NEW YORK NURSE: September 2009
by Erin Silk and Mark Genovese
“When a child comes into your office not feeling well, a lot goes through your head,” said Mary Owen, a registered nurse who works for the Horseheads Central School District near Elmira.
“You do neurological checks. You have to observe them carefully and start to rule things out,” she continued. “Is it just a belly ache or is it appendicitis? Will I need to make a phone call to the parents or to 911 for an ambulance?”
A school nurse may be a child’s only healthcare provider. And as students throughout New York State filed back into their classrooms this month, school nurses had spent the summer preparing for what could be a difficult year.
If the H1N1 virus re-emerges, as is forecast, school nurses will be on the front lines in protecting the health of both their students and the public in general. Many counties conducted midsummer meetings of school personnel to discuss strategies for dealing with the H1N1 virus.
Amityville school nurse Kathy Nardi believes, however, that the upcoming school year will be like any other. “Every year it seems there is something extra to prepare for,” she said. “The important part is getting everyone on the same page.”
Nardi, who is responsible for 400 first- and second-graders, thinks that interaction with parents is a key element of her job. She has recommended that the district send a letter to parents detailing how to prevent the spread of the H1N1 virus. It is part of her duty to educate adults, as well as children, about good health.
Other duties continue to expand. School nurses are now required to obtain certificates of dental health from families and to track the body mass index (BMI) of every student. In the Amityville schools, nurses utilize a computer program that automatically calculates a child’s BMI, but keeping track of each student’s weight is still a major task.
Nardi thinks that most people, even other nurses, assume that school nurses just “put on a bunch of Band-Aids®.” They do this, of course, but “with so many medical inclusions to manage – with asthma being the most prevalent – a nurse must be one part detective and one part caregiver to ensure proper care.” School nurses also are responsible for developing exposure control plans and first-aid protocols, inspecting buildings and grounds for health and safety hazards, and ensuring that the facility can accommodate students with disabilities.
In today’s schools, nurses are faced with an increasing number of complex issues such as diabetes, addictions, pregnancies, sexually transmitted diseases, abuse, and depression. In addition to dealing with sniffles and minor accidents during the course of a school day, a nurse will administer prescription medications, conduct health screenings, help arrange for social services, and even deal with life-threatening events such as seizures or allergic reactions.
chool visitors may need emergency attention, too. Nardi once saved the life of a school visitor by using the automatic external defibrillator. “In the school environment, the school nurse is the first medical person at the scene of an accident or medical situation. People rely on us to know what to do. We have no immediate medical backup and need to be prepared to respond quickly and efficiently,” she said.
Despite the crucial role of school nurses, financially strained districts are reducing funding for school health. More often than not, school nurses must split their time among several schools with several hundred students each.
Mary Owen covers three nonpublic schools in the Horseheads district over a four-day period, then floats to one of the district’s seven public schools on the fifth day.
“I’m there only one day a week. But when I come in, students are waiting for me with health problems or injuries they’ve suffered during the past week but haven’t yet been treated.” One student had dropped a piece of equipment on his hand at his part-time job. Rather than going to an emergency room, his family had chosen to wait four days until she could examine the injury.
“I immediately called to get him into an emergency room,” Owen said.