The School District of Philadelphia has suggested that partnerships with local universities can replace school nurses, but real nursing comes with the daily things we see and hear from our students. School nurses are advocates for our children and a necessary part of every school faculty and learning team.
The following is a work of opinion submitted by the author.
When I went to nursing school, we learned about the nursing process, the foundation of what a nurse does. It’s all about the patient.
Assess: What do you observe about the person?
Diagnose: What is the problem?
Plan and implement: What you are going to do about that problem?
Evaluate: Is your plan working? If not, revise.
I started my career in the hospital and rarely saw the same patient for longer than three or four days. It didn’t leave time for getting to know them.
I’ve been a school nurse for 14 years, and I have developed long-term relationships with my students and their families. Some former students now have children of their own who come to my school. School nurses do so much more than provide basic first aid or vision, hearing, weight and height screenings.
The School District of Philadelphia has suggested that partnerships with local universities can replace school nurses. I agree that just about anyone can measure a child, or perform a simple screening, but the real nursing comes with the day-to-day things we see and hear from our students. University partnerships, while helpful, are just like working in the hospital: They’ll see students for a few days and then never again.
On any given day, a school nurse might assess a student complaining of physical pain that turns out to be an emotional problem. We have many students with chronic conditions, like diabetes, asthma and seizures. Some students have family members who are very sick, or just had someone close to them die.
We all see the bumps, bruises, scrapes, burns and other injuries — but what about the child who is withdrawn, who has that blank look on their face, or who is crying and won’t say why?
What about the child whose injuries don’t appear to have happened the way they say — who has a “stomach ache,” but then eats a lot of food, who gives inappropriate answers, smells of cigarettes?
What about the children who don’t have the medication they need, the child who is obese or underweight, or the student with abdominal pain or burning when they go to the bathroom? What about that child who says he couldn’t sleep the night before because a family of six has only one blanket in their house and he was cold all night long?
Observe, diagnose, plan and evaluate
We observe kids with dirty, ill-fitting, ripped clothing, kids who have no warm clothes for winter. We nurses notice subtle changes in the students we see every day, and we know when a student just might need someone to listen or to help them figure out what to do.
School nurses diagnose asthma, colds, allergies, possible fractures, child abuse and neglect, obesity, eating disorders, probable infections. We find students with no food, heat or hot water in their homes, students with emotional distress, and so much more. We realize that all the things that go on outside of school affect the students’ performance in school. We also know how difficult it is for the child who lives in a home where there is drug use, violence and lack of utilites to even think about school work.
We plan and implement for students by referring families to medical, dental, behavioral and mental health, and vision assistance. We help families get food stamps, free food, and utility assistance. We counsel students, refer them to grief counselors, make countless phone calls — to interpretors, medical offices, pharmacies. Nurses educate and empower students to make healthy food and drink choices and to keep themselves safe. We give out clothes, shoes, blankets, food and whatever else that child needs to help them succeed in school.
We then evaluate if what we did worked by making contact with students and families and other school staff members. If not, we revise our plan and make changes until we get the best result for our students. We are advocates for children, and we are a necessary part of every school faculty and learning team.
Nancy Henry is a pediatric nurse practitioner. She has been a nurse for 21 years, and has also done obstetric nursing, pediatric and maternity home care and worked in a skilled nursing facility.