Published Dec 16, 2024
sergel02, BSN
200 Posts
Perhaps sicker isn't the right word. Maybe more health conditions?
I'm a new school nurse, coming from bedside for years. I love the job so far (even if it is a bit overwhelming and a lot to learn) but I was a little surprised all the health conditions I've seen so far. Through our district we have students with diabetes, seizures, post open hearts, blood disorders, asthma & allergies, VP shunts, more students needing straight caths and tube feedings, etc.
Some coworkers have said they feel like kids have more health issues these days, but I wonder if it's just my district or area or if it's something the rest of you are seeing.
BunnyBunnyBSNRN, ASN, BSN
1,010 Posts
Absolutely. I have more epi-pens and inhalers now than I did when I started this gig back in 2008.
k1p1ssk, BSN, RN
864 Posts
I think it's a combo of things - first, as far as number of diagnoses, many students have diagnoses that they wouldn't have qualified for 20 years ago. I think about the number of students I have who carry an asthma diagnosis after 1 bout of respiratory distress that happened when they were a toddler. Their parents insist on having an inhaler "just in case" which might be fairly reasonable, but whether or not they need to have it in school is questionable. I also see this with epi-pens. A kid will have a mild reaction to whatever and if the parent is concerned enough to bring them to the doctor, they will prescribe an epi pen "just in case". I have become so accustomed to this that I recently had a new, mild strawberry allergy diagnosed in a pre-k kid, and I was surprised when the allergist DIDN'T prescribe an epi-pen and told the family, just give Zyrtec.
Second, sick kids are in school more. When I was in school in the 90s, if a student required any regular nursing intervention beyond an oral medication, they were home schooled. With inclusion ruling the day, these kids are accommodated in schools much more frequently!
arlingtonnurse
128 Posts
Definitely more kids with diagnosis and emergency meds. In addition to advanced technology that allows these kiddos to be treated safely in a school setting, there is also the increased awareness of the repercussions of learning loss that comes from keeping kids out of school or in a separate environment. I also absolutely have many many epis and inhalers that are 'just in case'-- some of the time there is not even a known allergy.
Cattz, ADN
1,079 Posts
k1p1ssk said: I think it's a combo of things - first, as far as number of diagnoses, many students have diagnoses that they wouldn't have qualified for 20 years ago. I think about the number of students I have who carry an asthma diagnosis after 1 bout of respiratory distress that happened when they were a toddler. Their parents insist on having an inhaler "just in case" which might be fairly reasonable, but whether or not they need to have it in school is questionable. I also see this with epi-pens. A kid will have a mild reaction to whatever and if the parent is concerned enough to bring them to the doctor, they will prescribe an epi pen "just in case". I have become so accustomed to this that I recently had a new, mild strawberry allergy diagnosed in a pre-k kid, and I was surprised when the allergist DIDN'T prescribe an epi-pen and told the family, just give Zyrtec.
THIS! Times a thousand. Just makes me shake my head...as I'm making the gzillionth phone call and mail all the repeat letters- trying to get completed paperwork back.
It's good to read everyone else's experience. Yeah seems to not just be my area. Students are getting diagnosed more, and we're seeing even more seizures. Some with actual seizures, and some that had a reported one as a baby and never again, no meds.
A nurse did say medical advancement in the NICU world may have also altered things. Neonates are able to be viable at an earlier gestation now than they used to, but along with that some may face health issues through their early years especially.
RatherBHiking, BSN, RN
590 Posts
When I first started school nursing 30 yrs ago we had maybe 5 diabetics in the entire county (around 25 schools back then) to now we have 2-3 diabetics per grade school (high school there's 8-15). So that's definitely increased. I agree many premature babies kept alive earlier contribute. Also more drug/alcohol use and poor prenatal care is what I notice the most issues coming from. Also it used to be the exception to have kids not living with their own parents and now it's more common to have kids living with just mom or just dad, foster care or grandparents. I think the drug epidemic has also contributed a lot to that as well. I've noticed many more kids being diagnosed with mental health disorders which that's something that had a stigma back in the day and kids weren't treated as much however I almost never had a student coming to me for an anxiety attack back in the day but it's become almost a daily occurrence in the last few years. Definitely many more low income families as well but ALL of these issues have many contributing factors but none of it is showing a positive trend overall. 😔 It all makes working in a school system much harder.
NutmeggeRN, BSN
2 Articles; 4,698 Posts
BunnyBunnyBSNRN said: Absolutely. I have more epi-pens and inhalers now than I did when I started this gig back in 2008.
Same, started in 1994
RatherBHiking said: I've noticed many more kids being diagnosed with mental health disorders which that's something that had a stigma back in the day and kids weren't treated as much however I almost never had a student coming to me for an anxiety attack back in the day but it's become almost a daily occurrence in the last few years. Definitely many more low income families as well but ALL of these issues have many contributing factors but none of it is showing a positive trend overall. 😔 It all makes working in a school system much harder.
I've noticed many more kids being diagnosed with mental health disorders which that's something that had a stigma back in the day and kids weren't treated as much however I almost never had a student coming to me for an anxiety attack back in the day but it's become almost a daily occurrence in the last few years. Definitely many more low income families as well but ALL of these issues have many contributing factors but none of it is showing a positive trend overall. 😔 It all makes working in a school system much harder.
Oh this! and I think there is an increase of somatization of mental health issues leading to missed seat time, less ability to deal with what most would consider minor health complaints.
