If you’ve thought school nursing was just about taking temperatures and handing out bandages, a few hours at “Kids First” workshop at University of Texas School of Nursing proves you wrong pretty quickly.
During the course of two days last week, about 300 nurses from districts around Central Texas learned about the latest in managing diseases like ADHD, diabetes and mental health disorders, how to recognize child abuse, and how to recognize signs of stress and sleep deprivation in students. They also brushed up on skills such as catheterization, cleaning gastrostomy tubes, changing tracheal tubes and how to recognize abnormal heart and lung sounds and ear infections.
While school nurses cannot diagnose anything, they might be the first medical professional to see warning signs of life-threatening or chronic illnesses, and they also might be called on to help manage some of the care during the school day.
Some of the nurses who attended “Kids First” were regularly having to do things like catheterization or GT tubes because of the kids who are in their schools, others had never had a kid on their campus with those needs and welcomed the refresher lessons.
Deanne Hemmenway, CD Fulkes Middle School in Round Rock Independent School District, who regularly has done catheterization on a student, says it’s all about creating privacy and a trust factor, as it would be for any student she sees.
She’s been a school nurse for 20 years and knows that what comes into her office definitely depends on the time of year. There’s flu season, and allergy seasons, there’s also football season, volleyball season and track season. She also sees a lot of asthma and diabetes management come in as well as scrapes and falls. She’s called ambulances for football paralysis, severe asthma and falls down the staircase.
Sometimes the nurse’s office is where kids take a breather in the sanctuary of a quiet space and a nurse with an empathetic ear.
“Every day I have a handful of kids that don’t want to go to class,” Hemmenway says. Sometimes it’s a test they are trying to avoid. Other times there is more going on, like avoiding peers or family struggles.
The nurses office, she says, is like a mini emergency room or clinic, in the variety of things that come in.
“You never know what is going to happen day to day,” says Joanne Johnson, a nurse at Ridgeview Middle School in Round Rock ISD.
What has changed is some of the things that are coming nurses’ offices weren’t decades ago. Mental health crises, particularly depression and anxiety, and problems with stress management come into the office more frequently, says Violet Filley, who has been a nurse for 23 years and works with sixth-graders to 12th-graders at Round Rock Opportunity Center.
How can parents best work with their school nurses? We asked some nurses at the training what information they’d like parents to be given them and how parents can be better partners in their child’s care.
Make sure your contact information is updated online (if your district has an online emergency contact form) and also by paper (if they don’t have the online form or the power goes out).
Make sure your child knows your phone number and the phone number of a few more people to call in an emergency. It’s not enough to have it in their phone. Their phone might not be charged at that moment.
Take the nurse’s call when she calls you and have a plan on what to do if your child needs to go home. Have a backup person who can pick up your child if you’re not available and make sure that your backup person is on the emergency contact form.
Know that a school nurse cannot diagnose. They can make a suggestion of what they think might be going on, but you have to take your child to a doctor to receive a diagnosis and treatment. The school nurse also is not your primary care clinic. However, sometimes school nurses might notice things that a teacher or parent has not, and often, they know what ick is going around.
Follow the 24-hour fever-free rule to return to school. Our nurses understand that parents have to work, but giving a kid Tylenol or Advil to get the fever down, doesn’t qualify as being 24-hours fever-free. It has to be 24-hours fever-free with no assistance. This is for your child’s safety as well as other children’s to stop the spread of disease. Remember last year’s flu season in which some districts had classrooms with very few kids in them? Let’s try to avoid that this year.
For very young kids, put a clean pair of pants and underwear in their backpack and keep it there all year. Make sure your child and your child’s teacher knows where those clothes are.Nurses often have to send kids home or find clothes in the lost-and-found or try to clean up kids after an accident.
Share medical information with the nurse. They want to know if your child has a chronic illness, what medication your child is on and how much, what food or other allergies your child has and what to do if she has an attack, and what mental health diagnoses your child might have. If you think the teacher or the counselor has this information, don’t assume it’s filtering down to the nurse. It can be beneficial to sign a records sharing request for your child’s doctor’s office to send over medical information.
Let the nurse know if there has been flu, strep or other communicable diseases. The school districts’ health departments are required to share numbers with the state and even the Centers for Disease Control and Prevention. Those numbers start with the school nurse and can help establish a pattern of where and how quickly a virus is moving.
Share the 504 plan or individualized education plan with the nurse. The teachers, counselors and administration might know it, but the nurse also should be informed, especially if it’s for behavior, physical health or mental health. They want to know what works with your child. They also want to know if the behavior that has caused your child to go to the nurse is normal for them. If your child regularly has panic attacks, that’s helpful for the nurse to be able to rule that out if your child comes in with shortness of breath.
Let the nurse know about a long-term medical condition that might mean homebound services will be needed. Sometimes the school nurse gets tasked in getting assignments for kids who can’t attend school.
Have the right paperwork for giving a child medication. If your child needs to take medicine while at school, most districts won’t let you just give the kid the pill bottle. There will be paperwork involved that comes from your doctor if it’s prescribed or from you if it’s an over-the-counter. Each district has its own set of guidelines. Ask your nurse what you need to provide and know that she can’t give your child anything if the paperwork is not filled out properly.
Realize that kids are different at school than at home. Sometimes kids will have stomachaches and headaches at school and be fine at home or the opposite can be true. It depends on how your child is wired. Recognize that what the nurse sees might not be the same symptoms you see regularly.
Understand that the nurse might not need to call you. Most districts have protocols for calling parents if there is a fever or head injury. If there’s an injury that seems to be fixed with a bandage or if the kid just needs a break, the nurse might not call you. Sometimes nurses who know families well have more information about whether or not you’re the kind of parent who wants a call at every visit to the nurse’s office or not. If you are that parent, let the nurse know that you’d like a call. Realize that the nurse’s time is valuable (usually there’s only one of her for hundreds or even thousands of children). She might not be able to call you that moment. A good reason that you might want a call is if you’re trying to establish a pattern to your child’s symptoms or if you’re trying out a new medication and need data if it’s working.
When in doubt, overshare information. Often the school nurse is the last to know, but the first to see your child in an emergency.