Oh How I Miss School Nurses

[Sarah Matacale, BSN, RN]

I have wanted to write this article for some time and was pulled back to it after a statewide march at our capital for teachers and school advocacy. One of the major points focused on our lack of school nurses. In the southeastern state that I live in, each school system works with their nurses differently. The county I live in has ONE school nurse shared between THREE schools. I am gonna let you think on that for a bit and revisit this point again later......

As a "sickly little asthmatic kid" in the early 80's, my school nurses and I were best buds. At that time, school nurses did physicals, hearing and vision screens, lice checks, gave medications, nebulizer treatments, assess for fever, broken bones, bandage wounds and teach classes on healthy habits, puberty, cleanliness, and how babies are made (more importantly, how NOT to make babies). They kept our shot records and medical history in a tidy file cabinet in her office. In my school, she even had a shower for the kids who, for whatever the reason, needed one. The school nurse was an invaluable part of the team/ community that helped raise and mold us as kids.

Fast forward to my current stage of life as a mom of 3 children in public school as well as a nurse by trade (and spirit). My wonderful sickly asthmatic traits were passed on to our oldest son, whom I also should mention is our most accident prone of the three. No joke, he will manage to trip and fall in the middle of an open field. Oh how I worried myself sick sending him off to school when kindergarten came around. Who was going to watch over him like I do? Who was going to know when he was having an asthma attack starting so it could be controlled before getting to bad. He is also anaphylactic to peanuts.....what more can I say. You get the idea. As a parent you have to trust that your child will be cared for by teachers, administrators, school nurses and support staff during the 8 hours 5 days a week that they are not under our watch.

True story here....The very first day of school for our oldest and I am at the gym exercising my worries away when I get a call from the school. Instant panic.....it's his teacher. "I just wanted to let you know that your son walked into a wall and has a pretty big goose egg." I wasn't joking...he is a genius with absolutely no sense of personal surroundings. So of course I asked if he was ok and she said that she thought so but that his head hurt. I asked if the school nurse looked at. That was when I found out that "our school only has a nurse one day a week and she is primarily responsible for keeping up with the kids medication records, shot records, physicals etc, not really working with the kids". WHAT??? So who decides when my son needs the Epipen and who gives it? Teacher. The school nurse educates the teacher when a student is in their class that has chronic needs. Ummmmm.....this did/does not sit well with me.

So, I have my 4 year degree in nursing with some extra certifications and 20 years of experience as well as being a mom to these children for the past 12 years and I will say, that many many times, I am not sure what to do with childhood illness and issues. (I am not a peds nurse as you can tell). The burden of making judgement calls regarding health and physical welfare of our kids is now in the hands of the teacher. It should not be. They are teachers...educated on educating, not nursing. They already have waaay to much stacked against them in the classroom with class size, lack of supplies and funding etc, and now we ask them to care for the fragile type 1 diabetic child with an insulin pump that needs adjusting numerous times per day??! NOT OK.

Funding has been cut drastically in many states for school nurses. We as health professionals and parents need to speak up. I know of times in our school system where, a child's heart stopped on the playground due to a congenital abnormality that no one knew about. I have been at the schools during episodes of new onset seizures, heat stroke, broken bones, teachers with severe hypoglycemia etc. We need our school nurses back. Each school needs a nurse on site everyday. The kids, teachers and parents all deserve this. The health and safety of our kids should not be a, "we just don't have the money in the budget for school nurses" option. Many children lack quality healthcare, food, and sometimes unhealthy and unsafe living conditions. The school nurse helps to fill in the gaps for these kids. He/she is the child's advocate, the eyes and ears for parents who send their kids to school. He/she keeps important record of illness and accidents, and at times abuse situations. This information may be the proof needed to remove a child from an unsafe environment. They may help the physician with diagnosing, mental and physical health diseases based on patterns noted during the day. He/she can assess when my breath holding child passes out during his math test and figure out whether further care is needed...if there was a seizure, hypoglycemia, hyperthermia after a hot day on the playground, dehydration...or just his normal anxiety during a test.

I just want to say that I can not advocate or speak enough about how important school nurses are to our community. They are such an integral part of raising our next generation. Our children, teachers, parents, and schools deserve to have ONE school nurse per school. To have actual hands on care not only with the children within the school but the visitors, staff and parents when needed. School nurses are perhaps the foundation for community health and with all that is going on our ever changing world.....this foundation needs to be a solid and strong one!

I would love to hear how you communities and states manage the cuts in funding for school nurses. How has your school worked with this??

[OldDude]

Well said! Well written!! Our school district went through some lean times but, fortunately, did not cut the nursing staff. We have 7 campuses and they are staffed by a RN on each campus every day. Excellent and factual points in your article and quite compelling. I completely agree. Thank you!

[LovingLife123]

My school district has a nurse at each school every day. It shocks me that some don't.

[Racer15, BSN, RN]

My hospital put clinics on the campuses of several of our local schools, staffed by NPs. I think it's awesome.

[JenTheSchoolRN, BSN, RN]

I live in a state where there are more school nurses than any other state. But even with that, not every school has a school nurse on site five days a week for the entire school day.

It took me less than 1 week working as a school nurse to learn how valuable my role is. My school, thankfully, sees that as well. I not only cover the school day, but I work after school as well so I am usually present for students in tutoring or clubs. The first Epi-pen I gave as a school nurse was when a student with a known peanut allergy accidentally ate peanuts while studying after school with some friends in the library.

When I went to school (a small private school) we had a nurse come twice a week and mostly it was to do screenings. Thank you for this article. All of us school nursing appreciate the support.

[cowboysandangels, BSN]

This topic needs as much attention as possible. I am a school nurse and am blessed that I am able to be at one school full time. I cannot imagine what would happen if my role was taken away. In my school I take care of caths, trachs, diabetics, epileptics, severe allergies, and much more. How can these children be safely cared for without a nurse on duty? It scares me to think of what can happen when students have no one to care for them medically during the day. Our teachers are amazing but they are not medical professionals. They should not have to make decisions on the fly about the medical needs for the children in their care all day. In my school system, all school nurses hold a BSN and are nationally certified as school nurses. We love our jobs and work for very little pay. The knowledge we bring is impossible to deny. Where do we go from here?

[audreysmagic, RN]

My school district has a nurse at each school every day. It shocks me that some don't.

I didn't realize until I did school nursing how much of a rarity it's becoming and that's really terrible to me. Our kids deserve good school nurses, and administrators need to be educated on what the school nurse actually DOES and is responsible for. Some genuinely think it's only putting bandaids on boo-boos and it's so much more.

[Sarah Matacale, BSN, RN]

Do you have a national association for school nurses that I can send this to?

[Eleven011]

We sure do!

Home - National Association of School Nurses

[Farawyn]

I'm posting this on the school nurse board for more comments. Thank you.

[CJforme01]

Wow! Thank you for sharing this article. Very spot-on! I am a school nurse and up until last year, was assigned to one school only. The full time nurse at one of the other schools retired, and the powers that be decided that they would "combine" the schools and I was assigned to both schools. Nothing but problems and chaos has resulted. I have constant feelings of guilt that I am not doing a good enough job now, and that I will be at one school and be needed at the other school, etc. So many programs and helpful things I would love to do at both schools, but I do not have the time to do at either school now. I wish articles like yours could be plastered in front of the folks who make these important decisions every day for the children. Sorry for the rant, thanks again for your encouraging words.

[NutmeggeRN, BSN]

Great article and spot on!!! Thank you so much for highlighting our specialty practice. Yes, we are certainly a specialty in both pediatrics and public health.