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Health Matters


School nurses tackle new challenges to keep kids ready to learn.



National Association of School Nurses (NASN) President Susan Will is an NEA member who works at AGAPE, a St. Paul, Minnesota, alternative school option for students who are pregnant or parenting. She spoke with NEA Today’s Alain Jehlen about the challenges of nursing in today’s schools.

What do you do for most of your day?

Will: Our young students have all the issues any high school student would have, “How does my hair look?” in addition to, “How can I possibly be successful and take care of this baby?” They have big challenges. I have an excellent social worker and counselor on-site. Sometimes it takes all three of us to help a student hang on, stay in school, and successfully parent.

Pregnant students run a high rate of complications, in part because some of them aren’t getting good prenatal care. So I monitor blood pressure, work with them on diet, and help them understand pregnancy and labor.

After that, we have child care on-site for the babies. If a mom or a member of the child care staff has a concern about a baby, I’ll check it—rashes, spitting up, maybe a fever.

Most of your students probably would not have been in school in the past. How else has the job of the school nurse changed?

Will: We see more students with chronic health problems than we used to, and we don’t know why. Asthma’s increased, [along with] diabetes, food allergies.

Also, medical technology allows kids to be in school who never used to be. Kids go for cancer chemotherapy and return to school. I’ve taken care of students with heart transplants. Laws have changed, too. The Individuals with Disabilities Education Act requires all kids to be in school, and the school to support their learning. That’s good—everybody can learn something.

The number of children without health insurance is growing.

Do you see the effects of that?

Will: I am always dealing with kids who don’t have health insurance. Most states have insurance plans for kids, so the first thing is to try to get the kid into the system. But that child may have to wait four months before it kicks in. And right now, they can’t hear because of a middle ear infection, so they can’t learn.

School nurses have an amazing amount of knowledge about community resources and can scramble to get kids treated in the short term. But I’ve had kids show up on Monday morning with broken fingers because a friend’s bike rolled over their hand and cracked their bones, and they didn’t have insurance so they didn’t go to the doctor.

NASN supports reauthorization and extension of the children’s health insurance plans. It is appalling that a country of our wealth cannot take adequate care of our children’s health. With these problems, how should an educator who is not a medical professional work with the school nurse?

Will: Communicate, communicate, communicate. Let the nurse know what you’re seeing in the classroom. School nurses are part of the team that serves students, professionally prepared just as teachers are, which is why they should be included in the teachers’ union contract and paid professional salaries.

Do teachers and nurses usually communicate well?

Will: On the whole, yes.

But sometimes there’s not enough time, when the nurse is only there one or two days a week. Every school should have a school nurse every day. NEA passed a resolution last summer for a [ratio of at least one] school nurse to every 750 students. Teachers are more effective in teaching kids when we’ve been able to manage the health problems.

An NASN survey showed a huge range in students per nurse—300 in Vermont, 5,500 in Utah. What’s the effect on kids?

Will: School nurses can participate in IEP [Individualized Education Program] teams when they’re there frequently enough. They can get immunizations done and support teachers in health education. And they’ll have better case management for students with health problems.

There was a really tragic case in Utah where a child had an asthma attack at school, took her inhaler, it didn’t work, and she took it again, eight or 10 times. She overdosed, had seizures, and was hospitalized for an extended period of time.

That student’s parent started a one-woman effort to increase the number of school nurses, and the Utah legislature just authorized funds for more school nurses.

There have been several recent stories about school nurses who saved lives. We don’t do that every day. But the things we do make a student just a little healthier and a little better able to learn. That’s the day-in, day-out task of the school nurse.

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May, 2007