School Nurses Have Come Along Way

Last updated Saturday, November 22, 2008 6:05 PM CST in News

By Rose Ann Pearce
The Morning News

Improving Learning

Healthy children learn better.

When a child is sick, cold, hungry, has a toothache, is stressed or homeless, he often is unable to attend to the higher order thinking skills needed to learn. That philosophy is based on Maslow’s hierarchy of needs.

As one nurse put it, imagine trying to learn algebra when you have a toothache.

“Our job is to keep kids in school,” said Mollyanne Lloyd, the supervisor of nurses in the Fayetteville School District who doubles as the school nurse at Woodland Junior High School.

The job often requires quick thinking and quick response to situations that may require more knowledge than other specialties, Lloyd said.

“We’re actually independent practitioners,” she said.

Some students may begin school as kindergartners with a medical condition that requires daily nursing care. Or the condition may surface as the child gets older.

Some may only require daily medication.

For the nurse, the demands may change from year to year.

“It’s different nursing in each school,” Ludwig said. “Each school has its own personality.”

Teena Cobb, a school nurse for 18 years, divides her time between George and Lee elementary schools in Springdale. There are no students at Lee who require a daily medical procedure and only one at George who requires daily tube feedings.

Asked about the changes she has seen over two decades, she and other nurses are quick to top that list with the increase in paperwork — additional charting, keeping more detailed health records and writing individual health plans for students who require daily medical attention.

Cobb said nurses provide a connection to students and their families who may need the care of a physician but don’t know where to go.

‘Part Beggar’

“We’re part fundraiser and part beggar. Most of the time parents are very grateful. There is no shame in not having money,” said Robin Wykoff, nurse at Ramay Junior High School in Fayetteville.

Often, nurses are part social workers.

Students and their families are responsible for medical bills, but when the scope of a student’s needs are outside the family budget — such as eyeglasses or dental work or a referral to a specialist — or if the family has no insurance, nurses often step in to assist students.

Nurses may be the only health care professional a student sees.

They make sure students have warm coats in the winter and food to eat on the weekends.

Tina Huddleston, nurse at Springdale’s Elmdale, recalls a fourth-grader who struggled with a dislocated elbow suffered years earlier in his native El Salvador. The injury severely hampered the boy’s movement and would have limited his movement as he grew older.

Huddleston stepped in to assist getting the boy to Shriner’s Hospital in St. Louis where he had surgery to correct the dislocation. He is no longer in Springdale but reportedly doing fine, she said.

That’s a high point. At the other end of the spectrum, school nurses are among the mandated reporters in Arkansas, meaning they are required by law to report suspected child abuse and neglect.

Huddleston has had her share of cases in the eight years she has been with the Springdale district.

“It is hard,” she said. “I have gone to court for medical neglect of students. It happens a lot for all of us.”

Complex Care

Huddleston leans down to pick up the boy laying on a mat in the classroom. She helps him take a few steps as she sits down in rocking chair next to his floor mat. She cuddles the boy, much like she would a baby.

Blindness won’t let him see; he can’t talk to express his delight. But his squeals of joy tell her how glad he is to see her.

He is one of four students at Elmdale who are wheelchair-bound and require total medical care — tube feedings, diaper changes, tracheotomy care and other procedures — during the school day. Huddleston attends to each one.

“It’s a very big part of the day,” she said.

The youngsters who attend Elmdale are in the special education classroom part of the day; the rest of the time, they are in a regular classroom, accompanied by an instructional aide. This practice, called inclusion, involves educating students with special needs in regular classes for much of the school day.

“These children are involved in everything they can do,” Huddleston said.

At other times of the day, Huddleston, like her colleagues, performs state-mandated screenings for hearing, vision, scoliosis and body mass index. Springdale nurses spent 800 hours last year working on body mass index reports.

Then there are the usual stomachaches and finger cuts.

Huddleston has been at Elmdale since she joined the Springdale district eight years ago. School nursing is more family friendly, she said, than working long shifts in the hospital, which she did for 11 years. She has three children, one of whom was diagnosed with pervasive developmental disorder when he was young.

Other nurses agree family considerations brought them into the school setting.

“These kids are so inspiring, loving, selfless. I’m passionate about them,” Huddleston said.

Providing Support

Rebecca Schneringer is in her first year at Vandergriff, providing daily care to several students who have chronic health issues, one of whom is 5-year-old Max Baxter, a kindergartner.

“I had no idea I would be doing this. I deal with chronic health issues most of the day,” Schneringer said. “I worked in a level one trauma center, and I do more catheters here.”

A catheter is a type of tubing inserted to drain the bladder.

Between tube feedings and catheter care, Schneringer also has two students with diabetes that must be monitored. She meets with those students twice a day. One student administers insulin through a pump and the other student uses the more traditional injection.

Max was born with spina bifida, a congenital defect in which the spinal cord is not completely developed at birth, according to his mother, Xochitl Baxter. Surgical attempts to correct the condition weren’t successful for Max. He walks with the aid of leg braces and a walker.

His daily care consists of medication, and he has a catheter, which must be emptied every four hours.

“Honestly, my fear was more social. Will he have friends? Will he be accepted,” Baxter said. “Meeting the nurse was important. I didn’t really know what she would feel.

“(Schneringer) has to deal with so many things,” Baxter said. “She is a big emotional support” to parents and students, Baxter added. “I can’t describe how happy I’ve been. Max is doing wonderful in school and the kids in his class are accepting.”

Wykoff’s days at Ramay as the school nurse are spent passing meds, doing tube feedings for two students, chest regressions for students who can’t cough and other duties, including advising students who don’t have insurance to consult with a pharmacist on the best over-the-counter medication for what ails them.

She sees her job as largely empowerment and education, teaching students how to take care of themselves and empowering them to do so.

“Every moment is a teaching moment,” she said.