RatherBHiking said: When I first started school nursing 30 yrs ago we had maybe 5 diabetics in the entire county (around 25 schools back then) to now we have 2-3 diabetics per grade school (high school there's 8-15). So that's definitely increased. I agree many premature babies kept alive earlier contribute. Also more drug/alcohol use and poor prenatal care is what I notice the most issues coming from. Also it used to be the exception to have kids not living with their own parents and now it's more common to have kids living with just mom or just dad, foster care or grandparents. I think the drug epidemic has also contributed a lot to that as well. I've noticed many more kids being diagnosed with mental health disorders which that's something that had a stigma back in the day and kids weren't treated as much however I almost never had a student coming to me for an anxiety attack back in the day but it's become almost a daily occurrence in the last few years. Definitely many more low income families as well but ALL of these issues have many contributing factors but none of it is showing a positive trend overall. 😔 It all makes working in a school system much harder.
I'm noticing those aspects currently but have no frame of reference, but I guess it's just like what they say in the hospital.
We were constantly told inpatient patients are sicker than before, that a med surg patient today would have been in the ICU in the past, and some ICU patients wouldn't be alive.
Seems like the same stands for schools.
Which is why I chuckle a bit when people, whose only experience with their school nurse is decades ago, tell me "wow your job must be pretty easy and chill."
People really underestimate the occasional acuity today, and the feeling of being the only healthcare worker.
Will say I don't mind the occasional inhaler since it would have been helpful recently. Had a kid with a history of asthma but parents didn't bring one to school since he doesn't usually need it, but when they come in febrile with SOB and low SpO2 I really wish I had that inhaler at least.
sergel02 said: Will say I don't mind the occasional inhaler since it would have been helpful recently. Had a kid with a history of asthma but parents didn't bring one to school since he doesn't usually need it, but when they come in febrile with SOB and low SpO2 I really wish I had that inhaler at least.
Will say I don't mind the occasional inhaler since it would have been helpful recently. Had a kid with a history of asthma but parents didn't bring one to school since he doesn't usually need it, but when they come in febrile with SOB and low SpO2 I really wish I had that inhaler at least.
I had a student who kept having these issues and repeated requests for an inhaler, Dr visit etc nothing ever done as the poor child is suffering. I almost called an ambulance for him more than once but parent always brought an inhaler to me within 5 min so come to find out it wasn't even HIS inhaler, it was moms which is why she wouldn't get a Dr order and leave it for us. I said he NEEDS a Dr appt asap for proper diagnosis and treatment for frequent asthma attacks and even gave her the form that said he can't come back until he sees a Dr. She just took him to an urgent care to get the note signed. 🙄 (This was over the course of like 10 weeks.) I called CPS. Only then did she get him proper treatment after they got involved. I do everything in my power to give parents a chance to do right by their kid and when they don't and I'm worried about their well being I do what I have to.
It blows my mind how many parents just blow off medical care (and it's usually the ones that have a free medical card). I've had to call CPS for kids that have chronic ear infections not being treated, pneumonia, broken bones, frequent pooping or peeing of pants after being potty trained for years (usually abuse going on there) , not getting their kid to the eye Dr or dentist, etc...! We can provide them with clothes, shoes, coats, backpacks, and food but we can't prescribe meds, glasses, get teeth filled etc. It breaks my heart! THIS is one of the number one reasons I got so burned out on school nursing.
RatherBHiking said: I had a student who kept having these issues and repeated requests for an inhaler, Dr visit etc nothing ever done as the poor child is suffering. I almost called an ambulance for him more than once but parent always brought an inhaler to me within 5 min so come to find out it wasn't even HIS inhaler, it was moms which is why she wouldn't get a Dr order and leave it for us. I said he NEEDS a Dr appt asap for proper diagnosis and treatment for frequent asthma attacks and even gave her the form that said he can't come back until he sees a Dr. She just took him to an urgent care to get the note signed. 🙄 (This was over the course of like 10 weeks.) I called CPS. Only then did she get him proper treatment after they got involved. I do everything in my power to give parents a chance to do right by their kid and when they don't and I'm worried about their well being I do what I have to. It blows my mind how many parents just blow off medical care (and it's usually the ones that have a free medical card). I've had to call CPS for kids that have chronic ear infections not being treated, pneumonia, broken bones, frequent pooping or peeing of pants after being potty trained for years (usually abuse going on there) , not getting their kid to the eye Dr or dentist, etc...! We can provide them with clothes, shoes, coats, backpacks, and food but we can't prescribe meds, glasses, get teeth filled etc. It breaks my heart! THIS is one of the number one reasons I got so burned out on school nursing.
Oh I feel ya. Are we really healthcare workers if we don't encounter people who we try are hardest to help and they just don't care?
A colleague told me even if we can get one kid glasses who really needs them, we have accomplished something, and I agree. But he also understands the frustration.
I get it's a lot of forms to fill out, and getting a doctor to send the approval digitally or sign it physically is a lot of work. But it's good for the whole school year and really is important for their health.
I think many people think we don't really do much as school nurses so they wonder what's the point of signing forms and bringing in meds, we'll just call them or 911 anyway. I try to explain that 1). We may not have to have them rush over if we have the med, and 2). It LITERALLY COULD SAVE YOUR CHILD'S LIFE. EMS sometimes are far away.
A real story related to that, our state has stock Epis, so sometimes parents don't bother brining one in. Well one of my coworkers who has a high school as run out of stock epis since they were needing them so much, and none of those students had an epi on site. Wonder what will happen when one more has a reaction....