Much More Than Band-Aids

Platteville School District nurse Mary Kay Logemann listens to the lungs of 2nd-grader Courtney Edge in Logemann’s office at Neal Wilkins Elementary School.

By Joanne M. Haas

Rita Simon is a school nurse who makes home visits, sometimes several in one day.

Recently, she visited a home to try to find out why a student in the Shawano Gresham School District was not learning.“I came to find out that the father is in Iraq and the mother is alone and a bit overwhelmed,” she said.

In her 26 years as a school nurse, the last 14 with Shawano-Gresham, Simon’s responsibilities have evolved as the medical needs of children “have changed drastically.”

Far from the “Band-Aid patrol” some may think, school nurses handle a lot more than the daily management of physical emergencies like dislocated shoulders, bloodied limbs or the sudden onset of a stomach ailment. They deal with mental health issues involving eating disorders, depression or suicide attempts.They also are key players in crucial school teams that make it possible for a child facing a serious health issue, such as a brain tumor or cancer, to continue learning.

When their usually jammed schedules allow, the nurses are in the classroom instructing students of all ages on topics such as personal hygiene, puberty, sexually transmitted diseases or cardiopulmonary resuscitation.They also sometimes perform blood pressure tests and set up flu vaccinations for teachers.

And, in recent years, a growing legion of parents without access to affordable health care or lacking health insurance have come to rely on school nurses for medical needs.

Mary Kay Logemann, the sole nurse for the five schools of the Platteville School District and the secretary-editor the 540-member Wisconsin Association of School Nurses, recalls the day a boy with a painful abscessed tooth showed up at her office. It was not a rare event.

“School nurses are on the front line,” Logemann said.“There are a lot of
kids in school whose parents are not covered by health insurance. I’ve had children show up and say, ‘My mom wanted me to see you. She didn’t know what to do.’ ”

Logemann, reflecting an attitude expressed by other nurses interviewed for this story, said:“I don’t know everything, but I know how to find out.” So Logemann went to work with colleagues and community resources to round up help for the boy with the toothache.

It’s that investigatory skill coupled with an independent ability to address any and every medical issue to surface at school that is key for today’s school nurses, who will be honored on May 11 during School Nurse Day. “We feel we are directly related to school learning,” said Cindy Weller, the first school nurse employed by the School District of Denmark.

‘Someone they can talk to’
Shawano-Gresham’s Simon has been a nurse for 28 years – 26 of them spent with schools. Her first two years as a nurse were with the University of Wisconsin Hospital and Clinics in Madison before she took a public health position and worked with schools in Bowler, Tigerton and Antigo.

Fourteen years ago, she joined the Shawano-Gresham district as the fulltime nurse and handles the district’s five buildings and about 3,000 students. Two days each week, she has help from another nurse, who she said helps immensely since medical emergencies cannot be scheduled.

And, as is common with other school nurses, she gets help from designated education support professionals. For instance, a student who needs insulin can get assistance from another designated person in the school if the nurse is not available.“I trust them completely,” she said of support staff. “They’re kind of like nurses’ aides.”

While she’s too modest to admit it, Simon is well known in her community— likely rivaling the popularity of a local physician. She’ll often get asked questions when she’s out and about on her own time.“I don’t mind,” she said.

“People have no idea what school nurses do,” she said.“You’re on call all the time. I get calls at home.”

Her focus is on the students, but she’s always there to help teachers also pressed for time, with blood pressure tests or other needs.

In Wisconsin, school nurses are not required to be certified by the Department of Public Instruction unless their district requires it. Simon, also active in advising DPI about school health policies, is certified by the department and recommends other school nurses do the same.

The school nurses association is active in arranging to have experienced school nurses serve as mentors to new nurses.

“We want to make sure they are not too overwhelmed,” she said.

That can happen, she said, as the student-to-nurse ratio is high.And as districts are facing tight budgets, all departments, services and staff—including school nurses—are subject to the sharp knife of a school board seeking financial relief.

Educating all students
Schools today try to make it possible for all children to be in school, even if they have severe medical problems. That may require a school nurse to devise guidelines for a teacher of a student with health problems or working with a family and the family’s physician on an in-school health care plan for a student with a serious health condition.

If the situation is severe enough, the student may come to school with his or her own nurse.

No matter what is needed, Simon said school nursing comes down to sharing information and teaching.

Her favorite duty is classroom teaching, when time allows. In the elementary school, she may be called upon to teach young students about hygiene and perhaps nutrition. In the 8th-grade classroom, Simon has been known to bring in guest speakers to talk about AIDS.And in high school, the topic might be cardio-pulmonary resuscitation (CPR).

“As the kids get to know me, they’ll come to me a lot,” she said of the relationship a school nurse often has with students.The nurse is neither the teacher who grades them nor their parents who discipline them, but a trusted professional.“The school nurse is someone to talk to.”

‘Full gamut of the life span’
Trained as a hospital nurse, Platteville’s Logemann ended up in school nursing, a job she says she absolutely loves.

As a Platteville Public Schools staffer, Logemann is the sole nurse for the district’s roughly 1,500 students in five schools – two elementary, one early learning center, a middle school and a high school.

