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BURLINGTON, Iowa (AP) — The practice of school nursing can be traced to the early 1900s, when a New York City school hired a nurse in an effort to reduce student absences.
According to the National Association of School Nurses, the role of a school nurse is to assess students' health statuses, identify vision and hearing problems that impact learning, administer medication and vaccines, perform health care procedures, emphasize disaster preparedness and provide health counseling and wellness programs.
A student's health status is related directly to his or her ability to learn, as children with unmet health needs have a tough time learning, The Hawk Eye (http://bit.ly/1O5qF7Q ) reported.
Through assessment, intervention and follow-ups, nurses support students' success.
One side effect of hiring school nurses is improving student attendance, which in turn can help improve academic success.
Six nurses work in the Burlington School District.
Gail Weeks splits her days between Sunnyside and Corse elementary schools, Karie Kroll is the nurse at North Hill and Grimes elementary schools, Jill Smith works at Blackhawk
Elementary, Kathy Menke is the nurse at Edward Stone Middle School, Esther Murphy is the nurse at Aldo Leopold Middle School and Shelly Breuer works at Burlington High School and the Burlington Innovative Learning Academy.
Students in the James Madison building are attended to by the nurse at their original school.
Joann Prosser was a school nurse in Burlington for 30 years before retiring in 2000. She was responsible for six schools at one time.
"We just did everything," Prosser said, laughing. "At the beginning of each school year, we tested each child for vision, checked heights and weights, recorded their growth throughout the years. For those who had special needs, you recorded those. And since we covered so many schools, we couldn't be there sometimes to administer medications, so you made sure staff members know about medications and how to administer those."
Prosser said she spent a lot of time traveling from school to school and making home visits.
"We also began the first CPR classes they had in the school district for students as well as personnel," Prosser said. "You tried to cover as many bases as you could with what you had.
You would get a call from the office saying so-and-so student has been absent for so many days, and you'd check into that. We spent as much time in the car as we did in the office."
Murphy is responsible only for Aldo Leopold and said she couldn't imagine covering six buildings.
"I feel pretty spoiled because I stay in one building and that's it," she said. "I feel bad that you guys had to travel so much. Gail (Weeks) travels, and she's sometimes spread pretty thin between two buildings. I can just imagine what it was like to have six."
Murphy said school nurses no longer do head lice screenings for all students, but they do individual tests if a teacher has a concern.
"We just don't do the whole classes like they used to back in the day," Murphy said.
But that doesn't mean nurses now are doing less work.
"Besides slapping on a Band-Aid or cleaning out cuts, we have to know about mental health, depression, anxiety, bipolar (disorder) and suicidal (thought)," Murphy said. "We wear a counselor's hat. And sometimes, kids come up to me asking if I can sew on this button or mess with a zipper. We wear several different hats."
Julie Griffin was a school nurse for 25 years before she retired two years ago. She was responsible for every school at one time or another with the exceptions of Prospect, Perkins, James Madison, Blackhawk and Middletown elementary schools.
"That was before you had computers or walkie-talkies," Griffin said. "Before computerized records. When beepers became more popular, we did get beepers, which was very helpful when you have four or five schools to cover."
Griffin said before beepers, cellphones or email, if a nurse was needed, someone would have to check the schedule and see where the nurse was supposed to be, and then hope he or she was there.
"When I first started, all the special needs kids were at Central Avenue, and that's when they made the law that they have to be integrated with the rest of the students," she said.
"Therefore, we had those special needs go out into our buildings, and it made things a little more difficult since they weren't in one school."
When nurses hear the term "special needs," Murphy said it refers to students who are in wheelchairs, unable to communicate, have tube feedings, oxygen, catheterizations, special diets or gastricfeeding tubes. Nurses would develop individual health plans for them, similar to teachers' individualized education programs.
"Those consisted of measurable goals with evaluations, interventions, nursing diagnosis, outcome and measurable outcomes," Murphy said. "Then the student works with the nurses to achieve those outcomes."
Menke wasn't able to give an exact number of health plans, but said, "Suffice to say, a lot."
