsels in a cookie.
"Each year, I talk to the school nurse and his teacher about what would be best for Matthew as far as safety in lunchroom, classroom, and snack time, and we work as a team."
Matthew is about to begin fourth grade, and thanks to the vigilance of the school nurse, his teachers, and his mom, he hasn't had a reaction since first grade.
Growing numbers of students take daily medications for a wide range of medical conditions, and as a result medication errors can and do occur, says Ann Marie McCarthy, RN, PhD, associate professor of nursing at the University of Iowa College of Nursing in Iowa City.
McCarthy and colleagues surveyed school nurses and found that the secretary is often the primary person dispensing medications in many schools, and about one-half of school nurses have had medication errors in their schools.
"The more students, the more unlicensed personnel dispensing medications, the more likely it is to have a medication error occur," McCarthy says.
So "if any medications or treatments can be done at home before or after school, that helps the nurse," Robinson says.
While parents with health backgrounds may want to volunteer their services, this can be tricky, Robinson says.
For example, if you rotate people who dispense medications, the person may not notice that the new bottle has a different color or different-sized pill.
Parents Pitching In
"If a nurse determines a child needs to be sent home, parents should have a system in place where a kid can be picked up quickly," Robinson says. "And don't send sick kids to schools."
This helps because "we now have students in public schools that used to be in hospital care or institutionalized," says NASN's Robinson. "[They] have far more involved medical conditions, plus there's an increase in chronic conditions like asthma and diabetes," she says.
Part of this is due to the passage of the Individuals with Disabilities Education Act of 1997, which mandates that all children, regardless of physical or mental abilities, have the right to a free education.
Today, school nurses care for students on ventilators and feed students through gastrointestinal tubes in the abdomen. They also do dialysis for children with kidney problems and use nebulizers -- facemasks that deliver medication in the form of a fine mist -- for asthma treatment. About 98% of NASN members say they have saved a child's life.
"Nurses have intervened and prevented a suicide or if a child gets kicked in the stomach and starts bleeding internally through a slow leak, the nurse would recognize these signs," Robinson says.
Betty Stone, RN, the health services coordinator of the Granite City Community Schools in Illinois, is responsible for about 850 students each year. Once, she recalls, a boy in the second grade boy complained daily of tummy aches.
"I finally said, 'What's really wrong?' and he said, 'I don't want to be a kid.'"
When she asked what he wanted to be, he replied "dead." He also said he had a plan.
"As the school nurse, I understood what he was telling me and got him the proper help, and now he is doing well," she says.
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