School Nurse’s role is evolving as the world changes

Beyond Band-Aids and ABC’s When we grew up, parent volunteers ran the school clinics, took temperatures, gave out Band-Aids, and called your stay-at-home mom. Schools were a place of learning with parents respecting the schools’ authority and decisions. Life was much simpler then. Since the 1997 Re-authorization of IDEA (Individuals with Disabilities Education Act), and the closing of State homes for the disabled, the school systems now accommodate all medical problems of school-aged children from ages 3-21, or 22, depending upon when their birthday occurs in the school year. They must deliver any service regardless of the manpower, severity, educational payoff, cost or liability incurred. Consequently, national mandates, lawyers, and parents often dictate the health care provided at school. Lobbying parents got the law changed back allowing delegation of emergency nursing procedures for their child to lay personnel, rather than opt for a school with an on-site nurse, while licensed professionals retain the liability. Only school nurses who have been medically educated can determine appropriate and safe provision of health services at school. With such drastic changes in the schools, there has evolved the need for more school nurses. Since most moms work, hurt and sick kids get sent to school for the nurse to assess, allowing mom to go to her job, rather than take them to their doctor. Often school nurses are the first to know a child has been hurt at home, because they never told a parent. Frequently working mothers can’t miss work, so the school must provide sick care until mom’s lunch break or all day. Often transportation problems occur, due to zoning out of neighborhood schools, making it difficult to pick up sick or hurt children. Often you can’t even reach a parent. Too, many students lack access to affordable health care, so medical needs often go unmet, except for those schools with medically staffed hospital grant funded clinics. Kids with critical illnesses, some with DNR (Do Not Resuscitate) orders, attending schools with on-site nurses, a private duty nurse, or a nurse to ride the bus, may require special emergency and medical equipment that often is paid for by the schools. School Nurse S. Scruggs, RN observes, “There are now such medically fragile kids, that some even die during the school year.” There are classrooms resembling pediatric medical wings, and procedure nurses traveling to several schools daily for mainstreamed students. Most nurses cover several schools, exceeding “the NASN (National Association of School Nurses) recommendations of 1nurse per school, or at least l nurse per 750 students”, according to M. Harris, RN, School Nurse. There’s been a drastic rise amongst the student population of Asthma, Diabetes, Obesity, Depression, Attention- Deficit, and Mental disorders some with criminal records of violence or drugs. “We’re seeing a lot more students on medicine and requiring more skilled care, than in years past,” according to D. Stinnett, RN, Sevierville School Nurse. Schools also provide custodial care, i.e. teeth brushing, diapering and feeding of students. In our present time of broken homes, more medically involved kids surviving, and financial worries, it seems the schools have become a catchall to meet these societal challenges. Delivering these services are hard working Licensed Nursing Professionals that must be knowledgeable in Adult, Community, and Pediatric Nursing: (Caring for the kids and staff). Evolution of the school nurse role continues as medical technology expands, requiring more highly educated nurses than in the past. Although school nursing is not a high paying profession, the rewards come with helping students become healthy productive citizens. After all, our children are America’s future.