School nurses serve many needs

JANESVILLE, Wis. — School injuries usually don’t require much care: a Band-Aid for a scraped knee, an ice pack for a bump or bruise, or a tissue for a bloody nose.

That— and some TLC — usually does the job.

At a recent meeting, the Janesville School Board received the annual school nursing report. The report showed that while Band-Aids and ice packs are applied by the hundreds, school nurses are dealing with more serious concerns.

Between the 2014-15 school year and the 2018-19 school year, the number of students requiring health plans, daily medication, inhalers and emergency medication has slowly crept up. Nurses, with the help of health aides, hand out daily medication; set up medical kits for field trips; work with doctors, nurses and parents to serve students with medically complex needs; give eye exams; and provide education and support to parents on everything from bed bugs to seizures and toilet training to allergies, The Janesville Gazette reported.

That’s the short list.

By the numbers

In the 2018-19 school year, the Janesville School District had five nurses serving 10,049 students at 21 district schools and 13 private or nonprofit four-year-old kindergartens. That’s a ratio of one nurse to 2,010 students. Student numbers will remain about the same for the 2019-20 school year.

“While the Department of Public Instruction does not mandate a specific ratio to school districts, the average ratio of school nurses to pupils in Wisconsin school districts is 1 to 1,625,” district Director of Pupil Services Kimberli Peerenboom wrote in her report to the board.

State law does not require schools to have nurses but does say “emergency nursing services shall be available during the regular school day and during all school sponsored activities of students.”

Along with the five nurses, the district also uses health aides. Each elementary school has four hours a day the principal can designate as health aide hours, according to Peerenboom’s report. In the upper grades, principals don’t have hours to designate, but they can assign health-aide duties to office staff, the report stated.

Some health aides are also secretaries or serve in other paraprofessional roles that involve working with students.

Apart from the general cuts and scrapes, 1,715 students had a documented health condition. Asthma, allergies and attention deficit disorder make up the majority of those cases. Other conditions include Crohn’s disease, diabetes, migraines, cerebral palsy, depression, anxiety and autism spectrum disorders.

In addition, 227 students take a daily medication at school, that’s up from 183 students in the 2016-17 school year. The number of students who need emergency medication has gone from 134 students in the 2014-15 school year to 231 in the 2018-19 school year.

Nurses aren’t in charge of figuring out why those numbers have increased, they just have to deal with the results.

In the 2018-19 school year, nurses and health aides reported 161,089 visits from students, according to Peerenboom’s report. A visit counted as anything from needing a Band-Aid to taking daily medication, the report said. With 21 schools, that’s an estimated 43 visits per day.

The numbers in action

Based on a recent morning spent with school nurse Heidi Bakke, 43 students a day seemed like a reliable count.

An hour before the 8:20 a.m. bell at Wilson Elementary, Bakke was updating a health plan. Such plans are for students with chronic conditions who might need monitoring or intervention during the school day. Creating a plan involves a complex back and forth among the school nurse, parents, and physicians and their nurses. It can be a complicated process.

“(The nurses) are probably not going to be in the building when the emergency happens, so we train medical emergency response teams at each school,” Bakke said.

The nursing team recently implemented “grab-and-go bags.” The bags contain all the emergency supplies for children with medical needs and a copy of each child’s health plan.

Nurses also must prepare a similar kit when a student with a health plan goes on a field trip.

And the nurses also have to let teachers know what to look for.

“The kiddos who have diabetes — those are the hardest ones to train teachers on because they have frequent blood sugar checks.” Bakke said. “If the kid is out hiking at the Janesville Schools Outdoor Lab, their blood sugar might drop, so you have to have snacks available.”

The morning we visited, Bakke was mentoring a new nurse, Holly Cavey. Also in the small office was Cheri Diehls, the school’s part-time health aide.

Once Cavey is trained, she will have five schools to cover, while Bakke has six. That’s another change. Nurses used to travel to all schools, now they’re assigned to five or six.

“It’s a better model,” Bakke said. “It provides better continuity of care. I want the kids to get to know nurse Heidi.”

While the nurses worked on reports, responded to emails and took calls from physicians’ offices and parents, kids needing immediate attention trooped in and out of the office. There were general owies, issues with hearing or sight, a bloody nose, a student needing their daily medication, another needing help with an inhaler, and a half dozen other issues traditionally associated with a trip to the nurse’s office.

Cavey and Bakke then headed to Franklin Middle School, where there seemed to be a lunch rush in the nurse’s office.

Health aide Angela Basurto-Bonilla was keeping things calm, explaining to students that if their temperature was normal and they weren’t throwing up, it would be best for them to stay in school.

The nurse’s office is across from the main office, and sometimes the new students got them mixed up.

The proximity works well since sometimes the office secretaries worked as health aides.

“Do you feel sick? Well, you’re in the right place,” Basurto-Bonilla told a student.

Bakke said the health aides were crucial to the success of the district’s nursing program. Their skills, demeanor and their day-to-day knowledge of students are crucial to the nurse’s work.

Despite the number of reports she writes and the amount of training she does, it’s the interaction with students that’s the most important to her.

By Kerry Minor

Leave a Reply