In the century-plus time that school nurses have taken care of children in school settings, their roles and responsibilities have evolved. There was a time when a school nurse was in charge of reducing communicable diseases, such as the cold or flu, through education of hygiene and intervention, or offering support along with a Band-Aid to children with scraped knees. In today’s world, both these childhood common problems are still on the radar of a school nurse. However whether in a public or private school, a nurse plays a much more complex role today, tackling new complexities in health, both physical and mental.
According to the National Association of School Nurses (NASN), the first nurse entered a school in New York City in 1902 in order to reduce absenteeism from communicable diseases. Students learn better when healthy.
The NASN goal states that, “The school nurse supports student success by providing healthcare through assessment, intervention, and follow-up for all children within the school setting. The school nurse addresses the physical, mental, emotional, and social health needs of students and supports their achievement in the learning process.”
Naomi Stevens, nurse for Kingston’s public high school, echoes the same goal in slightly more specific terms. “The primary goal of a school nurse is to make sure students are healthy enough to be in class and be learning to the greatest potential,” she writes in an email.
A school nurse is often kept busy by a flow of students coming through the door. At various times, a writer seeking information is frequently put on hold, asked to phone after school hours, or asked whether questions could be submitted via email and completed after hours. One hears the same answer from various nurses, the gist of which is “I can’t talk right now, I have a student with me.”
Nurses are required to extinguish metaphorical large and small fires hindering student well-being. State mandates require that students be checked for a myriad of health-related issues, including but not limited to Body Mass Index (BMI), scoliosis, hearing, vision, and mental health.
“All of the health offices at Onteora deal with comprehensive health and wellness which includes physical, mental, emotional, spiritual, and social health,” explains Onteora nurse Colleen MacDaniel in an email. “Students bring a wide range of problems to the health office, ranging from head lice to suicide threat to broken [eye]glasses. Many students require care for chronic illness such as diabetes, seizure disorder, asthma, daily medication etc.”
According to the state education department (NYSED), nurses are required to know how to use and keep on hand medical equipment such as, emergency epinephrine injector (epi-pen) for allergic reactions, cardiac defibrillator and nebulizer. NYSED mandates have become both a blessing and burden to school nurses. The paperwork never ends. Parents must fill out pages and pages of it. Every nurse must then review and check off data for hundreds or more students.
These records are not unimportant in keeping students safe and healthy. Says Woodstock Day School nurse Colleen Short, “We have systems in place now and the assessment piece is very important.” Covers students from nursery school through grade twelve, Short must follow the same mandates as a public school. Nursing being “a litigious profession in general,” she notes, the mandates help establish a protocol. If there is a head injury on the sports field, she explains, a system is in place that helps a nurse make snap assessments in what could in extreme circumstances be a life-or-death situation.
The paperwork begins in nursery school, where health forms and immunization records must be up to date, reviewed and signed off by the nurse. Nurses are responsible for assuring that all vaccines are current as required by law. Parents sometimes need to be notified. If immunization arrangements are not up to date, children cannot attend school. Immunization mandates have increased due to the larger number of diseases prevented through vaccines.
“The newest immunization schedule has created problems for school nurses, doctors and parents due to the every changing state mandates,” writes MacDaniel.
By secondary school, more forms must be submitted with the latest information. If a student wishes to join a sports team, additional forms, including data on a physical from a doctor giving permission to play sports must be filled out, signed and submitted to the school nurse. If the student is unable to get to a doctor, the school will provide one for him or her.
“We have a large sports program at the high school which require yearly physicals and much paperwork for each sport season,” explains MacDaniel. The nurse and athletic coach must review all of the information and take necessary precautions.
Stevens summarizes, “Paperwork is an necessary evil in the scope of medicine.”
State education law no longer allows a student to carry prescription medications on their person unless it’s needed in emergency situations, such as epinephrine injector or inhalers for asthma. A backup for these types of medications is normally supplied by the nurse’s office, kept under lock and key and with physician instructions.
It doesn’t appear there’s much turnover of employment for school nurses. The nurses interviewed have been in the profession a minimum of 19 years. Why such longevity? “The bottom line is,” replies Short, “the love and care of the students and advocacy is a big part of it.”
Oh, yes, there are other responsibilities. The health offices in the Onteora district coordinate arranging for coats, helping hands, and holiday food baskets for needy families.