More than band-aids and ice-packs

August 1, 2013 | By More

Rita Hugen has been the school nurse for Russellville Middle School for over two years now. Before working with students she was employed in a hospital, and later as a pediatric nurse. “We lived in Texas for thirty years,” she explains, and “couldn’t wait to get back to Arkansas.” Knowing she wanted to work with children, she jumped at the chance to take this position, making her one of the ten nurses that serve the 5,045 students in the Russellville School District.

On busy days she may see up to fifty students per day. “It’s not just about band aids and ice packs,” Hugen explained. “We do so many things people don’t realize.” Duties include hearing and vision screenings every other year to make sure children can adequately see and hear their teachers. Nurses keep track of students’ shot records and ensure they are up to date on all needed immunizations. They measure for BMI (body mass index), screen for scoliosis, and educate the entire staff on flu prevention measures. Much of the nurses’ job is about providing staff and students with information, resources, and the practical skills to stay healthy.

In recent years nurses have also begun caring for a growing number of students requiring special medical care, including students with asthma and those requiring tube feedings and daily catheterizations. A large number of students in the school district have Type 1 diabetes and need assistance in checking blood sugar, counting carbohydrates, and administering insulin. Like other school nurses in her district, Hugen describes her days as “nonstop.” Some days it can feel a bit like a “mini-ER, but without a doctor around,” she says.

The Russellville Public School System took a bold step and instituted a school-wide policy to place a nurse in every school in the district. This decision makes Russellville schools unique. Currently the state requires one school nurse for every seven hundred students. An interim study in the state legislature will investigate this current suggestion and, depending on the findings, the state may recommend increasing the number of nurses. Russellville Public Schools, however, did not wait for the word to come down from the state.

“The more I looked at it,” explained Jenny Barber, director of Federal Programs and the woman in charge of the nurses, “the more it appeared to me that we were pushing these nurses a little too hard.”

Jenny Barber was hired in 2004 and began working with the nurses in 2007. When she arrived there were seven nurses and ten buildings, with many of the schools sharing a nurse. Kids were not suffering, Barber explained, but it wasn’t an optimal situation. “I started noticing our nurses were very, very busy,” she added. “And it seemed almost every time something would happen the nurse would be somewhere else.”

The school district went from six to eight nurses, which helped a great deal. But lunchtime was still difficult, Barber explained, because of the large number of diabetic students in the schools.

“Nurses were having to rush from one building to another,” she continued. “If someone needed to be gone for training or a personal day or during flu season we could really be scrambling to cover what needed to be covered.” Reiterating her belief that student care was not compromised, she noted that simply looking at the numbers made it clear the situation needed revamping. “If you have ten buildings and eight nurses somebody is going to be without a nurse.”

Serving as a supervisor for the nurses Barber has a bird’s eye view and is readily familiar with the diversity of age- related needs nurses meet. And she’s been witness to the growing number of students requiring nursing care. “There are a number of students who need daily tube feedings; a few kids are on ventilators,” she noted. “Some students need two to three catheterizations per day, and students with asthma may require multiple updraft treatments.” Growing numbers of young students are being diagnosed with Type 1 diabetes, a topic that came up multiple times from every nurse interviewed for this story.

Previously referred to as juvenile diabetes or insulin-dependent diabetes, the causes of this autoimmune disease remain unknown. Current research suggests a correlation with genetics, environmental causes, and exposure to childhood viruses. Type 1 diabetes accounts for only 10-15 % of diabetic illness in this country and differs greatly from the more commonly known Type 2 diabetes, which accounts for around 80-90% of all instances.

Barber noted there are also a few students in the school system with Type 2 diabetes, an illness typically not diagnosed until after age thirty-five. But most students have the less-common form, Type 1, a chronic condition wherein the pancreas does not produce adequate amounts of insulin, the hormone that allows glucose to enter cells and produce energy. Despite their differences, treatment for both forms of diabetes remain the same, including regular blood sugar checks and insulin shots. Referring to the full spectrum of special needs Barber sees in the schools, “having direct access to nursing care,” she explains, “allows these students to stay in school.”

Not only does the Russellville School System have a nurse in every building, they also offer better pay. Ensuring a strong nursing staff meant more than just hiring more nurses, Barber states. As she began looking for support to make additional hires she also sought ways to keep nurses in their positions long term. “Initially the school was paying nurses an hourly rate comparable to LPN pay in the area,” Barber says. But given the school schedule, nurses work fewer hours than nurses in other settings. Despite the great hours and time off, Barber says that most nurses could not afford to stay. “We weren’t paying them very much,” Barber stated, “and there was a high turnover.” For many nurses it made more economic sense to travel to Conway Regional or Children’s Hospital rather than to continue working for the schools.

