When the average person thinks of school nursing and what it entails, one’s mind may think of a fall on the playground and a scraped knee and the need for antiseptic and a Band-Aid.
But it’s so much more than that.
It may begin with a scraped knee, but as children grow so do their health needs. School nurses do more than take your child’s temperature. They keep their fingers on the pulse of a growing and changing population.
Nurses from Stuarts Draft Elementary School, Shelburne Middle School and Robert E. Lee High School speak openly about back-to-school health concerns. Here are some of the situations and stages of school life these nurses encounter.
“Hand washing. Hand washing. Hand washing.”
Teaching young children basic hygiene is the first line of defense against spreading germs, and the challenge Nicole Babinger, school nurse for Stuarts Draft Elementary, faces every day. Little kids touch everything. Keeping their hands out of their mouths and reminding them to wash their hands is essential to a healthy environment for elementary school kids.
“You can’t help it so much cause kids are kids,” says Babinger. “Everybody shares everything.”
Babinger’s advice for parents is to teach hand washing and follow the county’s sick and wellness policy. She says parents need to be more proactive in sticking to the 24-hour rule. That means no fever or vomiting for 24 hours before parents send their children back to school.
“The stomach virus spreads quickly,” says Babinger. “If parents didn’t tell us that their child was home the day before vomiting, with so many kids, we may not see them until it has spread. Parents don’t understand, it just takes one. Especially the younger they are, the quicker it spreads.”
As far as common illnesses the first month back at school, it just depends on what’s going around in the community, she says.
“I think what we see the most, especially the first week, is the first day jitters so you get a lot of headaches, upset stomach. A lot of that is nerves, anxiety. You get a lot of that stomach ache where they threw up that’s really more attributed to first day.”
For elementary school teachers, hand sanitizer is a lifesaver, she says. Though on a personal level, she doesn’t keep it in her office. And she never uses it with her four children.
“I just personally believe that you can totally over-sanitize. There are healthy germs in your body that help to fight off bad germs.”
But for teachers with a classroom full of little kids with runny noses and wet fingers, they may not have the luxury of building their immune systems if it means having to write their own notes to stay home from school.
Welcome to middle school
Big changes are right around the corner for children when they begin middle school. They are not children anymore. They are tweens entering puberty, and teens growing so fast they can barely make it through a season without needing a bigger size. Making friends and fitting in while making sense of all those emotions pretty much fills up the mind of a middle schooler. It’s both a confusing and exciting time. Who doesn’t remember their first dance?
Shelburne Middle School school nurse Megan Marinelli’s primary concern for her middle schoolers is to see them make a successful transition.
“A lot of anxiety with the sixth graders because it’s a new school,” says Marinelli. “Sometimes the parents are equally as nervous with their kids going to a new school.”
This year, Shelburne tried something new to help with this transition, and Marinelli thinks it made a big difference. The middle school had an orientation specifically for sixth graders and their parents prior to the school’s traditional open house.
“They came in and got to do a little bit on their own first,” says Marinelli. “Some of their parents were nervous about that and didn’t want to leave the parking lot.”
Getting to meet their teachers and walk the hallways helped to diminish the anxiety kids experience when starting a new school.
“I haven’t seen as many kids as anxious this year. I have not been that busy yet, which is very different than last year.”
Another big deal for sixth graders is lockers.
“The locker issue,” says Marinelli. “They want to be able to open their lockers. Practicing takes the anxiety off of that.”
Kids at Shelburne have about three minutes to get in and out of their lockers to get what they need in between classes. Combination locks can be tricky, especially if a child feels rushed or overwhelmed by his or her new environment. While practice leads to mastery for most kids, some may need another option. For children with special needs, arrangements can be made to have built-in combination locks replaced with a key lock, numbered lock or no lock at all.
Hand washing and the 24-hour rule still matter in middle school. Always important, says Marinelli, but the most common issue she encounters is anxiety.
“They have stomach aches because they are afraid of being here,” she says. “It is just getting over the anxiety of the first few weeks of school and getting used to everything.”
