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Rx for a Healthy School

by Norma B. Bergey

The school nurse's job isn't what it used to be. Once, they were the people who checked students' heads for dreaded lice and dispensed bandages. No longer! The school health situation has changed tremendously in recent years. Today, the school clinic functions as a mini emergency room. A student walking into the clinic may have anything from a bloody cut suffered in physical education class to a headache that has him frightened because he's a brain cancer survivor. It's also not unusual for a student who is a diabetic to appear, acting confused, or a student with asthma to walk through the door, wheezing audibly. While all this may be happening, multiple children could arrive for their daily medications, along with a teacher returning from the bus ramp with a child who is crying frantically as a result of parent separation anxiety. A staff member with a severe headache might request that her blood pressure be checked. All of these and more are everyday occurrences in today's school health office clinic.

Professional school nurses care for a myriad of student medical needs, but their contributions don't stop there: Nurses also support student academic and social success. According to the National Association of School Nurses, school divisions with "adequate nursing coverage" have fewer absences, a decreased dropout rate and higher test scores.

School nurses reach out not only to students and staff, but often to the community, as well. They are, in some cases, the first and only health care provider that some students see. In addition to first aid and emergency care, some of the services many school nurses offer:

• Health education
• Health records maintenance
• Health surveillance and intervention
• Mental health appraisals
• Health and social service referrals and follow-ups
• Communicable disease surveillance and control
• CPR and first aid certification for staff
• Environmental and safety control
• Medication dispensing
• Screenings for scoliosis, dental, hearing and vision problems
• Sports physical screenings
• Health and nutrition counseling for students and staff
• Crisis intervention and child abuse reporting
• Medical referrals and Medicaid billing
• Employee wellness programs and specialized exercise programs for students.

Also, as members of consultation and child study teams, school nurses contribute important health/nursing assesments that may affect the student's educational process.

Over the last decade, more children with special health care needs have been mainstreamed into regular education classrooms as a result of federal laws that affect students with chronic health conditions. Mainstreaming can be a positive step for both students and teachers, but can also raise issues for the care of students with ongoing problems. About 15 to 18 percent of U.S. children have a chronic health condition, according to the University of Michigan Health System, and it's been estimated that 1 in every 20 students needs a prescription medication while at school. Problems can develop when school staff members who are not medically trained, such as teachers, teacher's aides and secretaries, are given the responsibility of dispensing medication or otherwise treating students with chronic health issues.

School nurses receive years of training in order to deal with both chronic and acute health issues and can assess, plan for, implement treatment of, and evaluate each student's health concern. It can simply be dangerous to have such steps taken by a staff member without the educational background to effectively do so. Yet in Virginia, this often happens. Parents and staff may mistakenly believe that a professional school nurse is in the school full-time to take care of their child. However, this may not be true since school nurses are not mandated in every public school in Virginia. There is no school-nurse-to-student ratio in the state's Standards of Quality for public schools, as there is for speech therapists and guidance counselors. As you might expect, the major issue is money. Unfortunately, it may take a tragedy to open the eyes of the public to the fact that non-nurse school workers are attempting to care for sick children.

Because more children are attending classes with chronic and acute health problems, it is clear that professional nurses should be an integral part of every school. There needs to be one school nurse in every building in order for school nurses, educators and parents to work hand-in-hand in order to support the success of all students. The children and teachers of Virginia deserve one school nurse in every building!

Bergey, a member of the Chesapeake Education Association and a school nurse at George W. Carver Intermediate School, is the immediate past president of the Virginia Association of School Nurses.