School Nurses Provide Wide Range of Health Services for Children

By Jean Yaeger

School nurse Lori Hamman provides first aid and comfort to the students at Wedgwood 6^th Grade Center who arrive at her office with assorted injuries and illnesses on any given day.

She treats nosebleeds, headaches and vomiting. She helps manage asthma flareups and the extremes of diabetic blood sugar levels.  At set times, she dispenses medication to students with chronic conditions like seizures or attention-deficit/hyperactivity disorder. Occasionally, an upset sixth-grader will need a few minutes in Hamman’s office just to calm down.

“It can vary from minor things to complex things like a broken bone,” she said of her job at Wedgwood, in the Fort Worth Independent School District (FWISD). “That’s kind of the exciting thing about being a school nurse.”

Rekha Sivadasan, M.D. at Cook Children’s Pediatrics in Frisco described school nurses as a valuable extension of the pediatrician’s office. Dr. Sivadasan hears from school nurses who may call to check on a patient’s immunization records, or to discuss a severe food allergy, or to alert her that a student has elevated blood pressure. Communication and collaboration – among pediatricians, school nurses, and parents or guardians – make the best approach, per Dr. Sivadasan.

“Ultimately, the child benefits to know that there are different people who have eyes on them to help the child feel safe, to feel cared for, to feel loved,” Dr. Sivadasan said. “If they know that there are different entities that are all working together to ensure their success and their good health, then I think that just adds to the security and confidence for the child.”  

Expert input shared by school nurses plays an important role in developing accommodations for students who have disabilities, Dr. Sivadasan said. Other critical duties may include reporting suspected child abuse to state authorities, and notifying help for a student who expresses suicidal ideation.  

 “If a child has something that is bothering him or her -- whether it’s physically, emotionally, behaviorally, mentally – the nurse is their go-to person at school,” Dr. Sivadasan said. 

School nursing is a specialized practice of the nursing profession. What difference does it make when school nurses work together with a child’s doctor and parents? The American Academy of Pediatrics explains: “Academic achievement, improved attendance and better graduation rates can be a direct result of a coordinated team effort among the medical, family, and educational homes all recognizing that good health and strong education cannot be separated.”

Tips for Parents

At Wedgwood, Hamman encourages parents to communicate directly with her at the beginning of the academic year if their child has a chronic condition. She enjoys the relationships formed when students come to her office.

“It’s a safe place,” Hamman said. “I don’t expect homework from them or written assignments or testing. They can just come in and relax and destress.”

Depending on the grade level, Hamman and her colleagues at FWISD encounter a wide array of ailments and issues, from playground bruises and wiggly teeth to drug abuse and pregnancy. Some students require specialized care for catheters or feeding tubes. Others turn to their school nurses for help with mental health. Meanwhile, the nurses are gearing up for the 2022-2023 flu season while continuing to check on students out with COVID-19. 

School nurses also implement screenings for spinal abnormalities, growth, hearing and vision. Hamman recalled one student who had trouble seeing the eye chart. 

“I made a referral and now she has glasses," Hamman said. "I rescreened her, and she can see 20/20.” 

We talked to a group of experienced local nurses about key things parents should know:

• Send any meds to school in the original packaging with a specific written request signed by a physician or licensed prescriber.
• If your phone number or address changes, or if your emergency contact’s information changes, tell the school nurse and data clerk. They might need to reach you.  
• Make sure the nurse’s office has your child’s most current shot records.
• If your child’s health history changes, tell the school nurse. This includes a new diagnosis or starting/stopping a regular medication. 
• Give signed permission for the school nurse to communicate with your family’s health care provider.

School nurses say their role involves social work, counseling, advocacy, record-keeping and disease prevention. Why do they love what they do? Here are some perspectives.

More than Band-Aids

Shannon Cooper, Director II for FWISD Health Services, said the biggest change in her 17 years of school nursing is the increase in diabetes, asthma and medications. “It has become so much more complex,” she said. Cooper said the familiar presence of nurses at school shapes in a positive way the students’ view of health care. 

Verby Nash, Health Services nurse specialist, recalled a few unusual situations in her experience, including a student with a bead stuck up the nose, and a teacher hit by a car during morning drop-off. As they gain the trust of families, school nurses might be asked to examine a baby’s rash or a grandparent’s blood pressure.

“We do what we can to help and assess,” Nash said. “We are not doctors. We cannot diagnose. We cannot prescribe. We are very, very careful about that.”

The nurses educate teachers and staff about various illnesses and what symptoms warrant a trip to the nurse’s office. 

“It’s not just Band-Aids and tummy aches, which unfortunately is still what some people think,” Nash said. “We are there to advocate for those students because if they’re not feeling good, they cannot be successful in class.”

Cassandra Miles, Health Services nurse specialist, said school nurses are a source of “safe, sound and appropriate” information when students come to their offices to talk. She considers it a privilege to serve children and teens from pre-kindergarten through high school graduation.

“For many students, we may be the only person who they see medically,” Miles said. “Or we may be the gateway to those resources in the community or to get to the pediatrician or the mental health provider.”   

Seventy-one FWISD campuses participate in free Goodside Health telehealth services. Morningside Elementary School nurse Sasha Dawkins said pointed out the benefits of telehealth appointments in reducing student absenteeism and allowing parents to stay at work.

One frequent challenge Dawkins encounters on the job is collecting the required vaccination paperwork. 

“It may take a few more phone calls or a few more letters to get parents to understand the importance of being up-to-date on their shot records,” she said. “Sometimes at the beginning of the year it can be a little bit of a struggle to get the documents you need.”

She welcomes questions and hopes to provide support and resources. And Dawkins feels motivated every day by the opportunity to help students. “I love making a difference in someone’s life. That’s the biggest joy for me. That is the reason I became a nurse.”