After doing research on regional hospital pay, and exploring other school nursing programs experiencing less turnover, the school board made the decision to put the nurses on a salary schedule linked to the teacher’s salary. “I saw immediate results,” explained Barber. When a recent nurse position opened, the phone began “blowing up,” Barber says, long before the position was even advertised.

Jessica Holman is the school nurse for the Upper Elementary building where all the 5th grades converge before going on to middle school. She’s been in the school since November. Before working as a school nurse, she worked in a medical/ surgical clinic and later as a research coordinator at a cancer clinic. She says her current job is “fantastic,” and she “ feels blessed” to work with the students. She regularly travels on fieldtrips, for example, insuring those with special needs can take part in these learning activities. Her days are filled with caring for students with Type 1 diabetes and helping students with asthma and seizures disorders.

There are also regular accidents at that age, she explains, bumps, bruises, and other minor recess-inflicted injuries. She also points to the large amount of poverty she sees, something she finds “shocking,” even though she grew up in the area and is the daughter of a long- time Russellville school teacher. Many children, she explained, do not receive early or preventative care due to lack of resources and/or medical insurance. One of her key roles, is to work with parents and empower them to make the best decisions for their child. When families can’t afford care she often connects them with social workers who can find financial resources for more in-depth care.

She says she’s “proud” of her district for taking this step in ensuring a nurse in every school and wonders how other schools make due with less.

In linking the nurses salary to the teachers salary, the Russellville Public Schools also began requiring nurses get the same amount of professional development as all other educators, focusing especially on training to help them effectively work with parents. Cindy Jones has been a nurse in the Russellville School System for nine years now, longer than anyone else currently serving. Over the years she’s seen drastic changes in student needs, including the rise in diabetes. She currently works at the London Elementary School, one of the two rural schools in the district. Being at the same campus everyday, notes Jones, provides nurses a “chance to know the kids and their situations. It’s so much more than just a band aid or a head lice check,” she explains. Nurses work alongside counselors in many cases, helping children when emotional needs may be causing physical symptoms. “School nursing,” she adds, “encompasses the entire person.”

Jenny Barber says when looking for people to fill the nursing positions she carefully screens for those who understand the complexities of working with multiple age groups. “Sometimes when you have to meet with the nurse it’s not a happy thing and parents are upset, maybe even going through a grieving process if there is an illness they just discovered. Children have a lot of difficulty adjusting to chronic illnesses such as diabetes,” she explains. Nurses help students and parents understand and implement a doctor’s care plan and educate the rest of the staff, even other students, about that student’s needs.

They may also be called on to help

mediate situations that may be fearful to those unfamiliar with the illness, such as students with seizure disorders. “How do you explain in a cafeteria when a child has a grand mal seizure that you can’t move the child, yet you want that child to have privacy? How do you explain to other adults who may be panicked?” Barber said. When looking for new hires she seeks out those who exert a calming presence in the most difficult or confusing of situations.

Delana Rice has been the school nurse at Russellville Junior High for three years. After working in home health and medical case management she found this job, something she’d always hoped to do. Like other nurses, she points to the rise in diabetic students in the schools, but says by the time she sees them as teenagers many are proficient in checking their blood sugar. However she is still needed to help with counting carbs and figuring out insulin doses. While the rise in diabetes is certainly a large part of what makes a school nurse so essential, their daily interactions with students are about much more.

Many kids, Rice notes, “overcome many conflicts just to get there.” Students may have unstable home lives, come from families with untreated drug or alcohol addictions, or may be facing the crippling effects of poverty. They may be experiencing undiagnosed vision problems or reeling from a diagnosis of scoliosis. Nurses on staff mean a familiar face is always there to meet the students’ physical needs and help create an environment where all students can succeed. “School must be a place,” she explained, “where students have everything they need to learn.”

Nurses may help young children work through those intense stomach aches they have before every spelling test or help a middle school student gain access to a hearing aid. In the end, the nurses explain, it’s about the bond they develop with the children. London nurse Cindy Jones says she’s continually reminded of how important her work is when a former student emails her from their new home across the country or comes up to say hello when she’s shopping in an area store. When a student reaches out to her, years after graduation, “I know I’ve made a difference,” she says.

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