Thank you Dr. Burbach...

Couldn't have said it better....

I am extremely concerned about a proposal to replace registered nurses (RNs) with licensed practical nurses (LPNs) in USD 259 schools.  My views are formed from 14 years as a nurse educator, 11 years in public health, and another ten years as a previous coordinator of school health in your district.   These views are consistent with leading professional organizations in nursing and national standards for school nursing, which recommend that only bachelors prepared registered nurses be hired in school nurse positions. 

Your charge to reduce the budget is indeed a challenging one, one I don’t envy.  I ache every time I see another news item about cuts to education funding.   Regardless, the decisions you make must be well-informed and based on consideration of exposure to risk in several areas.    

·         Financial – My assumption is that replacing RNs with LPNs has been suggested for no reason other than financial savings to the district given lower cost.    However, until current revenue sources for nursing staff are thoroughly analyzed, a simple savings-by-lower-salaries represents only one variable in the financial equation.  The Medicaid reimbursement you currently realize for payment of nursing services for special needs and potentially regular education students is most likely not eligible for LPN services.  The loss of that income must be weighed against estimated gains by decreased wages. 

·         Legal – Kansas law specifically regulates the practice of RNs, LPNs, and unlicensed (non-nursing) personnel such as your teachers and school secretaries when delegated to perform nursing tasks.   KSA 65-1113(d)(2) sets qualifiers for LPNs related to their supervision by an RN, the type of care they may provide, and the required match between their educational preparation and expected activities.   Additionally, KAR 60-15-102, in prescribing how RNs may delegate nursing activities to others, expressly includes language about LPNs and their delegation authority.  It is a given that nursing activities will be delegated in schools; it not a given LPNs can do it.  The district does not need a major legal battle after you’ve placed legally unqualified people. 

·         Supervision – The law clearly states that LPNs must be supervised by RNs, so unless you plan to assign them as assistants in buildings with RNs, they are not likely to receive the supervision their license requires.   Closed clinical environments such as hospitals and doctors’ offices provide adequate supervision, not schools where they are the only health staff.  In my capacity as coordinator, I felt keenly our inadequacy in supervising school nurses.  They called their peers and me often for advice, but never knew the luxury of in-building supervision and mentoring, except for the principal.  Most principals generally know a good nurse when they see one, but they clearly are not qualified to judge their clinical decision-making and technical skills.  Even in the coordinator’s position, I supervised from afar by proxy measures of reporting, recording, and secondary evidence of judgment calls.  Responsibility for principal supervision and evaluation of LPNs only makes this phenomenon more worrisome, not to mention the expectations of principals after years of relying on bachelors prepared nurses.

·         Scope of practice—The role of an LPN in our health care system fills a legitimately well-trained need for technical nursing skills.  However, this is not consistent with the role of a bachelors prepared RN in a school setting.  The aforementioned Kansas regulatory language states that LPNs function “within the framework of supportive and restorative care.”  Language about the scope of registered nurse practice is lengthy and describes a much broader and substantial expectation of assessment and actions, including wording about diagnosis, treatment, counseling and health teaching, management and supervision.    Comparable differences exist in the practice of advanced register nurse practitioners, who function in an even more expanded role and may prescribe medications.   Environments and expectations should match qualifications and scope.  Just because nurse practitioners can diagnose and prescribe medications does not mean they should be doing major surgery.

Look at your current school nurse job description and ask yourselves whether this level of performance can be met by a licensed technician with one year training.  You currently have twelve board-approved policies under the responsibility of Health Services and school nurses.   Many of these are absolutely incompatible with the qualifications of an LPN.  Much of the practice of a school nurse is assessment, a skill LPNs simply aren’t schooled in.  The technical skills LPNs are trained for are also used by RNs, but only as a part of the larger health situation.  When faced with cuts to nursing services in San Diego, Linda Davis-Alldritt of the California Department of Education was recently quoted in a San Diego paper.   She stated, "I could teach you how to give an injection, but I couldn't teach you in a day how to assess that person to make sure they need that injection."   Our school nurses are constantly assessing your students and their needs for the next action. 

