Complex Health Issues
Linda Evans checks the dosage of insulin that Hickman senior Sean Callhan drew for himself. Evans sees between 60-80 students every day with a variety of health concerns. ¿All my students with chronic illnesses have care plans, and I¿m aware of each and every one of them even though they are more independent,¿ Evans says.
While education is the primary goal of schools, they also form the foundation of our children's physical and mental health as well as their safety. These factors are also directly related to student achievement, states the American Nurses Association (ANA).
The increasing incidence of chronic diseases, behavior disorders and learning disabilities in the classroom has complicated the nurse's job providing for students' health care needs during the school day.
The key to the success of this vital public health function is the professional registered school nurse, states the ANA report.
"The school nurse has a central management role in the implementation of school health services," states the American Academy of Pediatrics in 2001, "including acute, chronic, episodic and emergency care as well as health education, counseling and advocacy for students with disabilities."
Barbie Underwood is well aware of the differences between actively involved schools nurses and those just filling the position.
Her son, Derek, was diagnosed with Cystic Fibrosis at 18 months. It was then that the MS-prepared social worker decided to stay at home with Derek and not rely on outside care.
Then Derek entered the CPS district.
"It is crucial that I have a relationship with the school nurse that is built on trust," Underwood emphasizes. "Ardith was one of Derek's first nurses and we all hit it off from the beginning."
Harmon and Underwood talk out Derek's care plan in the summer and his plan was in place before school started.
Those with CF have compromised lung capacity, so exposure to any other type of lung diseases causes more extensive damage. Additionally CF patients carry individualized bacteria in their lungs so they can not be exposed to others with CF due to cross contamination.
And this past fall when whooping cough was diagnosed in the CPS district, Derek's school nurse, Judy, had to know without a doubt if Derek or other CF students had any contact with that student.
She also has to be aware of each CF student's schedule (there are four) and make sure they don't cross paths throughout the day.
"We need a full-time RN at school just to monitor Derek's situation because he turn bad quickly," Underwood states. "For instance, if his feeding tube was pulled out he'd need immediate action to have it put back in. If that didn't happen, it could mean hours in the ER just to replace it."
Derek and those with CF aren't the only students with complex health care needs that school nurses must manage. Today, school nurses are managing students who need life-sustaining medication, those with cardiac problems, cancer, asthma, diabetes and severe food allergies.
According to statistics kept by Robinson's office, in the past four years the number of diabetic students in the CPS system tripled.
And the CDC reports from 1998 to 2004 the number of school-aged children diagnosed with asthma increased half a million. Severe asthma is the largest health threat to today's students; it affects about 1 in 10 students, which means there are approximately two students in every classroom who are asthmatic.
However Robinson says the most alarming statistic is the rising number of students who have severe allergies.
"We are seeing more and more students with severe allergies," Robinson says. "In fact, last year a student was saved by a nurse who used an epi pen."
Due to their theory-based education, BSN and MS(N) school nurses are able to train teachers and other school staff how to handle asthma attacks, seizures and other life-threatening situations until they can get to the student.
"These nurses handle general education of the staff and one-on-one training with teachers who have students with health challenges in their classrooms," Robinson says. "We have an emergency plan for each student. Everyone is aware of the plan - teacher, staff, families and students."
But as the demand for nurses increases in hospitals and other facilities, and school-district budgets getting tighter paying top dollar for a BSN- or MS(N)-prepared nurse, health care coordinator like Robinson are having to justify the expense.
"With this economy," says Atkins, "we need to demonstrate the positive outcomes that show why our jobs are essential to our children's and their family's health."
So although they hold the same title they did for the last 150 years, the line of defense for school nurses has become more complex to manage.
Their job responsibilities are as varied and different from one another as the communities they live in. However, the one item they have in common is their passion for keeping children strong, healthy and learning.
continued...MU Connections