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A Day in the Life of Your Friendly Neighborhood School Nurse

The names have been changed, but the situations are real. They are part of the daily routine in your local public middle school! If you’ve ever wondered what the school nurse and your health assistant do, perhaps this helps to create a clearer picture.

About This Article

  • Author: Cheryl R. Brubaker, BSN, MSN, APRN-BC, cFNP
  • Date: April 10, 2007
  • Copyright: 2009, Health in 30

The alarms on the ventilator chime persistently, and the educational assistant assigned to the student radios the nurse. “The rate alarm is going off, but Bobby is looking o.k. and says he feels fine.” The nurse heads for the science rooms, where Bobby’s class is located, to further assess the situation.

Clancy is wheeled in his wheelchair to the Health Room for the administration of medication in to his gastrostomy tube, which will help him digest his food more effectively. In about thirty minutes he receives a tube feeding through the g-tube, as he does every morning and every afternoon during his school day.

Several new medication orders come in and must be reviewed, and transcribed to the administration forms. The bottles need to be checked to make sure that the label and what is in them matches the doctor’s order. More students today are on medications to aid in the treatment of a variety of medical problems. The chance for serious medication errors has increased as result. A new Individualized Healthcare Plan needs to be completed that addresses the reason the student takes regular medication in school and the impact the condition and the medication may have on the student’s educational program. Nearly two hundred of the one thousand students in the school have some degree of asthma and need to have an up to date Asthma Action Plan and medication orders. Many need teaching about asthma and the proper use of the inhalers used to treat asthma, as well the signs and symptoms that could mean danger for the student.

Classrooms of talkative, excited eighth graders take turns going to the Health Room to have their eighth grade health screening done. Each gets their height, weight, vision, hearing and blood pressure checked. “Did I pass?” many ask as they go through the stations set up to check each student. Several students have elevated blood pressures that will require follow up to see if they have chronically high blood pressure. Many are sent to see their eye doctors about the possibility of needing glasses. Some are referred for further hearing evaluation to see if they have a confirmed hearing loss.

One thousand to twelve hundred individuals visit the Health Room of this middle school every month. Some have a stomachache or a headache and just need a brief rest. Some are more ill and are sent home. Some have injured themselves playing basketball during lunch. Occasionally, there is a true emergency that requires immediate medical attention to save life or limb. About fifty come in for medication daily. Some are severe and profoundly physically, emotionally, intellectually, and/or socially disabled and are reliant on advanced medical care and technology “in order to access their educational environment.” Some need a kind and listening ear. Some need a stern reminder that the Health Room is NOT a convenient place to avoid PE, or math, or social studies, or language arts.

A frustrated parent complains that he didn’t know his seventh grader had to have the Hepatitis B series of shots done before the start of school. The school nurse and the health assistant go through hundreds of records to assure that all immunizations are up to date to prevent the possible outbreak of these diseases in our schools and to comply with state and federal laws.

A tearful student who passes out in class, tells about how she wants to be popular and doesn't want to eat lunch (or breakfast) because if she’s thin she’ll have more friends. Gentle listening and referral to the counseling office starts her on the road to some healing. Perhaps touching base with her parents and talking about the situation, recommending community resources and support opens opportunities for the family.

The school nurse sits in on Joe’s Individualized Education Plan meeting and discusses classroom strategies for managing Joe’s difficulty with staying on task in the classroom and his increased motor activity. Joe’s Individualized Healthcare Plan outlines his health needs related to his educational needs in the classroom. His IHP is one of nearly two hundred written for the students who have health needs in the school.

All the sixth graders gather for an assembly. The school nurse shows them a brief video on the dangers of ditches and arroyos, then spends the next forty minutes answering a deluge of questions about ditches and arroyos, listening to tales of friends, siblings or neighbors who had “close calls” in a ditch or an arroyo. Many have to be convinced that it could happen to them too and ditches are not safe places to swim or arroyos safe places to roller blade or skateboard.

The names have been changed, but the situations are real. They are part of the daily routine in your local public middle school! If you’ve ever wondered what the school nurse and your health assistant do, perhaps this helps to create a clearer picture. Many students have no access to any medical care other than the Health Room at school. The Health Assistant has a high school diploma, some CPR and some first aid training. The school nurse is a Registered Nurse who has attended a college baccalaureate program and is prepared to meet the diverse needs of the population. Some have a Masters Degree that further prepares the nurse to act as an independent caretaker. This is all the more helpful in schools where nurses are isolated from other healthcare providers to consult with, or when the role of “case manager” falls on the school nurse in order to coordinate the care required for a student with significant medical problems. Yet most schools only have the nurse on site half time!

All students with all levels of disability are entitled to access “a free and appropriate education.” Without nurses in every school this becomes a nearly impossible task. If you have any questions about school nursing, please feel free to call one of us, or better yet, come visit us! I’ll be glad to give anyone a tour.

About the Author

Cheryl Brubaker has over 28 years of nursing experience in a variety of settings. She served in the Air Force for 14 years and served in Desert Shield/Desert Storm, has spent time as Medical Staff Development Officer for Tactical Fighter Wings, and Self Aid and Buddy Care Advisor which included the training of all instructors in the Wing on Self Aid and Buddy Care, the 1st echelon level of medical care in the military warfare medical care system. 

Cheryl has experience as a staff educator in a Family Birthing Center teaching postpartum, labor and delivery, newborn and newborn intensive care classes. As the Nurse Manager of a Surgical Intensive Care Unit and the Supervisor of seven intensive/specialty care units, Cheryl was involved in providing orientation and in-service in intensive care, emergency care, post anesthesia care, and similar topics.

Cheryl is a published author and is a board certified family nurse practitioner. Cheryl is on the faculty at the University of St. Francis in the Family Nurse Practitioner program. Presently Cheryl is a school nurse practitioner and serves as the district nursing resource for special needs and special education.