Under-appreciated challenges faced by all school nurses

National School Nurse Day is Wednesday, May 11. The following reflections on school nurses and their value to schools was originally published by nurse attorney Edie Brous and has been reprinted by permission.

A few days ago I had the honor and wonderful pleasure of having an extended lunch with a colleague I haven't seen in a few years. I have two school nurses who have always been my "go to" persons for school nursing questions.

I have represented many school nurses and have spoken at school nurse conferences for years, but have never worked as a school nurse myself so I have not been able to rely on my own personal experiences in that arena. I ask my school nurse gurus and friends, Jeanne Kiefner, and Carla Wolbach, for an opinion and to explain things to me and they have always been willing to share their expertise.

After years of representing and speaking to school nurses, it has become my opinion that school nursing just might be the most difficult and challenging specialty in the profession today.

One of the reasons for that opinion is that the public has no idea what school nurses actually do. More importantly, the nursing community itself does not understand their role.

It is not boo boos on the playground and immunizations. The student population does not consist solely of healthy children happily playing at recess and learning in structurally sound classrooms during the day, then returning to functional families in supportive environments and safe neighborhoods where they eat nutritionally sound meals and get adequate sleep.

For many school nurses, the students they care for have complex medical, social, economic, and emotional troubles. Survival itself is a struggle for some of these kids. Whether they succeed in that struggle or not can depend entirely on whether or not that school nurse is in place. Many school children have to contend with poverty, systemic racism, malnutrition, domestic violence, predatory gangs and substandard housing.

School nurses are the safety net and might be the only hope for an otherwise broken childhood. Elected officials and school administrators making economic decisions to cut funding for school nurses miss this simple fact: School nurses save lives.

Most nurses also don't understand the unique pressures school nurses face. They are more likely to report to a non-clinical person who doesn't understand nursing law or scope of practice restrictions. They are less likely to have the clinical resources or tools they need to do the job effectively or to be advised of practice standard changes. They work in isolation and cannot just go down the hall to get another opinion or assistance. If they are represented by a union, it is likely to be a collective bargaining unit that also does not understand the particular needs of nurses.

Some of the students are responsible for are medically fragile or have special needs. About one in three is on medication. Some have diabetes, asthma, seizures or other complex medical problems. The school nurse to student ratio is completely unmanageable in some regions and some school nurses cover multiple buildings over large geographic areas.

As an example, while at lunch with Carla, we discussed the lead toxicity situation in Flint, Mich., and the terrifying fact that in a city with a neurotoxin poisoning epidemic, there is only one school nurse for 7,000 students.

School nurses not only save lives, they also improve lives. The position of trust the school nurse holds means it is the school nurse the student is most likely to confide in when experiencing depression or mental health issues, abuse in the home, trouble with alcohol or drugs, pregnancy, or other life-altering situations.

It is the school nurse who is most likely to connect that child with the resources and services that can change his or her future.

We will never know how many adults do not have permanent psychological damage from undetected childhood sexual abuse or how many teen suicides were prevented because of school nurses. We can only imagine the number of adults who wouldn't be here to celebrate birthdays if a school nurse had not been there at some point in their childhood.

How many kids didn't drop out of school because a relationship with a school nurse gave them what they needed to keep going? How many more graduates were there because school nurses improved attendance rates? How many children, because of a school nurse, obtained the counseling or therapy they needed before it was too late to intervene?

We owe a debt to those front line professionals who face enormous political, bureaucratic, financial and regulatory pressures in caring for this country's children. It is a debt that cannot be measured or ever repaid in dollars.

Thank you, Carla. Thank you, Jeanne. Thank you to my own school nurse at Maple Park Elementary School who treated me for a concussion in fifth grade.

Thank you to all school nurses. Thank you for saving lives. Thank you for improving lives. Thank you for being there. Thank you for being school nurses.