Sometime in the first month it seems there’s always a bug that carries from one grade to the next. This year, Shelburne middle schoolers seem to be battling a bad cold that develops into virus with a fever. Lasting anywhere from a few days to a week, it can make the transition back a bit more challenging as sick kids need time to recover and then get back into their new routine for the school year.
After middle school, right before life
Teenagers get their first taste of what it means to be an adult in high school. Understanding responsibilities and expectations, says Jennifer Arnold, school nurse at Lee High, helps teens acclimate to high school and behave responsibly.
While teens are still nervous and anxious when they begin high school, Arnold says at this level, they meet up with their friends. They have an existing peer network for support.
“If we have someone that is having a little trouble, we work it through. There is a little more responsibility here. At first the kids are a little surprised, shocked.”
Parents also need to understand responsibilities and expectations.
“Sometimes parents need reminders to make sure they bring in their child’s information, their orders and their medications,” says Arnold.
Arnold says it is essential that health care plans are updated, especially if a teenager has asthma, severe allergies that require an epipen, ADHD or any other emotional or physical need requiring chronic care.
“We like to be preventative,” she says. “We remind them to be proactive.”
This includes parents and teenagers understanding the risks involved in extracurricular activities, such as contact sports, and making sure they know concussion policies.
As far as common illnesses, “all the goodies that come with teenage years,” Arnold says. “We see a lot of viruses that are spread through contact. We’ve got boyfriend-girlfriend kissing or boyfriend-boyfriend kissing, girlfriend-girlfriend kissing.”
The school is proactive through education, says Arnold.
“Kids are kids. It is just at a different level. I would prefer that contact be minimal, especially when we have a lot of bugs and viruses.”
Parents have all been through high school, so even though teenagers think they can fool them, mom and dad already know every play in the book. Parents set curfews. They give them phones so they can check in to make sure they are safe. They hope to meet all of their friends. And then parents do the hardest thing of all – they trust their teenagers so they can learn how to thrive independently. They teach them how to drive and then they give them the keys.
‘Adult decisions. Adult consequences.’
Arnold’s concerns are far bigger and more serious than catching two teens kissing in the hallway. Sexually transmitted diseases, teenage pregnancy and drugs are some of these serious health concerns Arnold encounters when the door closes and it’s just her and a scared teenager.
“I have students who come in and ask me questions, and we get them resources and get them with the right people to get them help as far as emotionally and physically,” says Arnold. “Children having children – it just never ceases to amaze me.”
While the conversation between Arnold and a teenager is private, parents have the right to look at their child’s chart and medical records. And all school nurses are mandated reporters.
“There are certain things – mandated reporting – where we have to report to CPS,” explains Arnold. “If we have a child that comes in and says I’m pregnant, I have to explain to her that I am a mandated reporter. I’ve been fortunate enough where the kids will still talk to me. There’s certain programs in the area to help them, and get them set up with resources.”
Pregnancy is not her biggest concern.
“There’s a cure for that nine months later. These kids are getting diseases.”
Arnold’s concerned with HIV and hepatitis.
“That’s lifelong. We have treatments, but there is no cure. To have a teenager who is 15 being told you’re HIV positive,” sighs Arnold. “I want kids to know that this is something serious. This is something you will deal with for the rest of your life.”
“I don’t think kids realize. Adult decisions. Adult consequences.”
These are realities in every school, she says.
“And no, we don’t have a crisis here,” says Arnold about Lee High. “We do see it. It is a problem. It may not be the biggest problem I got, but it is here.”
The other day, Arnold received literature about having a pharmaceutical drug used to treat opioid overdoses at school.
“Oh my goodness, we are coming to that, and I’m sure eventually one day we will end up with it. Nationwide, it is a problem, and it worries me. Nobody wants to hear that that’s at your school. You can call all the nurses. It’s in every high school.”
School nurses, the administration, teachers and parents all partner in guiding children not only in the educational world but in the health world. School nurses can be the first line of defense for children. They give parents a window into what is unfolding within the school environment should a situation require more care.
Parents hope that something is as simple as a scrape on the knee, but when it is something far more serious, they depend upon school nurses to shepherd their children until they can bring them back home.
Article by: Monique Calello, Staunton News Leader