The evolution of the H1N1 flu pandemic and its spread across the US includes the powerful story of a school nurse who discovered a first-of-its-size outbreak of H1N1 in this country in a NYC high school.  To quickly discover and contain the massive numbers of sick students and staff, she expertly used skills of physical assessment, communicable disease investigation, epidemiology, and people and system management, all the while humbly claiming that she was “just doing her job.”  This is the job of a much higher qualified person than an LPN. 

·         Safety – Every day committed teachers, nurses, and non-certified support staff reach above and beyond their job descriptions, many time at the limits their professional capacity to serve students who need their help.  It is likely that good LPNs would do the same.  However, if they lack the training, expertise, or legal authority to care for the health care needs that arise, but attempt to respond anyway due to supervisor expectations and their own commitment to helping, they risk student health and safety, place the district in a legally precarious position, and put nursing licenses in jeopardy, both theirs and the RNs who supervise them.

·         Education – Education is your business; so, not surprisingly, it is valued.  School nurses reside on the same pay schedule as teachers, where increased education is rewarded, albeit insufficient to pay the tuition it costs.  Like teachers who are required to regularly take coursework to maintain certification, professional nurses are required to regularly take approved continuing education to maintain licensure.   Many of your nursing staff have earned masters degrees; the more senior nurses possess a school nurse certificate, obtained by post-bachelors coursework. 

After rigorous entrance requirements, minimal education of a bachelors nurse includes a broad base of liberal arts and sciences, including supportive coursework in natural sciences, social and behavioral sciences, nutrition, pharmacology, ethics, and possibly child growth & development.  Nursing curricula include pediatrics, community and public health, health promotion & teaching, leadership training, and significant preparation in assessment skills—all providing a perfect foundation for the needs of school health.   USD 259 hires predominately bachelors prepared nurses over the alternative 2 year ADNs.  Will you consider cutting back two-levels to licensed technicians? This hardly speaks to value placed on education by an educational institution. 

·         School support – The school nurse is a vital member of an educational team that includes principals, teachers, and professional staff such as psychologists, counselors, and social workers.   These individuals benefit from years in the school environment and education in education.  Members of the Child Study Team, for example, most of whom are masters prepared, function as the school nurse’s peers.  LPNs typically get one year of training with no requirements for college work.  How will they ever be perceived as peers, contributing equally to the important team work of problem solving, leadership, and school improvement?   

·         Student welfare and achievement – Your mission statement clearly emphasizes learning and student achievement, both of which are highly dependent on their social welfare, health, family support, and readiness to learn.  School days lost to many related factors, including illness, all contribute to less learning, lower scores, and lack of achievement.  While schools do not choose to become families’ major source of health care, unfortunately this is often the case, and the very children who are at most risk for under achievement are most dependent on school nurses to do everything in their power to keep them in school.  This can only be done by someone with qualifications for comprehensive assessment and care.  It has been shown that on days when a qualified school nurse is not in the building, more children are sent home for developing symptoms that otherwise might be assessed and managed by the nurse, allowing the student to stay.   It is also possible that EMS (and thus hospital emergency departments) may be over- or underutilized by non-professional staff, due to their lack of assessment skill.  This can be avoided with the use of qualified nursing staff. 

·          Responsibility to parents – In my position as coordinator, I regularly spoke with parents who were either new to Wichita or new to schooling of their young children.  Parents of children with chronic health conditions were pleased to know that USD 259 provided school health services, but were then bothered learn that not every school had a nurse, or not every day of the week.  What happens to the brittle diabetic on that day the nurse is not there?  What are parent options?  Do they get to choose a school that has a nurse every day?  Do those schools deserve to have more of the community’s chronically ill children?  If my child has severe asthma, do I know if my particular school has an LPN, or an RN who’s been trained in the assessment and care of asthma, a major condition seen by school nurses?  LPNs have no training in assessment of mental health conditions, which are increasing steadily in our school children.  Sadly, the current epidemic of obesity in children already exhibits itself in blood pressure and heart conditions in our youth.  These are conditions and children that deserve the attention of a highly qualified clinician such as your current bachelors prepared nurses.   The acuity level of many children is worsening.  That trend will not change any time soon.  Now is not the time to risk potentially serious outcomes. 