"Health plans are an ongoing process," Menke continued. "Some are short-term, but for the most part, they are longterm and may follow a student from elementary all the way through high school. They are evaluated and updated on an annual basis and as needed."
As far as how successful each IHP is, Menke said, "I would say the success is that it helps to guide us defining the care we provide to affect safe and optimal school attendance and academic performance on an individual basis."
Joyce Kuster was a school nurse for 28 years and retired three years ago. She views lice differently than most.
"We are forever grateful to head lice for ensuring that school nurses forever had jobs," she said, laughing. "That used to be the big thing and why they wanted school nurses. We have to know a little bit of everything, and that's the exciting thing about being a school nurse. You get to do so many different things all the time. The opportunity to do good every day for kids, I miss that the most."
According to a 2008 study by the National Association of School Nurses, Iowa ranked 19th in the nation with 889 students per school nurse.
Vermont was first with a 275studentpernurse ratio.
During the 201314 school year, data shows 504 Burlington students had asthma, 33 had seizure disorders and 16 were diabetic. Thirtyfour students required EpiPens because of their allergic reactions.
"Another big change in recent years is the number of students that come into the clinic,"
Griffin said. "Joann says she would see up to 200 students sometimes if it was flu season or homecoming week. And even at the grade school level."
The most recent data shows 63,404 clinical visits during the 201314 school year. In 201213, there were 71,673.
The three retired nurses agreed the new clinics are far and away better than what they used during their careers.
"Perkins School, that clinic was no bigger than a cupboard," Kuster said. "It had two windows that were way up — and of course, no air conditioning. You couldn't open the windows, and (there was) no hot water."
Menke started at the James Madison building in a tiny room, while Prosser compared some of her old clinics to a closet.
Murphy said she loves her clinic at Aldo Leopold Middle School, which is five years old.
"I like mine," Murphy said smiling. "I adopted mine from Julie (Griffin) and it was movein ready. Now we have showers, washers and dryers. Mine is more open and they made me a little office because confidentiality is huge. It's one big room, but to talk to parents I'd have to go in the hallway or bathroom. So I asked for an office, and they whipped it up over spring break, and I was, like, wow, thanks."
Technology has made school nurses lives much easier.
"I use this Google Voice app, and I love it," Menke said. "A lot of times when you call a parent who's at work, they can't take the call and don't check their voicemails until lunch or something.
"But if you text them — and that's what you do with Google Voice — they text back and it pops up on my email that I have a new email if I don't have the app open. I get a lot quicker responses. It's great because I can say, 'We are running low on medications,' or 'I saw him or her today.'"
Menke is able to retrieve a student's health records from their time in the Burlington School District, compared to the old days, when each clinic visit was handwritten.
"We communicate very effectively with the kids and their parents," Weeks said. "I know what the kids are all about, and if there are issues or concerns, principals and staff come to us and ask if we can help them."
Communication between nurses is also vital.
"We really rely on each other, because in a school district, you are the only health professional in the building," Menke said. "If something comes up that you are questioning, you call each other. In a hospital, you have nurses and doctors to turn to."
If any prospective nursing students dreams about becoming a school nurse, each nurse recommended working in the field first before moving into a school setting.
Each nurse worked in a hospital or nursing center before becoming a school nurse.
"There are a lot of grads interested in school nursing, but they really should have some type of experience first," Murphy said. "Just straight from college is not good. At the high school, she's seeing anywhere from 120 and 140 kids. I saw 79 just today. It's more than just taking care of the kids who walk through the door."
School nurses have a significant amount of autonomy and must have access to a huge field of knowledge, Kuster said.
"They (school districts) like to see more education and experience," she said.
Schools are different than any other nursing jobs, Menke said.
"I worked in a residential juvenile detention facility for 10 years, and when this opportunity came up, it was a good one," Menke said. "Every student nurse we've had, no matter where they are from, is kind of taken back. They have no idea that a school nurse does this much."
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Information from: The Hawk Eye, http://www.thehawkeye.com
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