topic Re: Health care at schools in Community Chat

Health care at schools

feline groovy — Thu, 11 Apr 2019 23:40:18 GMT

it often does take a village

The school nurse is often still out as kids' health problems like suicide, allergies soar

USA TODAY

Published 6:00 a.m. ET April 11, 2019 | Updated 1:40 p.m. ET April 11, 2019

The health clinic at her son's Colorado high school is "the best thing ever," says Hannah Chupp.

"My teen can go there for advice and private help when he is too uncomfortable to discuss something with me," Chupp says of the clinic and its nurse practitioner. "I am fine with him seeking help from someone other than myself. It’s part of growing up."

The Chupps are among the luckiest.Their school in Cortez has a clinic that includes a nurse practitioner who can prescribe medication and perform exams, plus a school nurse. Chupp's son got his sports physical from the nurse practitioner, who started last year when the clinic opened. If he has a migraine, he can get crackers, ibuprofen and a place to rest from the school nurse, Chupp says.

As complex and often-chronic health conditions soar among children, worsened in some areas by the return of diseases largely eliminated by vaccines, full-time school nurses remain hard to find. About 40% of schools only budget for a part-time school nurse, and 25% have no nurse at all, the National Association of School Nurses says.

"School-based health clinics," which are typically run by local hospitals, are an increasingly attractive solution, growing by 20% between fall 2010 and fall 2013, according to the School-based Health Alliance. At that point, there were 2,315 of these clinics.

School nurses and parents who rely on them say the clinics – rare as they are among the 100,000 public schools in the U.S. – aren't enough. Along with the primary care services the clinics provide, more school nurses and mental health professionals are also needed, groups representing the health care providers say – especially with teen and even preteen suicides increasing.

The new school nurse: Allergies to suicide prevention to gender transition

Treating everything from severe allergies and concussions to suicidal thoughts and gender transition, the role of the school nurse has come a long way from the colds and cuts they've been long known to care for. Among their other jobs, nurses say they serve an important role to triage and refer students to other health providers.

"The intensity of needs of students is a change," says Donna Mazyck, executive director of NASN and a former school nurse. "There's an inverse relationship between the growing need and the funding."

Although schools increasingly offer mental health services, demand still outpaces supply. School nurses and psychologists or social workers collaborate.

The National Association of School Psychologists recommends having no more than 1,000 students per school psychologist, but it says most school districts don't meet that standard and estimates the ratio is 1,381 to 1 in the U.S.

"When school budgets get tight, health services are tending to be on the chopping block," says Laurie Combe, NASN's president and a longtime school nurse.

Against that backdrop, slightly more than half of students in public schools live in poverty, notes Mazyck. That increases the risk of household and neighborhood trauma, which can exacerbate conditions such as anxiety and asthma. School shootings and the security measures adopted in response also heighten students' anxiety.

"Our bodies’ response to trauma comes in many forms," says Combe.

Students at Richard Wright School for Journalism and Media Arts in Washington come from the lowest-income wards of the nation's capital and "have a lot of things going on mentally," says school nurse Belinda Millner. When teens come in with physical complaints, referrals to the school psychologist or social worker might be in order.

"We have to use our nursing judgment, as it could be something else they are having issues with," says Millner, who started in October. "We’re kind of like the gatekeeper with the children."

Millner's background as a paramedic and emergency room nurse didn't prepare her for everything at the school. For example, students who identify as transgender have come asking for advice, including on which bathroom to use.

"I'll say, 'Hey, I’m still learning these things, too. Please explain to me what your feelings are,' " says Millner. It's far different from the "bumps and scrapes" she dealt with when she was an elementary school nurse.

"It's something different every day with the children," she says.

"Sometimes they really want someone they can talk to about something that’s confidential."

Without a nurse, students with diabetes could wait for insulin

Suicide, stress and addiction may steal the headlines when it comes to teen health, but there are growing physical health problems as well. Combe, who managed health services for her school district in Houston, notes that as hospitals save premature infants at earlier ages, some of these children's health needs follow them through life – and school. Some, she says, have feeding tubes in their stomachs and "need health care provision within the walls of the school."

Americans' increasing obesity has ensnared the schoolyard set, too. Type 2 diabetes is becoming far more common among overweight children and teens, and Type 1 tends to afflict students beginning at about 14 years old. The school nurse shortage can complicate diabetes care.