Cindy A. Burbach, RN, DrPH

Apples and oranges...

Ever have one of those conversations with someone and you realize, at the end of the conversation, each of you were talking about something entirely different?  Even though it sounded like the same thing? That's what it's like talking to people about the importance of having RNs in schools versus LPNs. 

If you've been following the Wichita Eagle article about RNs in schools, as well as letters to the editor, you are probably wondering what is the BIG DEAL?  You're probably saying, why is it necessary for RNs to be in school?  They are more educated, and cost the district more.  Why can't a caring person fill those shoes?  While frustrating to those who are licensed RNs, it does have some validity. 

I didn't become an RN until I was 34 years old.  I had always planned to be an RN, from the time I was about six years old.  But life got in the way.  So, when I was 32, I applied to nursing school, got accepted and went about my studies to get my associates (2 year) degree in nursing.  At the time, Newman University had just merged with St. Mary's of the Plains School of Nursing, which was a Bachelor's Degree (4 year program).  After graduation, I readily got a job in a hospital working in an area I had dreamed of.  I loved my job, loved taking care of my patients, and believed that I was just "as good" as those nurses with a BSN.  I dared to think that I would pit my technical skills against a BSN prepared RN anyday. After a few years, I had the opportunity to work at Newman in the nursing program, and while there I pursued my BSN.  The first nursing class was such an eye opener.  The realization that this degree was so much "more" than the technical degree I had received earlier, began to dawn on me. And the lights went on for me that this education really was the key to becoming not just a good nurse, but a great nurse.  I began to learn about life for "patients" outside the hospital setting.  The idea of community, continuum of care, intervening in the "whole" person, were concepts that I began to embrace and pursue.

So...apples and oranges.  LPNs are trained in the "technical" aspect of nursing.  Their education was designed to be a "helper" to RNs or doctors, in the busy hospital setting.  The ability to work automously is not a part of their education, or the expectation of their profession.  LPNs work very, very well with RNs in a hospital, or physicians in a doctor's office.  I've had the privledge of working with many very qualified LPNs in the hospital and homecare setting.  But, they worked in conjunction with me, my skills guiding their decision making, my knowledge guiding them in thier tasks.  Never by themselves.  And this is what "people" don't understand about RNs in schools. 

The first year I worked as a school RN, I was astounded at the "alone-ness" I felt.  I was used to having doctors telling me what to do and other RNs to lean on.  I quickly realized that this job would take all of my skills to perform and provide for children, families and staff.  I had to call on all the education, college and otherwise, that I had learned through the years.  My knowledge of hospital, physician and community services were called into play everyday.  I was the "go-to" person for families and staff when they had a medical question.  I utilized every assessment tool I had been taught by professors, other RNs and physicians.  And I did it outside of the health care system, with no physician to give me orders, no protocols to follow, no algorithms to adhere to, no RN by my side.  This is the real issue here.  The ability to work outside these "normal" situations.

LPNs have a very valid role in our world.  They are trained to work in close conjunction, with RNs and physicians, in nursing homes, medical offices and homecare.  But they are not qualified to work autonomously in a school setting without someone near them to help guide their interventions.  So, apples and oranges.  Just because they are both a fruit, they are not the same.

The RNs in Wichita schools are working hard everyday to educate the public.  It's a difficult task, but in the words of a phenomenal school RN, "It's only 50,000 kids."

My voice...

Politics is something you either love or you hate.  I guess there are those who love to hate it.  Regardless, it's the way things get done in our society.  We listen, read, make a decision, then vote for the candidate of our choice.  That's how it's supposed to work in a democracy, right?  But what if you have no voice?