A University of Wisconsin-Madison graduate, Logemann also worked in public health with schools north of Eau Claire before moving to Grant County, where she also worked in public health and handled the schools south of Lancaster.“I was on the road all the time,” she said.“I called it my ‘drive-by, say-hi’ school nursing.”

Echoing concerns by nurses handling multiple schools and hundreds of students, Logemann said of her former multi-district position,“There is so much you can’t do. I visited them once a week.You help with major things. And there are certain things they want you to do -- like hearing and vision screenings, and lice (checks). But follow up is hard.”

She held that public health job for about 1.5 years before the Platteville school nurse position opened, and she snatched it up.“The thing that is so different about school nursing is I work with people from 3 years old to teachers who are almost retired,” she said.“I have the full gamut of the life span.”

“I’m more of a generalist,” she said, although her specialty is pediatrics.

“The other thing I really like about school nursing is I really get to know the families over time,” said Logemann, adding she is now dealing with the children of former students.

Logemann said there are great rewards in crafting health care plans for children who are very sick, or who have a chronic problem, but can be managed to remain in school.“Kids used to stay home in wheelchairs,” she said.“Now, more kids with serious health issues are in school.And that’s the way it should be.”

Some children in school need to be catheterized; some were born with diseases such as spina bifida and require extensive care.“We take care of that in school,” she said.“A lot of people don’t realize the health procedures that happen in school. Kids are integrated.”

In the 1980s, she was a home health care nurse for a boy with a terminal brain tumor. Now, “We have kids with brain tumors in school, and they are with their friends. And we try to meet their needs. Part of that is having the parents trust us enough to allow us to care for the child,” she said. Plus, she said, it is good for the parents to see their children in school with their peers.

‘Directly related to school learning’
Cindy Weller is in her 9th year with the School District of Denmark, a district of four schools with about 1,600 students. She also is the first school nurse Denmark has employed.

“I work with pre-kindergarten through 12th grade,” said Weller, who has lived in a few places and worked in hospitals but wanted to get into community based nursing. “School nursing is a very independent practice ... and away from the illness-based model in the hospitals.”

Weller, also a board member with the state nurse organization, said school nursing is “getting back to the wellness base,working with kids and having an impact on their health.”

The range of issues for any school nurse is immense. For Weller, that range includes adolescent parents, asthma and allergy reactions, the school’s emergency response plan, blood-borne pathogen training, child abuse cases and more.

“Our day has a lot of variety,” she said. Coming into work in the morning with a specific agenda for the day never works, she added.

Health insurance and health care cost issues also are having an impact in her district, Weller said. She is seeing more and more children from families
caught in financial binds.

“I make darn sure these kids get to the doctor,” she said.“It is really hard for these parents. ... I have seen such an increase in the last three or four years.”

She, too, sees time as the biggest challenge facing nurses.“We try to catch the kid with health issues who may not otherwise be helped. Most school nurses are trying to catch those kids who no one else notices,” she said.“We feel we are directly related to school learning.”

‘It’s like a mini-triage’
The first hour of Lori Kawleski’s first day as a school nurse at Stevens Point Area High School began with an inoffice visit from a teen who said: “I think I kinda sorta had sex this weekend.”

“You never know what is going to come in that door,” said Kawleski. She
and Cyndi Desteffen, who are both Portage County public health nurses, share the school nurse position at Stevens Point Area High School, which has more than 1,800 students.

The two have different specialties—Desteffen’s is maternal child health,
meaning pregnancy and parenting, and Kawleski’s is communicable diseases.

“When you are in a school setting, you are in a different environment,” said Desteffen, who has been a school nurse for two years.“You are working with children who are going through tremendous change—physically and mentally.

“It is almost like a mini-triage emergency room,” Desteffen said. “People are depending upon you for that whole eight hours.And it is constantly challenging.”

The range of emergencies can include students who have an illness or injury that might have occurred off school grounds, and their parents aren’t sure if it can be treated at home or needs professional care. “It can range anywhere from ‘I have a sliver,’ to ‘I’m having a mental health crisis’ or eating disorders, or ‘I’m off my depression meds and my parents lost their health insurance so I can’t go in (to see a doctor),’” Desteffen said.

Both nurses say the loss of health insurance and increasing prescription drug costs have resulted in some people delaying treatments, which results in bigger problems down the road.

Kawleski, who has been a school nurse for 10 years, said she knew in high school that she wanted to be a nurse. While classroom teaching is not the primary focus of their jobs, they do teach a summer health course, and the students of that course work as health aides in the school’s office.

Not only are the student health aides a “huge cost saving” measure for the district, Kawleski said, these 20 high-functioning students also are earning class credits, gaining on-the job professional experience and serving a valuable role to their peers.

“High school students may feel more comfortable talking to a peer first,” Kawleski said of the student workers, who are monitored closely. Time is the big enemy of school nurses, they said. Desteffen said paperwork is always overwhelming. “We are pulled in so many directions that you can’t keep up with so many things,” she said.

The school nurse is a position that may not be understood, Kawleski said.

“There is a misconception that we are the Band-Aid patrol.While Band-Aids are an important thing, there is more to our job than that,” she said.

Posted August 16, 2005