School nurses valued despite tight finances

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By Kelly Cantrall

Madeline Rivera remembers the nagging feeling she had about a student at a school where she worked in Illinois. He had been vomiting for a week and was losing weight. A physician attributed the symptoms to a virus, but the diagnosis didn’t sit well with Rivera.


She visited the student’s home and pushed for further evaluation and treatment. The student eventually was diagnosed with leukemia.

That student now is in high school, and Rivera now works in Hardin County Schools as a nurse.

“I still get emails from the mom,” she said.

Rivera is one of nine Lincoln Trail District Health Department nurses who work in HCS schools. Elizabethtown Independent Schools employs one nurse as a district staff member. Though districts aren’t required to have a nurse, but the local schools systems see value in having trained medical personnel working with students on a daily basis.

Since 2002, state law requires districts to provide medical services if students need them to attend school, said Karen Erwin, a school nurse consultant for the Kentucky Department of Education.

Districts can meet this requirement by hiring nurses, contracting with a health department to work in school buildings or using other local medical personnel to supervise and delegate tasks to district staff who care for students, Erwin said. She works with districts to determine how they will meet the requirement.

“The problem is it’s an unfunded mandate,” she said.

Boo-boos and band-aids. Along with treating playground scrapes and upset stomachs, a large portion of a school nurse’s job revolves around treating students with more severe needs, especially those with diabetes, food allergies and asthma, said Wendy Keown, director of school nursing at the health department. They administer medications and provide education, such as showing diabetic students how better to control the condition through their diet. Public health nurses also certify immunization records.

“We’re not just boo-boos and Band-Aids,” she said.

The EIS nurse is stationed at Morningside Elementary School but can be called to other schools. HCS nurses each work with two to three schools, depending on the needs of students.

Rivera, a nurse at North Hardin High School and North Middle School, has been a school nurse for 11 years. She learned of the opportunity after treating a teacher in the hospital where she was employed at the time. She applied for a position and “ended up loving it.”

“I saw the importance and the need,” she said.

Nurse Jasmine Seger works at Heartland Elementary School and G.C. Burkhead Elementary School. Her daughter was diagnosed with diabetes, which was how she was introduced to school nursing. She needed to see who would care for her daughter during the school day.

“I just needed that peace of mind,” she said.

Now, as a nurse, she knows what kind of care her child receives.

“Now I can’t see doing anything else,” she said.

The duties of nurses have changed over the years, Keown said. They deal with many more cases of disease such as diabetes.

“I think we just see it a lot younger than we used to,” she said.

Bobby Lewis, associate superintendent of school services, said in past years many of these students likely wouldn’t be attending public school. But now nurses make it possible for the students to be among their peers in an educational environment.

There is a recent push to be proactive about health, said Janay Sutton, HCS director of health services. Education about nutrition and wellness are a big focus in schools as a way to combat the epidemic of childhood obesity.

“We’re seeing obesity at an alarming rate,” Sutton said.

In Sutton’s 18 months in the position, the district’s wellness policy has grown from a paragraph to a centerpiece of health directives. Every school has a wellness council now. It’s a direction Sutton is happy to see school health take.

“I hope it’s not just taken off as a fad,” she said.

Nursing financial health of districts. Meeting medical needs of students presents a challenge to many districts across the state, Erwin said.

“It’s just like anybody else who has a budget, you have to set your priorities,” she said.

Erwin works to show districts nurses can be a financially positive service as well. In Bourbon County, the local district saw attendance increase by 2 percent when they hired a nurse for every building, she said.

EIS Superintendent Jon Ballard said not only does the district’s nurse work with students, but she also assists in medical training of its staff members.

“She is a valuable asset to our district,” Ballard said.

HCS is paying more than $400,000 for nurses this year, Lewis said. The district shares the cost of the nurses with health department.

While the district values the service, it had to cut the number of nurses from 10 to nine this year because of cost, he said.

Sutton said she does not envision a time where HCS no longer would have nurses. She doesn’t see how other districts manage without them.

“That’s just not a system I even like to imagine in my mind,” she said.

Kelly Cantrall can be reached 270-505-1747 or kcantrall@thenewsenterprise.com.