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MBM welcomes contributing editors for future articles of contemporary relevance in our Words Of Wisdom column. E-mail or fax your request to us, and we’ll do the rest! |
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Health duties expand, but
some districts The kindergartner was pale and shaky after vomiting in her classroom at Philip Schuyler Elementary School. Janet Sollecito, the school nurse, directed her to a cot and looked over the crowd gathering in her office. Sitting nearby was a fifthgrader with a finger swollen almost to the size of a hot dog. Another complained of a headache. Behind her, a student waited for his daily dose of Ritalin. "When six kids walk in at once, it's a triage," Sollecito said. "You have to figure out who needs you first." Forget BandAids and scraped knees. Demands on school nurses are spiraling. Not only are they seeing more children who need regular care for chronic conditions, such as asthma and attention deficit disorder, they are dealing with a host of complex problems from cerebral palsy to spina bifida as schools mainstream children with special needs. The increased workload comes at a time when school administrators say they can't afford to hire more nurses. As a result, today's school nurse is so busy that some state officials worry basic health needs aren't being met. "There are some things you can't squeeze on," said Albany School Superintendent Lonnie Palmer. "You have to have a teacher for a class. You have to have a bus to transport the students." Schools, on the other hand, aren't required to have a school nurse in every building, so in a time of tight budgets those positions are often the first to go. "Every one is doing their own thing," said Grace Stevens of the state Education Department. "There's really nobody in the Education Department whose responsibility is school health services. A healthy child is a better learner." School officials agree, especially in light of the new, tougher Regents standards. But tending to kids' health problem so they can stay in school and learn has never been tougher. At Philip Schuyler, Sollecito eased the nerves of a fourth grader struggling with attention deficit disorder. The boy's mother had forgotten his medication that morning and he'd already gotten in trouble with his teacher. Can the nurse give him his Adderall? Stocked with Ritalin, asthma inhalers and anti seizure drugs, the medicine cabinets in schools today reflect the changing role of the nurse. One reason for the change is the American with Disabilities Act and the movement to mainstream children with special needs into regular classrooms. In Albany, some 300 special students from places like the Center for the Disabled have been placed in regular classrooms over the last two years and another 40 are expected this fall. The trend is the same in schools across the Capital Region. "We're seeing many more children for different conditions that years ago you didn't see in a school setting," said Pat Pone, the school nurse at Mont Pleasant Middle School in Schenectady. "We give out a lot more medication than years ago." The needs are especially pressing in inner city school districts, where nurses say the students are burdened with a host of social ills, including drug and sexual abuse, violence in the home, neglectful parents and poverty. "The nurse is the door to all those issues," said Stevens, with the state Education Department. "It's heavy duty. The front line is the nurse." At Philip Schuyler, the largest in the district, about 67 percent of the 980 students are poor enough to qualify for free meals and Sollecito spends a lot of time just urging students to arrive in time for breakfast. Some days, she's on the phone soliciting charities to pay for eye glasses, referring low income families to clinics and reminding parents about doctors' appointments. "I talk to parents," she said. "But you have to pick your fights. Have you seen some of the grooming on these kids? Getting a hold of parents is a major problem. That's the biggest frustration of my job." Sollecito was unsuccessful in trying to get in touch with the fourth grader's mom to bring in his Adderall. Under state law, she can only administer medicine with a parent's written permission, the doctor's order and the medicine in the original container. "It's going to be hard for you," she counseled the student. "But you're going to have to make an effort to stay out of trouble and really try to concentrate. Now, go up and do your work." The challenges facing school nurses aren't limited to the inner city. The school nurse at Shenendehowa High School in suburban Clifton Park tends to students whose parents don't have health insurance. Many parents of elementary school children are under pressure not to take time off so they'll send a sick child to school anyway and wait for the school nurse to call their office. "It changes the dynamic when both parents are working," said Mary Lou Oliver, past president of the New York State Association of School Nurses and a district nurse for 17 years. An estimated 13.8 percent of children in two parent families and 19.8 percent of children in single parent families have no health insurance, according to the federal Agency for Health Care Policy and Research. As a result, a few school nurses find themselves the sole health care provider for some families. More often, they serve as a liaison among doctors, teachers and parents. "It's not just pointing out that somebody needs immunizations but figuring out whether the family will get to where they need to be to get those immunizations," said Dr. John Chessare, the interim chairman of the