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You have no clue what school nurses really do

School nurses matter enormously, though you couldn’t tell by the amount of attention they get from policy-makers (and even parents when it comes time to distribute end-of-year gifts). School districts that cut their budgets have no problem eliminating school nurses or forcing a single nurse to cover a number of schools, and increasingly teachers and others at school who haven’t been trained in medicine are being asked to do dispense medication and do other things that school nurses really should be doing.

For many students, the school nurse is the only health professional they ever see. Nurses do far more than bandaging scraped knees and twisted wrists but they deal with far more severe medical problems as well as social and emotional problems that children bring to school but often aren’t comfortable talking about with teachers and even counselors.

In honor of National School Nurse Day, which is today, here are some of the things school nurses do that you may have never considered, told to me by school nurses who work in public and private schools.

Major issues that nurses deal with include asthma; childhood obesity and diabetes; students with allergies, both food and environmental; drugs, both prescription and recreational; disaster preparedness; crisis management; school health documentation for local governments; head lice; immunizations; mental health; oral health; visual health; school wellness policies; violence and bullying. Nurses also provide health education to students, including on sex education, nutrition, substance abuse prevention, bullying and much more.

Here are some comments from nurses about what they face all the time:

*Growing stress levels and mental health issues among students of all ages.

There’s something wrong when at 8 o’clock on a Monday morning, you have a line 10 [students] deep. ‘Now, how did you get nauseated, dizzy from the time you were dropped off to the time the first bell rings?’ I’ll ask. A lot of it is anxiety.”
“We are seeing more young kids with mental health issues. They come to us in droves because its easier to somaticize your stress through headache and stomach ache. It is easier to go to a nurse if you are sexually questioning. We are the less stigmatized place to visit.”


*Growing insomnia among students, perhaps due to staying on computers and mobile phones.

*Parents who micromanage their kids and tell nurses how to do their jobs.

“We get reamed out for not providing information to parents about their children but there are confidentiality laws that preclude us from telling them everything. Parents don’t understand that.”
“Sometimes a kid will have a concussion and I won’t want them to play in a game. But the coaches and parents tell me to put the student in the game. It’s a struggle.”

*Parents who think kids can take care of themselves.

*Parents who don’t tell the truth on health forms so nurses don’t know a student has a particular condition.

“We have these great forms but there can be a child who is seeing a neurologist for seizures or a child seeing an orthopedist for something or a psychiatrist for something and the forms comes back with nothing on. Nothing about the condition. Nothing about the medication. Nothing. If a child presents with the problem at school, we are operating blind.”
“Sometimes you see the same handwriting on a form for the parents and the physicians. Or it is written in a way a doctor wouldn’t, spelled wrong and without the dose.”

*Parents who don’t understand the constraints of a nurse’s job and who ignore the advice of the nurses.

“They will say, ‘What do you mean you can’t give them Tylenol without authorization from the doctor. Every other school does it.’ No, they don’t. We can’t give meds that aren’t approved for certain things. Herbs. Sunscreen and bug spray have drug labels on them. We can’t dispense them without permission.”
“It happens every year. We tell the parents allergy season is coming. Be prepared. Its coming. And then the kids come in and their eyes are swollen and they are sneezing and coughing. And the parent says, ‘Well, it wasn’t bad when they left home this morning.'”

*Students who ask for drugs that nurses are not allowed to dispense without a doctor’s permission.

“They come into the office. ‘Do you have Zyrtec? Claritin? I left mine at home.’ “

*Students who need to be educated about their own conditions.

“They get inhalers but don’t know how to use them. Nobody has taught them so I do.”

*Working at more than one school because every school doesn’t have a full-time nurse.

“Look in Virginia. By law Virginia schools have to stock epinephrine [which treats severe allergic reactions] but they don’t have to have nurses so secretaries are learning how to administer it and making the decisions.”

*Problems from delegation of responsibility to teachers and other adults in the school on field trips. Nurses are responsible for decisions made by others because it is done under the auspices of the nurse’s license to work.

*Helping adults in the building with their medical problems and taking questions from them about insurance plans.

*Having to think through worst-case scenarios.

“It is my job to look at the worst-case scenario in different situations and tell the administration that they need to prepare for it. It makes me a Debby Downer in meetings.”

Nurses are primary care providers for a great number of kids. They have no one in the school who is trained in the same way for consultation, making it a lonely job. Nurses believe it is past time that their role in every school is better understood and respected. And they are right.