People who live in poverty often have no voice.  While many of us who have been educated, or have chosen to educate ourselves, vote every chance we get, there are millions who don't.  And probably have no desire to do so.  So what to do about those who have no voice, and sometimes, no inclination to develop that voice?  Do we ignore them?  Or do we use our voice to speak to them and for them?  It's a disconcerting dilemma.

Reading the comments posted on theWichita Eagle website regarding the article by Suzanne Tobias, I'm worried.  I've been worried for some time now about what the future holds for my grandaughter, and future grandchildren. I'm worried about the financial state of our country, like many.  But I think I'm equally concerned about those without voices.  Because this group is growing larger every year.  More children live in poverty now than ever before.  And the chasm between those that have, and those that don't, continues to increase. 

Using one's voice to speak for others isn't something that comes easily to most.  Many people are worried to share their thoughts or their views.  The fear of insulting someone, fear of feeling alone with your beliefs, even fear for a job will prevent people from speaking out.  I wouldn't categorize myself as one of those people.  Much to opposite and probably at the cost of pushing people's buttons and most likely, pissing people off.  But what if the button I push is the right one?  What if getting under someone's skin makes them think outside their safety net, and think a little differently about an issue? What if, I actually change someone's mind?  I cling to the hope that I can do this.  Especially for kids.  I've seen too much in the past ten years, to be quiet.

I had coffee today with a wonderful gentleman who is running for school board.  He is a retired business man, and most likely, he and I probably don't share many of the same political views.  But he is beginning to see the bigger picture of what public school districts have become in the past fifty years.  They are nothing more than a reflection of our society as a whole.  As more people live in poverty and use (or misuse in some cases) government assistance, this spills over to schools.  With the advent of special education, FAPE, ADA and many other government mandates, schools have become the repsitory of many of societies ills.  Children are hungry, physically and emotionally.  Their lives are filled with constant change and chaos.  They lack medical and dental care, and the adults in their lives are developmentally unprepared to be parents.  These children are fundamentally unready and ill equipped to be students who do well on state testing or with school expectations.  Yet, we continue to take away and take away from them in one of the only places where they have the most opportunity to thrive, their school.

Abraham Maslow proposed in a 1943 paper, that the most fundamental needs of a person are physiological.  The other needs are security, friendship and love, and esteem.  When these needs aren't met, an individual is not capable of having the strong desire or motivation to reach what he called "self-actualization."  This category includes morality, creativity, spontaneity, problem solving, lack of prejudice and acceptance of facts. Sounds a lot like school expectations. Herein lies the need for RNs in schools. If we help a child to have his physiological needs met, we help him to begin inching his way along this heirarchy and hopefully able to become a life long learner.

If you've been following my blogs, you'll see I've been criticized by someone who believes that the school RNs opposition to giving over the counter medications with parental consent only, has hurt the cause of keeping RNs in schools.  I wish it were that easy to explain.  School RNs in Wichita are acutely aware that their are children who live with pain and suffering every day.  We've seen their mouths full of rotten teeth.  Their headaches from the stress of their family lives.  The lice, the filth, the mildewed clothes. We've seen the anxiety, depression and mental health issues that is occurring in far too many children, far too young.  And we know, because we are RNs, the physiological reasons these things are occuring.  We recognize Maslow's theory in reality, and we work as hard as we possibly can to reach out and make a difference. 

Have you heard the story about the beach filled with starfish who were washed ashore during a storm?  A man walking along the beach saw a little boy throwing a starfish back into the sea.  The man approached the boy and said "Why are you wasting your time?  It won't matter because all these starfish will die."  The boy looked him in the eye and replied, "It mattered to that one."  So, I use my voice....

Allergies, asthma and meds...OH MY!

Just a short entry tonight folks.  I plan to have a regular bedtime...emphasis on the word plan!

WPS RNs continue to work hard to educate people about the safety and medical needs of kids in schools.  We opened the dialogue with the BOE members last night with a speaker from Newman University.  Bernadette Fetterolf, RN, PhD, spoke before the board regarding the high needs of pediatric "patients" and the importance of the continuum of care between physicians, hospitals and community settings (like schools).  She also emphasized the vast difference between LPNs and RNs in schools.  A huge thank you to Bernadette, who for those of you not in the know, is THE pediatric go-to RN in the state of Kansas.  And a fantastic teacher!

