A day in the life of the busy nurse at Maury High

Kim Elforsi is the nurse at Maury High School in Norfolk, seen here at left on Wednesday, March 14, 2012.

(The Virginian-Pilot) Kim Elforsi thought she’d have an uncharacteristically slow morning at Maury High. On this day, many students are immersed in mandatory academic testing, and that means no trips to the school nurse allowed, except for emergencies.But by 10 a.m., two teens with stomach bugs are resting in a darkened annex off Elforsi’s waiting room.

“She’s on the verge of vomiting,” she says of one, who is waiting for a ride home.

Elforsi receives students – about 40 a day – with motherly concern and a clinician’s inquisitiveness. When they feel sick, she looks in their eyes, peers down their throat, inquires about symptoms.

“I’m hot, but I have the chills,” one student reports. Elforsi runs a digital thermometer across the girl’s head. “No fever – that’s a good sign.”

Using a tongue depressor, she looks in Sarah’s throat. “Oh, yeah,” the nurse confirms, “I see the little pock marks where you’ve had infection today.”

Elforsi calls the girl’s mother at work. “We’ve got a sick puppy here – her tonsils are real red…. She actually feels worse than yesterday,” the nurse says while examining Sarah’s chart on a computer screen.

Elforsi passes the phone to the teen, who moans to her mom, “Do you think I have mono?” Nurse and mother ultimately agree to have the girl gargle with salt water and go home.

For many students in this urban division, school nurses are the only professional health care provider they have easy access to. School nurses, interim Superintendent Michael Spencer says, are the first line of care for those students.

Elforsi is, in a way, a solo practitioner in a small town where everyone happens to be 14 to 18 years old.

More kids trickle in to Elforsi’s office, including Jonathan Rowland, a freshman who’s come for a dose of pain medication his doctor prescribed for an injured knee. Students are banned from possessing any medicine, even over-the-counter products, on school grounds; the school nurse is responsible for dispensing any drug a student needs during the day.

Jonathan is followed by Cameron Blanton, a sophomore who complains of troublesome tingling in his elbow that won’t go away. In fact, he says, “I’ve been having a problem with my shoulders for a while; it feels like they’re dislocating.” Elforsi checks him out and gives him a bag of ice to apply to his elbow in class.

Like most nurses in South Hampton Roads school divisions, Elforsi, 47, is a registered nurse. Much of what she does is basic care, but her profession demands education and training that are far from basic.

In Elforsi’s case, she worked at MCV Hospital in Richmond and on Norfolk General Hospital’s cardiac transplant floor for several years until she switched to school nursing 20 years ago. She served at Blair Middle before moving to Maury High in 1997.

It’s the kind of background that gives Maury’s interim principal, Karen Berg, complete confidence in Elforsi.

“I have 1,700 children here, and I don’t worry about anything happening that she can’t handle,” Berg said.

By lunchtime, the waiting room is full as 10th-grade students drop in for vision, hearing, dental and scalp – think head lice – screenings, required statewide for certain grade levels.

At Elforsi’s direction, a 16-year-old stands a dozen or so feet from the eye chart.

“I can see some of it – E, D, I, C, Z, P,” she recites. Then she repeats the exercise, with one eye covered, then the other.

“Line six, is that clear or blurry?” Elforsi asks. Blurry, the student concedes.

“Have you ever been to the eye doctor?” Elforsi says. In the ninth grade, the girl replies.

“You just need a little help,” the nurse says.

The girl is shocked.

“I need glasses?”

“You do,” Elforsi says, and hands her a referral for a thorough eye examination.

“I didn’t know my vision was bad,” the girl says afterward. She doesn’t like the idea of wearing glasses but isn’t sorry she had the test.

Because disease and health management is part of her job, Elforsi will follow up to be sure the student gets the exam.

“Teenagers, in particular, want to blend in and be one of their peers and not stick out, so it takes a little bit of counseling and re-counseling for children, especially with chronic diseases, who want to seem as normal as possible.”

Elforsi says she’s often the first person to tell students about Virginia’s child health insurance programs that pay for medical services, including dental needs.

“You’d be surprised – many of the students have never been to a dentist before,” she says. “It’s not even so much them not wanting to go; sometimes it’s the parent with a lack of resources to get the dental care.”

Elforsi’s day is turning out to be busy, but in the back of her mind is an uneasy feeling.

