Dispensing more than Band-Aids

Burnout affects school nurses as much as it does hospital nurses, says B.J. Darby, a New York City school nurse and member of the AFT health care division’s subcommittee on school nurses.

Speaking at the FNHP annual professional issues conference this spring, Darby told conferees that growing numbers of schoolchildren who do not have health insurance look to the school nurse for care. In addition, there has been an increase in health problems and violence, an increase in depression and suicide, in asthma, kids with diabetes, and kids with special needs who are in regular education classes, said Darby. "Inclusion puts kids with disabilities and special needs in the classrooms, and school nurses are being forced to delegate functions to non-nursing personnel," she noted. There are kids on Ritalin and other daily medications, and it’s "teachers who are supposed to be monitoring these problems."

Darby noted that there are no laws limiting the school nurse’s caseload.

She explained that, in addition to the 12-18 "walk-ins" she has every day, she has 45 regular daily medications to administer, tracheotomy care and tube feeding. All of that means an increase in paperwork and case management.

So, what to do?

Since legislation governing school nurses--especially the ratios of nurses to students--varies widely across the nation, members can advocate the ratios recommended by the National Association of School Nurses:

• One school health nurse to no more than 750 students in the general school population.
• One school health nurse to no more than 225 students in the mainstreamed population.
• One school health nurse to no more than 125 students in the severely chronically ill or developmentally disabled population.
• In the medically fragile population, a ratio based on individual needs.

It’s also important for school nurses to highlight the key role they play in linking school kids to federal programs and community services. During the health division’s school nurse subcommittee meeting on May 25, members discussed the role of the school nurse in writing individualized education plans (IEPs) for children who have medical needs, as well as the role they can play in making sure that all eligible schoolchildren have health care coverage through the Children’s Health Insurance Program (CHIP) or other public programs.

The key to the top problems that school nurses face--underfunding and understaffing, for instance--is legislation, says subcommittee member Darby. Beyond that, the important role that school nurses play as a link for parents, teachers, children and community services is one that should be made more widely known, she said.

The subcommittee welcomed a new member to its ranks--Liz Reynolds, a school nurse and member of the Connecticut Federation of Educational and Professional Employees/AFT.
 

School nurse mentoring

The responsibilities of today’s school nurse include a lot more than "dealing with head lice and dispensing Band-Aids," said a participant at the "School Nurse Mentoring" workshop at the professional issues conference.

Workshop presenter Rhona H. Cooper, a nurse supervisor in Philadelphia, described a peer mentoring program established by the school to support and retain new school nurses and to ensure that they are familiar with district procedures and policies. "It’s a reciprocal process," Cooper said. "The mentor grows and becomes reflective--as does the protégé ."

"A lot of nurses have trouble fitting into a school situation," said co-presenter Jacqueline Himes, member of the FNHP school nurse subcommittee. "It’s very different from hospital practice."

The mentor and protégé meet early in the school year to jointly define their objectives. And then mentors visit periodically before or after school and keep in touch by phone. For participating in the program, mentors can select from a menu of incentives (not to exceed $1,000 per school year) that include credit toward registration at a professional conference, subscriptions to professional publications or a stipend.

As a mentor, Himes has shown her nurses how to set up a health room and maintain files, taught them about policies and procedures, and offered advice on "working with families that are difficult."

The hope, Cooper said, is that "the person who is a protégé today will be a mentor tomorrow and will continue the legacy." For details on the Philadelphia program, see their complete School Nurse Procedure Manual online at www.phila.k12.pa.us/osess/frn/nursesmanual.html.