Nursing new wounds Social changes make school RNs' jobs more complex

January 03, 1993|By Sherry Joe | Sherry Joe,Staff Writer

Ten years ago, a thermometer and a blood-pressure gauge were probably the most sophisticated equipment you'd find in a school nurse's office.

Scraped knees and bloody noses still reign in the schools, but new demands are forcing nurses to provide soup-to-nuts services -- from basic care for children whose families can't afford it to sophisticated treatments for rare illnesses.

"We're seeing kids with more serious health problems," said Carol Dunlavey, coordinator of health services for Howard County public schools. "You're not staying in the hospital for six or seven days anymore. You leave in 24 hours."

A changing socioeconomic landscape is responsible for many of the changes:

* Fewer stay-at-home parents mean schools more frequently care for sick children, who sometimes come to school sick and who often stay longer until a parent can arrive.

* Spiraling health care costs mean more families can't afford routine medical care for their children. School nurses help fill the void.

* Some illnesses have become easier to treat, so children who once would have been hospitalized can sometimes get care at school.

At Swansfield Elementary School, nurse Elsie Baker sees 50 to 60 students each day. She has received more than 3,100 visits from students so far this school year. Ten years ago, Ms. Baker said, she treated about 40 students a day.

The numbers don't seem to faze her. She greets each student by name as they enter the cheery health room, which is plastered with posters urging good nutrition and abstinence from drugs and alcohol.

"How's your day going, Andrew?" she askes one.

A growing number of cases require special attention. Just beforeThanksgiving, she tested the eyesight of a boy who needed glasses.

"He couldn't read below the big 'E' on the eye chart," Ms. Baker recalled. She had the child referred to the county health department because his mother did not have enough money to pay for glasses.

As medical costs rise, many youngsters with swollen glands, strep throat, and mononucleosis are lining up for treatment at school health rooms rather than see a doctor immediately, say nurses.

"There are many one-parent families, and they don't have the money to see the doctor," said Valerie Joyce, a nurse who began working at Oakland Mills High School in September.

School nurses and health assistants are limited in what they can do. Nurses cannot prescribe medicine or diagnose a disease. But they can give advice, assess health problems and recommend a visit to a doctor when they feel one is needed. Health assistants are trained to give CPR and first aid.

"We're needing to make more referrals to the Howard County Health Department for well child care," Ms. Dunlavey said. "It used to be that everyone in Howard County saw a physician for an emergency."

Although she has no statistics, Ms. Dunlavey said she has seen a "significant increase" in such cases in the past 10 years. Schools along Route 1 and in rural parts of western Howard County are more likely to have students whose families cannot afford medical care, she said.

School nurses say the situation will only grow worse. They suggest hiring more nursing staff. Besides the 10 nurses now in the schools, Ms. Dunlavey would like two more to help train and supervise the schools' 44 health assistants.

And Ms. Joyce said she hopes that nurses will one day have their own assistants.

"I see it down the road," Ms. Joyce said. "I see too many students that have too many needs not to do it."

The increased number of parents in the work force also is adding to the schools' health care duties.

Ms. Dunlavey recalls when parents could pick up their ill children within an hour. "Now, they're coming at the end of the day, or you can't reach the parent," she said.

Howard County has always had a high percentage of two-income families, but the jobs seem to have become more demanding, she said.

"Parents are not able to leave their work like they were able to," Ms. Dunlavey said. "The person is out on the road or in a meeting. The higher the level the job, the more difficult it is to attend the needs of the child."

New medical needs also are demanding attention from nurses.

Each afternoon at Swansfield Elementary, Ms. Baker oversees a group of 25 "medically fragile" children who take medicine for afflictions ranging from asthma and rashes to hyperactivity and a congenital lung ailment.

"We have more and more medically fragile children coming to the school setting," Ms. Baker said.

Last year, the school system enrolled 13 children who used intravenous lines for feeding, and kidney and heart problems.

Among the seriously ill children at Swansfield is 7-year-old Marcus Harper, who suffers from a chronic lung problem and is partially paralyzed on his left side. Each day, Ms. Baker hooks him up to a nebulizer, a machine that converts liquid medicine into an extremely fine spray to deeply penetrate the lungs.

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