By Kelly Phillips, NurseZone feature writer
School nurses, called upon to offer everything from a
bandage to a tube feeding, may be more revered by parents than by the school
districts in charge of hiring them.
A recent survey by the Center for Health and Health Care in
Schools showed parents’ expectations about school nursing don’t always mesh
with reality.
“I think some parents would be surprised to learn that
there is not a school nurse in their child’s building,” said Sue McCarroll,
APRN, MA, named the National Association of School Nurses’ Administrator of
the Year in June.
The poll found 83 percent of respondents supporting health
care in schools, with Democrats, Independents and Republicans alike showing
strong support, according to the Center.
Still, the Center said less than half the country’s
public schools employ a full-time nurse or offer health care services on site.
Some school districts may split nurses among a number of
schools or provide non-nurse health clerks or other health “para-professionals,”
while others provide no health care workers at all.
Nancy Spradling, executive director for the California
School Nurses Organization, said she wasn’t surprised at the results.
“I think I was actually kind of gratified that they felt
school health services were important to the schools,” said Spradling, whose
background is in consumer food science. She also was vice president for health
for the California State Parent-Teacher Association from 1999-2001.
The poll also logged parental support for schools providing
health care for uninsured children and those whose parents may not be able to
find care for them elsewhere, according to the study.
“Parents are wanting the school to take a greater role in
caring for the entire child, not just their educational needs,” McCarroll
said. “It makes sense because education is impossible without health.”
School nursing can fill that role, and the public
apparently wants that, McCarroll said, but funding is an issue.
The survey by the nonpartisan Center for Health and Health
Care in Schools asked 1,101 parents of school-aged children questions about
health care in schools, and was conducted last winter. The results were released
last month.
The nurse can also play an indirect role in academic life
by helping a child manage a chronic illnesses, such as asthma and diabetes,
Spradling said.
If a child’s illness isn’t being properly managed and
requires a trip to the emergency room or keeps the child up all night, “Is he
really coming to school ready to learn?” Spradling asked.
School nursing could benefit from showing a stronger link
between nurses’ efforts and academic matters, McCarroll said.
“It seems that even when we can demonstrate that school
nurses make a difference in the health of children, since our pay source is
school boards we also need to have data that shows we also can make a difference
in academic achievement,” McCarroll said.
McCarroll was a school nurse for 18 years before becoming
an administrator in a school district she said understands the role of school
nurses.
In the Aurora Public Schools where McCarroll is coordinator
of health services, there is a nurse in all middle schools and high schools.
Elementary schools are served by a full-time health para-professional, with
school nurses splitting their time between four campuses and also available by
pager.
Parents should find out about the availability of school
nurses at their child’s campus and otherwise inform themselves about the state
of health care in the school district, McCarroll and Spradling agreed.
“School nursing has changed since many of those parents
were young,” McCarroll said.
The health issues turning up in schools are much more
complex these days, she said, both because medical advances have helped more
children survive severe illnesses, and because federal law mandates that public
schools accommodate children no matter their health needs.
In California, “I don’t think there’s a district in
the state that doesn’t have a few students with chronic disease,” Spradling
said.
Nationwide, school nurses are seeing increases in diabetes,
digestive disorders, asthma and diagnosed mental health conditions in children,
McCarroll said. Children who need technical nursing procedures such as a
gastrostomy tube feeding also are on the rise, she added.
On any given day, a school nurse might find herself
providing emergency or injury care, giving medication to students, taking care
of a chronic or episodic illness, managing immunizations, or providing
nutritional education or mental health counseling.
“The role of a school nurse is really pretty varied,”
Spradling said.
McCarroll called school nursing “one of the most
autonomous, independent roles available to nurses because you’re really out
there on your own.”
Finding resources for uninsured children is another growing
task, McCarroll said.
School nurses are having to be more and more creative about
how they spend their time, McCarroll said, and may give priority to working with
students with attention deficit disorder or mental health conditions over
scoliosis screening.
“We can’t be content in our traditional role,”
McCarroll said. “We have to continue to have a vision about why we do what we
do.”
That’s in schools that have a nurse.
In California, some 2,700 school nurses served 9,000 public
schools in 1,000 districts, as of the last school year. The number of school
nurses is expected to drop further this year because of budget cutbacks.
“There are many districts with no nurse [or health aide]
at all,” Spradling said.
“We have
school secretaries who are giving rectal Valium, which is called Diastat, for
children who have seizures.”
Sometimes health aides or “or even secretaries”
misidentify themselves as a nurse, Spradling said. Also, an old office door may
incorrectly identify the occupant as a nurse.
“It’s very frustrating,” Spradling said. “There are
lots of reasons why parents are uninformed.”
Parents also may make the assumption there is a nurse on
campus because that’s how it was when they were young.
Despite all the challenges of being a school nurse,
McCarroll said the returns are undeniable.
“It really is the best job,” McCarroll said.
“You’re so exhausted when you go to bed at night, but it’s just the most
fulfilling work I think a person can do.”
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