department of pediatrics at Albany Medical Center Hospital. Vivian Steele, a parent of a 6 year old with behavior and emotional problems at Albany School for the Humanities, is grateful for the support she gets from school nurse Regina Pakosz. "She's always on top of what my daughter needs," said Steele, who dropped by the office on a recent afternoon to go over her daughter's latest anti seizure medication. Seizures are just one of the diagnosed problems that Pakosz juggles every day. She keeps medication on hand for 50 children with asthma, and doles out daily medications to 75 children whose diagnoses vary from cerebral palsy to muscular dystrophy. At lunchtime, when many of the children come for their daily dose of Ritalin, the line snakes out her door. "Hi, Romeo", she said, handing a pill and a plastic cup of water to one of her students. "Boys, stay in line. Is that how we behave? Dan, put your shoe back on. What do you say.?" Pakosz, a former critical dare nurse in Buffalo, admits to sometimes feeling overwhelmed. "We have a lot of regular-ed kids that need my time and attention," she said. "I'm asking for more help." State officials are beginning to recognize the problem. An audit released last month by state Comptroller H. Carl McCall revealed that the quality of health care for students varies district to district, with no oversight to ensure districts are complying with the law. Part of the problem, critics say, is a state law that hasn't been updated sine the 1940s. It was written in 1913, when schools had to worry more about outbreaks of communicable diseases, including measles and polio. Despite new immunizations and other medical advances, school nurses say they are still spending a lot of valuable time and money following an outmoded schedule of annual vision, hearing and physical screenings. But efforts to rewrite the law have so far failed in the Legislature. In the meantime, school administrators and school nurses are coming up with their own solutions to deal with the increased workload. "The pressures on nurses are increasing, and we're trying to plan for it," said Michael Johnson, assistant superintendent for curriculum and instruction at Niskayuna High School. Niskayuna is setting aside $10,000 in its budget for next year in case their nurses need to hire some substitute or part-time help. But not all districts are ready to dig into their pockets for more nurses. Shenendehowa, for example, denied a request from the high school to hire an additional part-time nurse nextyear. At Philip Schuyler, a creative arrangement with Albany Medical Center Hospital is helping the school without costing the district a penny. The hospital is picking up the $12,000 tab to loan one of its pediatric nurses to the district on a part-time basis. School officials recognized they needed help after Sollecito got so busy she could no longer leave her office to teach mandated health classes. "You can only spread yourself so thin, so when you have an extra pair of hands that's great," said Sollecito about the arrangement. Still she spends most of her days alone juggling her many duties as a nurse. An hour after her arrival on a recent morning, Sollecito had already given a clean pair of pants to a first-grader who'd had an accident, soothed the bruised ego of a sixth-grader who'd gotten into a fight and listed to the chest of a fourth-grader with a cough. By all accounts, it was a slow day, with no asthma attacks or visits by child protective services to follow up on her suspicions of abuse. But there was only so much she could do when a 7-year-old came in complaining she wasn't feeling well. Sollecito recognized she wasn't dealing with a medical problem but with a tired child staying up to 11 p.m. to watch television. "On school nights, what time did I tell you to go to bed?" she said. "You can go to bed even if your aunt doesn't tell you to go to bed." Sollecito sent the child back to class and sighed. "I have to put it on them to go to bed, even though they're 7-years-old," she said. "We don't have a choice. This kid shouldn't have been up to 11; someone should have put this kid to bed."
80% of School Nurses Cannot Read This!
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 The opinions expressed in this article are solely those of the author, and do not necessarily reflect those of Micro Bio-Medics. |
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MBM will be participating in the below 1999 shows. If you have a special sampling request for a show you will be attending, E-Mail us and we will do our best to accommodate you. |
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The following is a list of various sites of special interest to school nurses. These professional organizations provide a wide array of services and relevant information -- ones designed to enhance your knowledge and advance your career. |
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| American Nurses Association Nursing World http://www.nursingworld.org National Association of School Nurses AJN Forum for School Nurses School Nurse Forum Martha Dewey Bergren’s |
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We need your help! Although not up and running yet, The School Nurse Report will be your opportunity to electronically exchange ideas and information with your peers. Features can be any industry relevant and newsworthy topic including:
E-Mail or fax to us your request and we’ll do the rest. |
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If you would like specific product information on these or any other School Nurse Products, please feel free to E-Mail your request. |
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