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Michelle Davies | The Journal Gazette
School nurse Ronda Kissling talks to a patient in the clinic at Croninger Elementary School on Friday morning.

For school nurses, it’s far beyond Band-Aids

– The peak times for student visits to Ronda Kissling’s office are at the start of the school day and around lunch and recess time, but Kissling doesn’t get much downtime.

Kissling is the nurse serving three elementary schools: Croninger, St. Joseph Central and Shambaugh. She began her day Friday at Croninger to see the students who got off the bus not feeling well. By late morning, she was headed to Shambaugh to give insulin to the handful of diabetic students there. Shortly after noon she returned to Croninger to give students insulin and just in time to catch any students injured during recess.

Between student visits and charting throughout the day, Kissling checked on an uninsured student who had broken his arm; urged a doctor’s visit for a student with a particularly suspicious-looking rash; and worked on a letter to send home to parents about immunization changes for next school year.

She said most people don’t realize what school nursing is all about.

“They think we sit around all day and just give out ice packs and Band-Aids,” she said. “There’s so much more to it nowadays.”

Increase in ailments

Much has changed in school nursing in the past 10 to 15 years, said Chris Amidon, a registered nurse serving Crawfordsville Community School Corp. and president of the Indiana Association of School Nurses.

One area in particular is the increase in students’ mental health problems.

“A lot of us were not prepared to deal with that,” she said, because of nurses’ inexperience in psychiatry.

She estimates about 32 percent of school nurses’ time is devoted to providing mental health services, whether they realize it or not. Often mental health problems can show up as physical ailments like head or stomach aches, she said.

According to a 2011-12 survey by the Centers for Disease Control and Prevention, about 165,000 Hoosier children have emotional, developmental or behavioral problems that require treatment or counseling, and 41 percent of those children do not receive mental health services.

Children born prematurely or with other challenges now live and attend school.

“There’re so many children with time-consuming needs,” Amidon said, such as tube feedings or students who need help using the restroom. Thirty years ago, she said, these children probably wouldn’t have even attended school.

Rates of overweight and obese children as well as the number of children with food allergies are also increasing.

Mary Hess, head nurse for Fort Wayne Community Schools, said more than 13,000 students in the district report having allergies. That includes food allergies, such as to peanuts, and being allergic to bee stings and latex.

About 760 of those students report severe or anaphylactic symptoms if exposed to a certain allergen, she said.

“There’s been a huge increase in allergies from when I started 15, 16 years ago,” Hess said.

Hess reports allergies and diabetes among the top four reported chronic illness of students in FWCS, now the largest district in the state with about 30,600 students. Asthma and seizure disorders also top the list.

“We see an increase every school year with students reporting some chronic health condition,” Hess said.

According to the National Association of School Nurses, the incidence of obesity in the past 30 years has doubled for 2- to 5-year-olds; tripled among 6- to 11-year-olds; and more than tripled for 12- to 19-year-olds. In Indiana, 32 percent of children ages 10 to 17 are overweight or obese, according to the CDC survey.

A disease such as diabetes requires extra effort to manage as treatments have advanced. Diabetic children used to get insulin in the morning, and their blood sugar levels were simply monitored during the day.

“There was not the constant fine-tuning we see in today’s plans,” she said.

Many children require insulin when they eat, which could be twice a day if the child eats breakfast at school.

FWCS to hire nurses

Students’ insulin needs are what led the Crawfordsville schools to make it a priority to provide funding for a full-time nurse in each of its school buildings, instead of its old policy of staffing based on just a few students in certain buildings.

“We used to do that, but it got to the point where there’s at least one child in each building with diabetes or even food allergies,” she said.

Unlike Crawfordsville, not every school in Fort Wayne Community Schools is staffed with a full-time nurse. This year, about 24 nurses split their time among the district’s 51 school buildings. Some nurses, like Kissling, are responsible for three schools, Hess said.

“My nurses have been stretched very thin,” she said.

Northrop High School is one of the district’s busiest schools with more than 2,000 students. The school’s full-time nurse fields 650 to 850 student visits a month.

“Their traffic flow is extremely busy, but I wouldn’t say that’s particularly new,” Hess said. “I’ve felt for some time we’ve needed more nurses.”

FWCS plans to hire additional nurses for next year, bringing the total number of nurses to 30 with no nurses serving more than two buildings.

Ten years ago, Southwest Allen County Schools employed clinical aides, or someone who has medical training but isn’t licensed, in some of its schools instead of a registered nurse.

Amidon said many districts have moved away from using clinical aides, although some districts like Huntington Community School Corp. still use them or other unlicensed staff instead of registered nurses. And in FWCS if a nurse isn’t available, secretaries and other staff receive special training like CPR and medication dispensing.

Southwest Allen changed its policy when it became clear that student health was becoming more challenging and “too medically intense,” said Phyllis Davis, director of human resources in the district.

“In many schools we have children with severe disabilities and who are very unique, medically,” she said.

Southwest Allen employs 11 nurses, with at least one nurse working full time at each school. Others float among schools to give the full-time nurse assistance.

“I can assure you, they’re very busy,” Davis said.

Manic Mondays

A student sat on the cot in Kissling’s small clinic Friday waiting patiently for her to finish her phone call with a parent. He had come in because his eyes were red and itchy. After some questions, Kissling determined it wasn’t pink eye, a highly contagious infection, but that the student’s symptoms were caused by his allergies.

“It’s that time of year,” she said.

She offered him a cold cloth for his eyes and sent him on his way. He was the second student within an hour to complain about allergy-related symptoms.

Amidon said research shows that if students see a school nurse, they are more likely to have their problems addressed and to stay at school. Someone unlicensed who is providing care is more likely to send a student home.

School nurses are an important component in helping students achieve academically, Davis said.

“Our nursing staff is an important part of our school district’s success for our students,” she said.

They’re also an important part of children’s health care. Amidon said for many students who don’t have health insurance, school nurses are primary health care providers. She said Mondays are often busy times with students who’ve been sick all weekend, and their parents send them to the nurse to determine how serious the sickness is.

According to the CDC survey, nearly 12 percent of Hoosier children lacked consistent health care coverage last year.

For all they do, school nurses receive their own special day a year. Wednesday is National School Nurse Day, set aside to celebrate the more than 74,000 school nurses across the country.

“It is a very, very rewarding kind of nursing,” Amidon said.

sarah.janssen@jg.net

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