TREATING OUR KIDS
School nurses play vital role in keeping students healthy
By GEORGIA PURDY

RN JILL ROSE has been with the Jasper school district for 34 years and a number of those years at Jasper Junior High. Pictured right,Tonya Hancock attends to a student at Rowe Intermediate.

Registered Nurse Jill Rose has been with the Jasper Independent School District for 34 years and has worked on nearly every campus. For a number of years she has been the school nurse at Jasper Junior High, but because of her long tenure, she is also the "go to" person for nurses on the district's other four campuses.

Jasper is fortunate, she says, because we have a long history of employing school nurses.

"There is no statutory requirement for Texas schools to employ a nurse. We are fortunate because this district has seen to it that we have one on each campus," Rose said. "Some school districts don't have a single school nurse."

Those districts that don't, do have someone designated to help ill or injured students and to take care of immunization records. Current data, Rose said, indicates that 72 percent of schools in Texas have nurses available to students at least part of the time. The state average is one nurse to about 700 students.

Jasper schools used to have an RN on every campus. With the 1983 tax rollback, that number was cut to two. In 1984, the district hired two LVNs to cover the remaining two schools. When Few was added, that number was increased to five.

"We are a very blessed district because our school board has provided for one nurse per campus," Rose said. " As of the 31st of January (when the vacant position at Rowe is filled), JISD will have three RNs and two LVNs. The LVNs work under the supervision of the RNs."

It is hard to imagine a school without a nurse, for the amount of work required just in keeping up with immunizations, emergency medical forms, performing hearing and vision screening, and scoliosis testing is staggering.

Every student must submit an emergency medical form and immunization record, and it is up to the school nurse to see that those are updated. That means keeping records on file for each student, going through those files every year, noting which students need shots or boosters, and then notifying parents. It also means following up on those students who have not complied and continuing to notify parents until those immunizations and forms have been completed.

"You multi-task all day. Sometimes it makes me crazy but I really like what I do." - Few Primary Nurse Virginia Stone

The Texas Education Agency requires that school nurses be certified to do testing. Region V does the training. Jasper school nurses are also certified in CPR. In addition, they are also required to get 20 hours of continuing education per year.

"Region V offers some continuing education as does UTMB in Galveston," Rose said. "UTMB has a school health conference once a year. We love that because everything they present is strictly related to student health and school nursing."

School nurses spend a lot of time checking students with minor complaints such as jammed thumbs and skinned knees, and but the number of children with serious medical conditions has increased over the years, they say.

"Now we have students with more serious medical conditions," Rose said. "When I first started, many of these children were not in public school."

Every campus reports an increase in the number of asthmatic children and those with diabetes.

"Every campus has some asthmatic children," Rose said. "Some just need to use their inhaler before physical activity, but others have nebulizers that they have to use every day. We've also seen an increase in children with diabetes who need to have their blood sugar checked before a meal or checked when they are having problems."

A girl walks into LVN Sarah Smith's office at Parnell carrying a packet of over-the-counter medicine. Smith tells her that she can't give her the medicine and she can't allow her to take it. The student, of course, is unhappy; but Smith is following prescribed guidelines on the use of medication in school.

Those guidelines are precise and strict: Medicines must be in the original container and parents must submit written consent. Non-prescription medications require a written doctor's order and parents must supply the FDA approved medication; Prescription medicines must have the label, child's name, doctor's name, instructions and dosage instructions.

In addition, students are not allowed to administer their own medications; the school nurse must give those. However, asthmatics, with the proper written consent, can now carry their own inhalers.

Smith, who has been at Parnell for seven years, laughs about dealing with third and fourth graders.

"Children with asthma can carry their own inhalers, but sometimes they do things like squirt them under their desks," she said. "I have to give them a talking to like I would my own children."

Smith's comment points to the differences nurses face in dealing with children of various ages.

"I can tell by nine o'clock in the morning who has a sub," she said. "There will be a string of kids in here. It's like a chain reaction with chapped lips and cuticles that need a trim. They just want to get out of class. Yesterday, I had a girl in here that said she had worn silver earrings the day before and she wasn't supposed to. She had then worn them again yesterday and her ears were hurting. So, I said, 'Well, take them off.' At this age they think they are the first ones to think up these excuses."