Norfolk School Board members have talked about moving away from registered nurses to cut costs. The pay for licensed practical nurses generally is less, $31,000 to $40,000, than for RNs, who earn $38,000 to $57,000. The state gives no directive on school nurses’ minimum credentials. In fact, the state does not even require divisions to have a nurse at each school.

While no one in the division is talking about eliminating school nurses, Elforsi is uncomfortable with the notion of any change that could reduce the health care presence in schools and shift some duties to staff members who aren’t nurses.

“They’re two distinct roles, teacher and health care provider,” she said. “I don’t think it’d be fair to the child.”

Nurses’ salaries don’t come entirely from the Norfolk division’s budget. In an arrangement unique among local cities, Norfolk gets its school nurses from the state Health Department, and the state pays about $2 million in an annual subsidy to provide them.

Even with changes in the nursing staff, schools still could call 911 if a student had an emergency, School Board member Brad Robinson has said.

“We can’t be everything to everybody.”

But the death in January of a 7-year-old Chesterfield girl who had a fatal allergic reaction at school still looms over divisions around the state.

“Removing RNs from the clinics would be like replacing teachers with teacher assistants,” said Bethanne Bradshaw, the Suffolk division’s spokeswoman.

Elforsi’s experience is that many students come to school with complicated health conditions, including gastrointestinal tubes, diabetes and tracheostomies, all of which might have kept them out of class years ago.

Maury’s current enrollment includes 137 students with attention deficit disorder, 22 with asthma, 14 with seizure conditions and five with diabetes. Others have autism, sickle cell anemia, kidney disorders, cerebral palsy, scoliosis, traumatic brain injuries.

On any day, new students with specialized health needs could enroll.

“Without a nurse here, that would be very difficult,” Elforsi said.

Nicole Andrews, a 17-year-old senior with a pacemaker, gets home instruction in math and English and takes classes part time at Maury.

“I wouldn’t feel comfortable here without Nurse Kim; I wouldn’t feel safe,” Nicole said. “I’ve come in here several times with a fast heart rate, and she’s always checked it and made sure I was all right.”

Would she feel the same with a licensed practical nurse?

“No,” she said. “I really wouldn’t.”

Elforsi’s afternoon brings in two teens who spilled a compound on their hands during chemistry class. Elforsi questions the pair closely, trying to determine whether the substance was toxic.

Eventually she pinpoints borax, which isn’t lethal, and the teens sheepishly wash their hands.

“You are the biggest klutz, my friend,” she jokes to them.

Another student, a tennis player, shows up.

“I think I have hemorrhoids – no, hernia,” he speculates.

Elforsi advises him to see a doctor.

A pregnant teen comes in for a consultation. Elforsi has been caring for more like her since the division closed Coronado, its school for expectant teens and student mothers, in 2010. Elforsi tells this girl about Resource Mothers, a group based at Eastern Virginia Medical School that helps pregnant girls and young mothers get counseling, doctor visits, and information about Medicaid and the Women, Infants and Children nutrition program.

Another student, this one looking somber, makes her way into Elforsi’s office. The nurse checks her heart rate, blood pressure and temperature, then deploys another school-nurse tool – Kleenex. She talks with the student for a long time. Afterward, Elforsi doesn’t share details.

But she does note that the challenges facing teens include struggles at home and with peers. Budget constraints have pared down the school’s psychological support resources, she said. As a result, “this is the first door students come in, and I feel that this has been an important place for them to get over some of their trials.”

One thing hasn’t changed for school nurses: students like one now making her way to Elforsi’s office. The girl walks in and asks the nurse to send her home. She’s hungry, admitting she’d skipped breakfast.

“What is this whole thing teaching you?” the nurse chides, before answering her own question. “That you need to eat balanced meals.”

The girl refuses Elfori’s offer of a granola bar and reluctantly agrees to go to the school’s vending machine.

Minutes later, a security guard pops in to report that the “hungry” girl actually attended not one, but three, lunch periods.

Amused, Elforsi lets the girl know on her return that the jig is up.

“Mr. Holloway told you that? He’s lying!” the girl protests, but her rueful smile admits the cat is out of the bag.

“Thank you for the entertainment,” Elforsi says amiably.

By Maury’s 2:05 p.m. dismissal, the waiting room and its plastic chairs are empty, though one queasy student is still resting in the darkened side room. Elforsi has an hour’s worth of paperwork to do before she closes shop around 3.

She’ll be back by 7:30 a.m., ready to do it all again because, she says, “I love the children.”

But Elforsi knows that tomorrow, like each day before it in her 15 years at Maury, is sure to be different.

“You never know what’s going to come through the door.”