The title of this blog just barely touches the surface of health issues children deal with in schools.  The tasks associated with these conditions, are the "things" people associate school RNs with.  (That and those damn bandaids!)  Nursing is so much more than a science.  It's an art.  As I sat with Bernadette last night, we talked about her current nursing students and the differences she sees between the students now and when I was her student.  She talked about the loss of passion for the art of nursing.  Maybe, I decided, that's because we've become such a technical world.  And because of the technical aspect, and the science associated with it, nursing has become more of a job, a business to be done.  I'm sad that the passion for the art of nursing is being lost.  Because it is this passion, that I carry so deep in my heart.  A passion for children, and the need to make their world a better place.

Dreamius was a kindergarten student at our school who came on the first day.  He rode the bus by himself.  No excited parent with him to meet his new teacher.  No big sister or brother to show him to his room.  Just his little five year old self, clutching a note in his hand.  Looking lost, he handed the note to an adult, who immediately brought him to the health room.  The note, written in rudimentary hand writing with spelling errors, said "Dreamius can't have no nuts."  Peanut allergy.  One of the school RNs worse nightmares.  Peanuts or peanut products are in everything.  School lunches, treats in the classroom, birthday party treats, after school food fundraisers, and on and on.  And to exacerbate the allergy, most kids have a severe case of asthma to accompany it.  I immediately called Dreamius' dad, who I finally reached after a couple of hours of trying different phone numbers, leaving messages and playing phone tag.  All the while, worrying about Dreamius in his new classroom and having no emergency medication at school for him.  I worried about what he would eat for lunch, would he have a reaction to someone else's lunch, developing a plan of action in the back of my mind for that emergency I feared would happen.

When I finally talked to Dreamius' father, he told me that they had just moved to Wichita from western Kansas.  They hadn't been in town long enough to find a doctor, much less get Dreamius' medical card transferred to this part of the state.  He also confirmed that Dreamius had asthma, but had no asthma medication or emergency allergy medication that could be brought to school.  Besides, they had no car and no money for the bus or cab to bring them.  I kicked into high gear, calling a community case manager from one of the local hospitals.  Within a few hours, Dreamius had a physician appointment, arrangements were made to get his medications, and a cab voucher was received so that Dreamius' dad could take him to the doctor the next day.  We made it through that first day of school without mishap or emergency.  We found some food that Dreamius could eat for lunch.  I followed up with his father to get special lunch paperwork filled out, his medications at school and an appointment with the asthma clinic to be evaluated. (I could hear Dreamius' wheezing through a wall when he arrived at school each day.)  There were many times throughout the first few months that I made home visits to help Dad sign papers, get to doctor appointments and educate him about Dreamius' severe asthma.  At his first visit to the asthma clinic, Dreamius was diagnosed with "status asthmaticus," one step from respiratory failure and possible death.  It was obvious that Dreamius and his allergies/asthma had been neglected for a long time.  

I tell this story to emphasize a point.  The art of being a registered nurse includes having the knowledge of the science behind allergies and asthma.  And it doesn't just include understanding of community resources.  The ability to assess and intervene is part of the art, but passion is at it's core.  Passion to help, no matter what it takes.  Passion for a child to breathe comfortably and safely at school so that they can participate fully in their school day. 

When I first started as a new nurse, I was offered jobs at all three hospitals in Wichita.  I chose one of the Catholic hospitals because of thier motto..."That which you do to the least of my people, you do unto me."  That's my mantra.  Wish I could get others to see that too.

Night all!

Just trying to keep kids safe...

When RNs work in hospitals, it's pretty easy to quantify what they do.  They have an assigned patient "load." They perform assessments, administer treatments, medications, interventions.  They have "outcome" expectations related to infection control, discharge, etc.  There are consultants and nurse directors who determine how many patients can safely be handled by one nurse.  These are issues that require understanding and knowledge of safety.  Safety for patients.  Safety.  It's a word that needs to be explored in the school setting.

