SCHOOL NURSING: ENAHANCING THE POTENTIAL TO LEARN

Chart, Mar/Apr 2004 by Faist, Anne

As a school nurse with a type 73 certificate from the Illinois State Board of Education, employed by a south-western Illinois unit school district, I serve a population of approximately 430 middle school students, 880 high school students along with 160 administrators, teachers, aides, cooks, custodians, bus drivers, grounds keepers and visitors. Prior to 1991 each school in the district had a certified school nurse, but budget constraints called for staff reduction including two certified school nurses. It happened that our high school housed two morning and two afternoon early childhood classes then. Among the numerous disabilities in these classes was a three-year-old child with a tracheostomy necessitating my presence at the high school every afternoon, without fail. At the middle school, a student required noontime catheterization. Upwards of forty daily medications were being administered between the two schools during lunchtime. It was a hectic few years. Currently, a half-day RN, health aide assists with health room visits, immunization review, medications and treatments. Having an RN health aide is extremely helpful, but the certified school nurses, remaining in the district, continue to ask for a full-time, certified school nurse in every school.

School nursing began in the United States as an experiment to improve school attendance in New York City Schools back in 1902. Medical inspection by doctors in schools, beginning in 1897, sent children with signs of contagious disease home from school but did not stop the spread of disease; in fact, absenteeism increased. Lillian WaId, founder of the Henry Street Development, asked the New York Board of Health to allow Lina Rogers, a public health nurse, to tackle the problem of health-related absenteeism in four New York Public Schools. Using a nurse in the schools was so successful in reducing school absenteeism that additional nurses were hired within a month and Lina Rogers was appointed superintendent of school nurses. Rogers and her school nurses' goal was "to promote health in school children that will enhance their potential to learn" (Schumacher2002).

The National Association of School Nurses' mission statement: "to advance the well being, academic success and life-long achievement of students" (Wolfe 2002) is little changed from the goal of the 1902 school nurses. Today's school nurse continues to deal with problems associated with absenteeism, poverty, communicable disease, sexuality, diversity, immigration, lack of health care, safety and chronic illnesses. With advances in medicine, the development of technical aides, passage of the Education For all Handicapped Children Act of 1975. (Public Law 94-142), followed by the Individuals with Disabilities Act. Amendments of 1997, as well as section 504 of the Rehabilitation Act of 1973 public schools were obliged to educate and make accommodations for increasing numbers of handicapped children. The certified school nurse with a background in education as well as nursing is positioned to provide leadership in addressing the disabled child's health needs. Some children require both nursing and physician expertise for success in school. Nurse prescribed as well as physician prescribed interventions may be necessary to avoid complications such as seizures or hypoglycemia (Hootman 2000). By using the nursing process to develop goals for the student, collaborating with other health care providers, seeking outside resources, educating the child's parent and teachers the school nurse can "enhance the child's potential to learn".

Familiarity with the Nurse Practice Act, the School Code, special education rules, guidelines from the State Board of Education, the Standards of Professional School Nursing Practice and local district rules is essential for school nurses who are on their own when it comes to the many problem-solving and decision-making situations that arise in schools (Hootman 2000). Networking with fellow nurses in other schools and membership in professional organizations such as the Illinois Association of School Nurses, the Illinois Education Association and the Illinois Nurses Association assists the school nurse to develop a repertoire of resources for student and family referrals. Continuing education maintains and upgrades existing skills and screening techniques. Mentorship of new nurses keeps certified school nurses abreast of nursing innovations and supports their specialty practice by maintaining a supply of replacements as they retire.

What an opportunity it has been to take part in a child's development from seventh grade through high school graduation, which in special education can be twenty-one years of age. A school nurse becomes entwined in a student's life through vision and hearing screening, immunizations, illness, injury, substance abuse, family disintegration, child abuse, fights, pregnancy, special education, disabilities, medication, treatments and just as Lina Roger, absenteeism. To watch a child evolve into adulthood prepared for college or a job, ready to assume responsibility for himself, is a joy to behold. Watching the few who dropout, become involved in illegal activities, or form hurtful relationships is painful, but in spite of some unfortunate outcomes, school nursing is a fulfilling career.