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Alliance Times Herald

School Nurses: Care and Education Outside the Classroom

By John E. Weare

Tummy ache after lunch, bloody knee at recess? See the nurse. The student may feel worse and wait for mom to head home or return to class sporting a bandage, but not before an examination. School nurses know their patients and have an essential role that may not be as visible to the public as a teacher, coach or principal.

Thirteen years of public school without occasion to see the nurse at least once is not quite as uncommon as perfect attendance though a close second when hearing from the perspective of the three Alliance Public School nurses. Karen Aerts-Curtiss has been treating her second generation of children for some time after nearly 30 years at APS. Rayann Tolstedt has spent a decade in the district watching her first patients grow up. For a time she worked both at the hospital and at school. Some of her favorite memories were seeing kids at school and being there to treat them at night in the emergency room. At three years, Christina DeBaca is the junior member of the team. Unlike hospital or clinic employment school nurses do not work under a physician.

All three have different backgrounds and reasons for entering this area of their field. Tolsteadt transitioned from a hospital setting working pediatrics. “(You) have to see kids leave and not know what happened to them (afterward),” she said. “I like to see the kids on a daily basis then grow up from early childhood to graduation.”

The women split the workload, two working per day. Each takes one of the elementary schools and either the middle school or high school. Likewise, one nurse covers Early Childhood and the other the alternative school. Aerts-Curtiss said they are also on call for the other three buildings. She said it is not unusual to get a call and “go back to the building we left.”

School policy, state laws and the Department of Health and Human Services all dictate a school nurse’s job description. Tolstedt explained if the situation needs further assessment they call a doctor. Keeping current on new laws is essential. Continuing education requires 20 peer-reviewed continuing education credits and basic life support training every two years.

How often they usher a patient into the office varies. “Some days it’s a revolving door,” Tolsteadt said. Patient-teacher conference days “we don’t see anybody,” Aerts-Curtiss countered. They greet more younger students, 10-35 on average a day, than at the high school where, “they take care of themselves better,” Tolstedt said, and when needed what the nurses do is more complex.

Few visits mean a trip to the hospital, yet injuries do happen, DeBaca said. Seeing a nurse without a valid reason is also uncommon. Aerts-Curtiss said, “Teachers get a good feel for kids in the classroom,” usually knowing who is likely to be “faking.” DeBaca recalled a child who really was sick and threw up in her office.

Schools are aware of potential emergency needs. AIRE (Emergency Response to Life-Threatening Asthma or Systemic Allergic Reactions) protocol is specified by the State. Tolstedt said staff and first responders are trained, adding there is (at least) one student at each school at risk. “I feel EMS is really good (with a) quick response rate, and work really well with staff,” Tolstedt said. The nurses strive to identify students with asthma and allergies and work to intervene before symptoms escalate. Two laws are in place that allow older students (usually middle school grades and older) to carry medical supplies.

Certain children come daily because of health needs, such as medical treatments (specified in their health plans). Since the nurses’ availability is limited, Nebraska’s Medical Aide Act is meant to compensate by allowing school staff who are trained to give medication.

Frequency does not mean visits to their offices become predictable. Aerts-Curtiss and Christina De Baca agreed there had been something they had not seen before every year. “Even if it’s something you’ve seen before, not quite the same way,” Aerts-Curtiss said.

Since the late ‘90s, Aerts-Curtiss has seen a lot of change. Immunization is an example she cited. “Since I started chronic diseases have grown. I don't know what it is,” listing what had been considered conditions for adults such as diabetes, the biggest increase for Type 2 and a rise in Type 1. The district employed one full time and one part-time nurse then. Aerts-Curtiss said there were more students but fewer daily medication and care plans.

Nurses continue to play a unique role in education aside from day-to-day medical care. Aerts-Curtiss mentioned health classes for seventh and eighth graders, segregated by gender, including specific afterschool offerings for young women. She said the curriculum goes beyond “sex ed,” to teach healthy living. They are required to teach about HIV/AIDS and dating violence. “A lot of things nobody knows what to deal with and shuffle our way,” Tolstedt said.

School nurses know somebody will need their help every day, however, “(You) never know what’s going to walk through your door,” Debaca said.