In it's infinite wisdom, our legislature has decided to cut funding for public schools, to the point that safety of children will be a very important concern.  Legislators think that schools are overfunded.  They believe that there are too many "people" in schools.  Too many administrators, too many support people, too many this, too many that.  How do they know I wonder? Are they education experts?  Do they understand the population of our public schools today?  Have they visited a school lately to see?  Frustrating topic.

I've been really lucky in my professional life as a school nurse.  I've had the opportunity to participate in the Nurse in Washington Internship (NIWI).  I've served as a member of a national school nurse committee affiliated with my union.  I've lobbied on Capitol Hill, and in Topeka.  I've spoken before legislative committees and the Board of Education.  I've presented at a national EPA conference and participated in a CDC study of registered nurses in schools.  All of these opportunities have helped to form my understanding of the importance of registered nurses in schools.  It's also served to further my understanding that the public, the legislators, the board of education members, and even school administrators, really don't understand what a nurse "does" in a school.  The ability to "quantify" what a nurse does in a school is a difficult challenge.

Attend any school board meeting, you will hear about testing results, No Child Left Behind, new initiatives to reach students who aren't learning.  Graduation rates, math/reading proficiencies, all the things that quantify an education.  This is the language of learning.  The quest to produce life long learners.  And unbeknownst to most, health and safety are the integral missing piece.  For if you don't have those two components, life long learning cannot happen.

In Wichita, the BOE is trying to cut $30 million dollars from their budget for next school year.  Because of legislative decisions, public funds for education are being decimated.  And in an effort to keep the most amount of dollars cut, away from the classroom, support people such as Registered Nurses are being considered a luxury.  The inability to quantify the registered nurses role, thier positions are seen as non essential, and employees with less education looks to be a good decision to those making the decisions.  Decisions being made by people with no medical background and little understanding of the health and safety needs of students. 

I talked to a school nurse tonight after the BOE meeting and he said something that highlighted this issue.  He told me that the "tasks" he performs at his school (medications administration, bandaids, vomiting, etc.) take up the least amount of his time.  Dealing with the social and psychological issues facing students consumes the largest amount of his day.  The problems that children bring to school with them are, at times, unsurmountable.  They bring hunger, chaos, violence and abuse with them everyday.  They are just children, and have no defense against such things.  There is much new research about how stress affects young brains, but I'll save that for another day.  Registered nurses have the unique education to address these problems.  There are counselors and social workers in schools too, but none of them have the exact scientific background to help children with these issues.  They require so much more than a bandaid.