Smith says she likes this age group because they are old enough to verbalize their complaints but young enough to need adult sympathy.

"I like this age group," she said. "Third and fourth graders are old enough to tell you what is wrong. They are not babies. They are trying to be more independent, but sometimes you still have to be their mama."

Her experience as an emergency room nurse, she says, is also helpful.

"Emergency room experience is helpful. I saw a lot worse things there, but I still get nervous when a child is really hurt. So far this year, I've seen two broken arms and an ankle injury. I've also taken children to the ER and been their mothers until the parents arrived."

RN Virginia Stone points to a stack of forms in her office at Few Primary School.

"We see as many as 100 children a day," Stone said. "I have letters to write to parents, documentation on each child, and today we have more testing guidelines than ever. You multitask all day. Sometimes it makes me crazy, but I really like what I do."

Stone's background includes being a hospital and pediatric nurse. She has 28 years of pediatric experience and has been with the school district 18 years.

Working with children from age three through second grade poses a special set of challenges.

"Because they can't always express their needs, you have to be very observant. You have to do a lot of investigation," Stone said. "Teachers are very helpful with that. We also spend a lot of time on the phone talking with parents. I have informal parent conferences every day. A parent may ask me what to do about a certain problem."

Illness is not always the problem with young children who show up in her office.

"Sometimes we get children who are crying when they are actually sleepy," she said. "They can't tell you that at this age. They usually say their stomach hurts or they have a headache."

In the space of about 15 minutes, two little boys arrive who have bumped heads, one little girl comes in with a stomach ache, two children say they have chapped lips, one comes for a dressing change, one says her leg hurts, and a teacher needs her blood pressure checked.

Stone checks the boys' pupils, gives each an ice pack and tells them to be seated. She questions the children with the stomachache and the leg that hurts, takes their temperature, and sits them down for observation. She treats the chapped lips, sends the children back to class, changes a child's dressing, and then gets out her blood pressure cuff.

All of this will have to be documented as will every other case seen as the day progresses. And in many instances, she calls the parent to report the child's complaint.

Stone's office is filled with medications because so many of these young children require daily treatment.

"We get a lot of asthmatic kids who need breathing treatments," she said. "So, we have a shelf full of medications and equipment for them."

In addition to the daily load of medications and seeing to children's complaints, Few does even more hearing and vision testing than the other schools. There are 845 students to be tested plus this is the point where immunization records are entered into the system.

"I don't know what I would do without the help of a neighbor- volunteer and Jill Rose," Stone said.

Jasper High School LVN Tonya Hancock is new to school health. She came to work at the high school in December; however, she says that her emergency room experience equips her to automatically know what to do in urgent situations or those that would otherwise send a student to the doctor.

"For example, a student came in with a boil-type infection," Hancock said. "Having worked in an emergency room, I knew what to do and cleaned it up. If I had sent him to ER, the person there would have done the same procedure."

In the space of about 10 minutes, five or six students come to her office with minor complaints- chapped lips, a scab that fell off, temperature check, and a headache. And like other school nurses, she says that she sees some students repeatedly.

"Even in the short time I've been here, I've seen some of the same students over and over," she said. "And with high school students, some of the things you deal with are totally different. If kids have a tattoo, they come to get it covered. If a boy comes to school needing a shave, he has to come here and pay me a quarter for a razor."

But high school students also deal with serious problems, and Hancock says she wants to tackle some of those.

"I've already seen a number of students with high blood pressure and each was overweight," she said. "Then, there are the pregnant students. A school nurse also acts as a counselor because some students have issues that they need to talk about and I do that. That's important."

Hancock wants to focus on two issues: teen pregnancy and healthy nutrition.

"I want to focus on abstinence, eating healthy and exercise for good health," she said. "I plan to put up posters about those and also to talk with students when they come to my office with these kinds of problems."

One significant mark of insuring student health and safety is the commitment to the control of infectious disease. School nurses work closely with the health department. Because of her years with JISD, Jill Rose is the contact person.

"I am contacted when there is a case of infectious disease," Rose said. "I follow through. I call the parent and the health department. We work very closely with the health department, and it is wonderful because they have an infection control person. They are our immediate contact to give us directions."

All of these school nurses say they love their jobs. They are first-responders, counselors, temporary parents, caregivers, and most of all, medical professionals with a mission to protect the health of Jasper's students.