School Nurses
The joys and challenges of working with school-agers
By Joan Tupponce

It’s a good bet that at least once during the maturation process you or your children visited the school nurse with some type of ailment. School nurses have been delivering care to students for more than a century.

According to the National Association of School Nurses, “School nursing emerged as a public health nursing specialty following the experimental placement of a public health nurse in a New York City public school in October 1902.”

Ellen Muller, Janet Gibbons and Cathy Stith are all now working in the specialty field. We talked with them to get a better idea of what it’s like to work as a school nurse. Their stories follow.

Ellen’s Story - Charlottesville
Ellen Muller and her youngest daughter were both anxious about starting school the same day. Muller’s daughter was entering kindergarten and Muller was beginning her job as the school nurse at Venable Elementary School in Charlottesville.

“We were both very apprehensive,” Muller recalls. “I was putting my last little one on the school bus for kindergarten and afterward I was starting a new career.”

In her job, Muller sees students throughout the school day. “We treat everything from splinters and bloody noses to children crying because they don’t want to be at school,” she says. Muller remembers the day a little boy had a breakdown in her office. He was just starting kindergarten and not used to a five-day schedule. “What is this every day stuff about coming to school?” he asked sobbing.

“He wanted to come on Mondays, Wednesdays and Fridays like preschool,” Muller says. “He was not happy.”

The students Muller sees in the clinic come from a variety of cultures and socio-economic levels. “Our city schools have different needs than the county schools,” she observes. “Our school works with the International Rescue Committee to bring refugees in from all over.

We have gotten children from Afghanistan and this year from Burma. We work with them in getting physicals, entry immunizations, etc.”

Cultural differences have to be addressed immediately. “We teach them about regular hygiene, things like how to wash and to brush their teeth,” Muller says. “These are things that they have never done before.”

At times, issues may arise that are unique to school nursing. “One of the parents of a refugee from Africa wrote down mercenary as his occupation,” Muller recalls. “For his country that wasn’t unusual.”

Most days in the clinic are very typical. Common complaints include colds, headaches, stomachaches, cuts, bruises and the flu. Some students also have ongoing medical issues such as asthma, peanut allergies, seizures and diabetes. “We are seeing more and more health needs as more children with health care problems are being mainstreamed,” Muller says. “We have an obesity task force and we are working on that, helping with nutrition and exercise plans.”

On occasion, Muller deals with issues surrounding child and sexual abuse as well as domestic violence. “That’s rare,” she says. “Last year we also had a student killed due to gang-related trouble and that trickles down through the student population.”

As part of her job, Muller takes care of all medical records, vision and hearing testing, physicals and immunizations. She also talks to classes about proper hygiene and nutrition. “You become more of a team nurse because you are actually involved with the child’s education,” she says. “We try to keep them healthy and in the classroom.”

Because she works with children from the time they enter kindergarten until they leave for middle school, she becomes attached to her young patients. “I love working with the kids because of their honesty,” she says. “I feel blessed that the students at my school really do care about each other.”

Janet Gibbons - Floyd County
Janet Gibbons is in her sixth year as school nurse at Floyd Elementary School and Willis Elementary School in Floyd County. An RN since 1967, Gibbons is now 61. “I saw an ad in the paper and thought that it would be something I would really enjoy,” she says about her position.

Gibbons works a half-day at each school, typically seeing about 30 children a day. Her days also consist of meeting state requirements for immunizations and physicals, data collection, parent conferences and blood pressure and weight checks. “We have many diabetics in school and they require constant monitoring,” Gibbons says. “In Floyd Elementary, we have many students who are wheelchair bound or compromised physically or mentally.”

Gibbons also teaches CPR and makes sure that everyone in the school is aware of evacuation plans for medically compromised students. Most days at school are routine, she says. “Children are so well immunized we rarely see a breakout of a horrible illness. Mostly what we see are viruses.”

She does find that children will often come to the clinic with a general stomach ache. “We have to try to figure out the real reason,” Gibbons says. “I call the parents a lot. I call if it’s something other than routine.”

Often, Gibbons dispenses medications such as asthma inhalers. “Sometimes the [number of students who need inhalers] is huge,” Gibbons says. “We have had 20 to 30 in one med-cart drawer.”

Gibbons says that it’s her young patients who make the job so enjoyable. She never knows what they will say. For example, a first-grader came into the clinic one day and told Gibbons that his kidneys were broken. “I asked him to point to his kidneys,” she recalls, “and he pointed to his belly button. I couldn’t find anything wrong with him. I think he had overheard something and it was bothering him.” There are also instances that cause a school nurse to rethink her job, Gibbons says. “I had one child who said he didn’t feel good and vomited into my school bag with all my papers and calendar. You just never know what’s going to happen. It can range from soup to nuts on any given day.”

Cathy Stith - Richmond
Cathy Stith started in school nursing for the City of Richmond immediately following graduation from VCU School of Nursing in 1977. “I wouldn’t be honest if I didn’t say I took the hours into account but I also enjoy working with people,” Stith says. “This allows me to work with adults as well as children and have an impact on their wellness.”

Stith was first assigned to Chimborazo and Fulton Elementary schools in the city. Today she serves as a nurse manager alongside a nurse practitioner in the school-based health center that works with all of the city schools. As part of her duties, Stith travels to each school to handle sports and other physicals as needed. “We have a partnership with Special Olympics, as well,” she explains. “I go to the schools that are participating and make sure the students’ physicals are updated.”

Her job also has her out in the schools and the community participating in health fairs and health promotional activities. Collaboration is at the heart of her job. “We collaborate often with school nurses and administration,” she explains. “School nurses give us a lot of input.”

Education is also a large part of her work. “We put an emphasis on that,” she says. “We teach the children about health.”

Sometimes Stith tries to teach them about communication as well. “I remember that one time I was saying to a young boy in elementary school ‘Do you think you could phrase that better?’ and he replied, ‘You know Ms. Stith this isn’t an English class.’”

Stith believes that communication falls under holistic nursing. “Holism includes the mental and physical,” she explains. “To me, speaking and being able to communicate properly is so important.”

While the job is rewarding, it can also be challenging. One of the newest challenges Stith is facing is the fact that the Spanish-speaking community in the school system is increasing and there are language barriers. An ongoing challenge revolves around helping the educational staff understand the role of a professional school nurse. “A lot of times when people mention a school nurse they are talking about school aides or certified nurses,” she says. “A professional school nurse is an RN, preferably with a Bachelor of Science degree in nursing.”

School nursing is a specialty nursing practice, she adds. “We have standards and responsibilities that we often don’t get credit for. You have to be an advocate for the children and also a self-advocate. We have a very important function.”