Ryan was a kindergartener at my school many years ago.  He was a very bright, articulate little boy with dark curly hair and a smile that matched his enthusiasm for school.  Ryan was what we in the business, call a "frequent flyer."  He was in the health room for a myriad of complaints. Frequent tummy aches, frequent head lice, frequent cleanliness and hunger issues.  One day he came to me complaining of not feeling well and asked that I call his grandma.  He had a fever and needed to be sent home.  I knew he lived with his father, and offered to call his dad, but he cried and begged me to call his Mimi in Oklahoma.  I didn't have this phone number, but did have the number for his other grandma in town.  I made the call and asked grandma to pick him up, but also asked her why Ryan wouldn't want me to call his father.  Grandma told me that Ryan was new to living with his father.  He had been raised by his maternal grandmother in Oklahoma until his father found out about him when he was four.  Evidently, Ryan's mother hadn't told his father about Ryan's existence.  When his father found out, he insisted that Ryan live with him in order to avoid financial support orders.  So, Ryan went to live with a man he didn't know, after being raised in a loving home for four years.  Ryan's grandma told me that she didn't want to "tattle" on her son, but she asked me to please visit Ryan's father's house to see how Ryan had to live.  In the meantime, she picked Ryan up and took him home with her.  Home visits are one of the things that school nurses do frequently, that aren't written down, and therefore aren't a number that can be reported on a report for administrators to interpret.  The social worker at my school and I, went to Ryan's father's house.  It was a very small house that sat way back from the street in our school's neighborhood.  There were broken down cars, batteries and empty propane tanks littering the yard.  The windows were covered with heavy blankets.  His father answered the door and the stench from inside was palpable.  We weren't allowed in the house, and with concerns for Ryan, and evidence of possible drug manufacturing, I called our local police officer to further investigate. Because of the conditions of the house and living situation, Ryan was removed from his father's home.  Police reported that there was no indoor plumbing, so Ryan crawled out the window in his bedroom to defecate and urinate at night.  His father, in an attempt to make money, was raising rats to be sold to laboratories.  Unfortunately, he had allowed the rats to become feral.  Ryan was found to have numerous rat bites on his arms, legs and feet.  I was subpeonaed to court to testify on Ryan's behalf in a custody hearing, but was never called.  Ryan's father relinquished custody to Ryan's Mimi in Oklahoma.  A few months later, Ryan's Mimi from Oklahoma called me.  She wanted me to know that Ryan was doing well and excelling in school.  She also told me that she was a Registered Nurse and that whenever she talked to Ryan on the phone, she told him to tell the nurse at his school what was happening at his father's house.  And Ryan, in his kindergarten way, only knew to come see me and complain of various aches and pains.  He didn't have the words to tell me of the filth and terror that he lived in every night.  His Mimi told me that I saved his life.

I have an almost three year old grandaughter who calls me Mimi.  In honor of Ryan.  I think about him often.  I think about how he endured almost two years of feeling like his world had been torn out from under him and not knowing how to fix it.  And I am grateful that because of my nursing knowledge, my understanding of growth and development, I was able to help him.  Safety.  It's an important word.

How I got here...

First of all, THANKS to those who've decided to follow my blog.  I'm feeling very "techhy" these days! 

I started this blog because I wanted to try and get people's attention.  I wanted people to "follow" me and let me tell them about Registered Nurses in schools and the wonderful resource and support they are to kids in Wichita Public Schools.  But now, I'm thinking, maybe it's a little more personal than that.  Maybe, it's my attempt to validate who I am, what I did and what RNs continue to do for children in schools.

When I started my journey into school nursing, I really had no idea what I was getting into.  I was like the rest of the public, and probably like the rest of the "real" nurses in hospitals.  I thought it would be great to have weekends and holidays off.  I kinda thought that it wouldn't be as time consuming as my home health job at the time;  It'd be much easier on my feet than the hospital job I had.  Man, was I ever wrong.

I started out as a substitute registered nurse for WPS.  There were no openings, so I subbed as often as I could.  I'm trying to remember where my first assignment was, and I think it was at Truesdell Middle School in "South City."  It may not have been my first assignment, but it's the most memorable.  Truesdell is a middle school of close to 1000 students.  I think at the time, there were three or four students with Type I diabetes, so many kids with asthma it was hard to count, and tons of psych drugs to give at lunch.  There were also two students who were in a classroom of SMD (severely mentally disabled) children who needed tube feedings.  I remember walking through the hallways of this '60's era, institutional type school, and thinking to myself..."I'm the only one in this school with any medical background.  And I'm in charge of the health and safety of these kids and their teachers."  I wondered what in the world I had gotten myself into.  The kids in the SMD room were very low functioning, with about one adult for every three or four kids.  I was told by the teacher that the children would be taking a field trip to the grocery store that day.  Evidently, they took a field trip most days.  I asked to meet the children with feeding tubes and was introduced to two very sweet, very fragile children, kids I'd only seen in a hospital setting.  They didn't really respond to my interactions, but appeared happy and well cared for.  Their feedings took time, so, while waiting I assessed their breathing and skin, looking for evidence of overfilling their stomachs, or of reflux. Looking and assessing that their skin was not breaking down because of being positioned wrong in their wheelchairs, or because they had been in one spot too long.  This is what is called the "nursing process."  Registered nurses learn this process throughout their education. It's a process of constant assessment of the different functions of the human body and to look for abnormalities.  While performing this vital function, the registered nurse is also taught to begin identifying any areas of concern, to understand and know the physiological process behind the abnormality and planning how to address it and intervene.  This is one of the greatest "unknowns" among non medical people...what is it that nurses "do."

