Valley school nurses applying more than Band-Aids

( U.S. Surgeon General Jocelyn Elder is quoted as saying, “You can’t educate a child who isn’t healthy, and you can’t keep a child healthy who isn’t educated.”

School nurses in the valley are taking that sentiment to heart.

Nurses in Frederick, Warren and Shenandoah counties have prepared for the start of school by organizing their offices, scheduling meetings with parents and getting documents together for screenings and immunizations.

They also had one statewide mandate to implement for the 2012-2013 school year. Each school is required to not only have Epinephrine, or EpiPens, but there also must be several faculty members trained to use the medicine to prevent students suffering from allergies from going into anaphylactic shock.

The mandate came after a first-grade student in Chesterfield County died due to the shock, and didn’t have an EpiPen. In Warren County, school nurses and selected “back-ups” in each school are being trained to use the medicine, as well as how to recognize the signs of anaphylactic shock. In Shenandoah County, school nurses and the rest of the faculty will all be prepared to use an EpiPen.

All Warren County Public Schools have a full-time nurse, according to Loretta Stevens, supervisor of Special Services. They are all registered nurses.

“That was a county decision,” she said. “We have so many medically fragile children. There was a time when school nurses just put on Band-Aids, checked temperatures and called parents, but now they deal with children with cancer, disabilities, who have gone through transplants … they’re responsible for everything.”

Stevens noted the large amount of documentation that goes into the job as well. Any students with acute or chronic diseases require a care plan, which consists of parents sitting down with the school nurse, teachers and an administrator to go over the child’s needs. The plan is edited and approved by a doctor, and then put into practice at school.

“To some kids, the nurse is kind of like a parent figure when they’re at school,” Stevens said. “And it’s stressful for them because they’re putting their license on the line everyday.”

In Warren County, Stevens said asthma and type 1 diabetes are among the most common illnesses that students have. Lice outbreaks still happen, but not as frequently as in the past.

“We have a no-nit policy, so if one child has it, the whole classroom is checked,” she said. “Some parents still don’t understand, though, that it isn’t a dirt issue … it can happen to anyone.”

Stevens said another change for school nurses is in dealing with older students.

“There are so many issues and concerns that kids have, different things they can catch … diseases, pregnancy, AIDS,” she said. “Some of these kids really don’t have a clue when it comes to these things. It’s a scary time to grow up.”

Shenandoah County School Nurse Coordinator Becky Cooper has first hand knowledge of how things have changed in the field. She started the school nurse program in the county in 1976, and is currently the school nurse at Peter Muhlenburg Middle School.

“It was very different then,” she said. “But anything that gets in the of a child’s learning is what we try to address.”

She and eight other school nurses now serve the county, and she said one of her goals is to get full-time nurses in all the high schools. She, like Stevens, has found that just because students get older, doesn’t mean they can handle all the new issues and rigor themselves.

Cooper said she does her best to make sure the school division is up to date with all health related mandates and recommendations. Following the recent rise in pertussis cases, she urged school staff to get vaccinated.

“At our convocation, we the Tdap to 469 people,” she said. “I do not want to see an outbreak in this school division.”

Last year, school nurses in the county documented 19,101 clinic visits, and Cooper said that didn’t include students who came on a regular basis for medications.

“That number also doesn’t include the kid with gum in their hair, or the kid who spilt milk down their clothes, because we deal with all of that too,” she added. “We are everything from counselors and psychologists to friends and conflict mediators.”

Cooper said her school nurses will often check into parent concerns and advise them on whether or not their child needs to see a doctor.

“Some families don’t have the money to see a doctor first,” she said. “We carry a more global picture when it comes to our students.”

Cooper’s staff of nurses meet once every six weeks during the school year to share best practices and address concerns. More than half of them attended a four day conference over the summer, specifically for school nurses in the state.

“We stay right on the cusp of things,” she said. “Some of these school nurses are seeing the same kids for years, and we like to put big, big goals in place for them health-wise. That way it becomes a win-win for their academic progress.”