As I walked back to the health room, I heard them before I saw them.  Approximately twenty kids in the hallway outside the health room, waiting for my return.  Some of their needs were trivial, yes, the dreaded boo-boo, even at this age.  But some were overwhelming.  One boy complained of soreness on his foot.  He took off his shoe and revealed a sockless foot that was macerated and peeling with open sores along the bottom of his foot.  It appeared that he had started with a bad case of athlete's foot that hadn't been attended to, and had become infected and needed to visit the doctor.  A call to his parent revealed that they had no insurance and felt they had no other recourse than the local emergency room.  I worked with his parent to find a low income clinic where this student could be seen.  I washed his feet with warm soapy water, wrapped his infected foot with guaze and waited for him to be picked up.  While this was happening, I was working with the diabetic students whose blood sugars were not within normal ranges; calling parents for guidance; listening to lung sounds, and dealing with the non stop health room traffic.  I was by myself, assessing these students, prioritizing their needs, making phone calls, administering medications, making decisions about calling an ambulance for a student with asthma and conferring with the office personnel to make arrangements for students to go home or back to class.  I believe I saw forty to fifty kids that first day.  Of course, many of them had figured out that a "sub" was in the health room, and it was probably an easy ticket home.  And they were probably right.  I was trying to keep my head above water and make sure no one died that day.

Have you ever been to a foreign country?  Or a place where no one speaks your language?  As registered nurses, we are "raised" to speak a new language.  One that includes lots of acronyms based in the Latin language.  These include "PRN, BID, QOD" and many others you've probably heard shouted on those doctor showson TV.  Ours is a language specific to medicine, and when we work in medical situations, everyone there understands us.  Education, however, knows none of this language.  And why should they?  They have their own: FERPA, FAPE, IEP, MTSS, and so on. So, you learn this new language, all the while using the one you grew up with, and trying to figure out how the two can possibly work together.

And then it happens.  One day you're in your car on the way home and you realize, "I made a difference in the life of a child today.  A real difference."  It may have just been that hug you provided to a distraught kindergartener who lost his first tooth.  Or to that sixth grader who started her period for the first time.  But most likely, the greatest difference you made was that you helped a family find a physician who diagnosed a previously unknown, life threatening heart condition/blood disorder/cancer/broken limb/or child abuse.  And you know, just know, that you really did save a life today.

About me...

I'm a retired registered nurse who worked in Wichita Public schools for almost ten years.  I began my career as a labor/delivery nurse and thought I had found my passion, but things change, and so did I.  I found my passion in elementary schools where there are so many kids who need the interest and dedication of a registered professional nurse!

So, I know you're thinking, "What a cushy job....bandaids and boo-boos."  And guess what, we do some of that.  But in the middle of those bandaids and boo-boos, you find out that there's no food at a house, or someone there is hurting them.  One of my first little ones told me how his Dad had "friends that live under the highway" and came to their house to "smoke."  He continued to relate to me that one of these "friends", tied him up and hung him by his ankles from the ceiling.  I remember his name.  I remember what he looked like. I remember the bruises and rope burn marks on his ankles and wrists. And I'll never, ever, forget the house he lived in.  I went to his house with a school colleague and found no food, no heat, and no working plumbing.  There were cockroaches on the countertops, and wet clothes molding in a big barrel.  the house smelled of urine and feces. We called Wichita PD and the kids were removed from the home.  If he hadn't come to the health room with a boo-boo, I'd never had the chance to ask him about the bruises on his ankles, arms and neck. I'd never had a chance to ask the right questions, or assess the situation.

This blog is to educate you about the too, too many children in Wichita schools, who need professionals to intervene in their lives. Professional school nurses do so much more than put on bandaids and hand out ice.  They save lives.