And American children are having more severe allergic reactions, too.

Denie Gorbey-Creese, a Maryland school nurse who splits her time between two schools, has four diabetic students at one elementary school. She and her health assistants see them several times a day. The ones with insulin pens rather than pumps sometimes need to have the dosage for their insulin calculated based on the carbohydrates they ate for lunch.

Health assistants aren't legally allowed to calculate an insulin dose so Gorbey-Creese says if she's at the other school, they have to call her, tell her what the blood glucose level was, how many carbohydrates the student is eating and possibly even the child's activity level that day. Then the assistant can administer the insulin.

"If I'm busy with an emergency at my other school, I'm not available right away," Gorbey-Creese says. "So it might delay their care some."

Nurses and the clinics fill roles that can make the lives of parents, students and teachers easier. Nurse practitioners,found in some school clinics,can do everything a primary care doctor can do in about half of states. That saves children and parents time away from classrooms and jobs, which for hourly workers can mean lost wages.

Although the hospital-run clinics are often proposed as a solution for the school-nurse shortage, NASN recommends schools have a nurse even when there is a health clinic, a combination that Chupp agrees is important. Having both has made her son far more self-sufficient when it comes to his health, she says. Her college-age children, who didn't have access to health care in high school, "call me for advice all the time and are afraid to make their own doctor appointments," she says.

In Cincinnati, there are 26 school-based health centers, including three run by Cincinnati Children’s Hospital. Vaccination rates at schools with these clinics are far higher than at schools without them.

"We are meeting children and families where they are," says Lisa Crosby, the nurse practitioner in charge of the hospital's health centers. "You do become a part of the community."

Like Chupp, Crosby has seen how the clinics improve health literacy. Her former students will often tell her they're paying closer attention to their children's health because "I saw what you did for me."

"That's the best story ever," says Crosby.

The Cincinnati health department provides a school nurse for schools with the health clinics, but they were overwhelmed with vision and other screening tests for 500 students, Crosby says. The Children's Hospital clinics also see other children in the community and have about 500 other patients up to age 18.

In Washington, D.C., school nurses are now required under a law that was sponsored by former Mayor Vincent Gray, who is now chairman of the City Council's health committee.

At the Richard Wright charter school in D.C., founder and CEO Marco Clark says that when it came time to pay for a school nurse – which he had long wanted – "we just had to figure it out within the budget."

"I didn't want to rob Peter to pay Paul," he says. "But it’s money well spent."

Cosandra Wright, whose four children have all been patients at the South Avondale School clinic in Cincinnati, agrees. She says she doesn't think her oldest two children would have graduated if it wasn't for the clinic.

"It made it possible for them to learn and focus in school," says Wright. Of the staff, she says, "My children love them because they’ve always taken care of them."

Re: Health care at schools

NicksmomESQ — Fri, 12 Apr 2019 00:16:06 GMT

That sounds interesting.I would imagine that there would have to be prior parental consent given if kids are going to be examined & treated. It becomes a legal issue.

Re: Health care at schools

FancyPhillyshopper — Fri, 12 Apr 2019 02:10:02 GMT

Unfortunately, school nurses have traditionally been covered by school and/or district budgets, and with ever-rising education costs, are frequently on the chopping block.

The innovative community schools model includes schools partnering with health providers to establish public clinics within school buildings. Therefore, health services are covered under insurance and other medical provisions.

Re: Health care at schools

happycat — Fri, 12 Apr 2019 03:00:15 GMT

Sadly, my district only has one school nurse and thats for all grades- 4 different buildings. She is my sisters friend, this is how I know and I'm pretty sure its only a part time position. I think there should be a nurse in every building. When I was in school, that's how it was. All the elementary schools had a full time nurse, as well as the jr high and the high school.

Re: Health care at schools

sidsmom — Fri, 12 Apr 2019 03:22:25 GMT

I couldn’t get past the 2nd paragraph.

Talk about a disconnect with your child.

“My teen can go there for advice and private help when he is too uncomfortable to discuss something with me," Chupp says of the clinic and its nurse practitioner. "I am fine with him seeking help from someone other than myself. It’s part of growing up."

Re: Health care at schools

Mominohio — Fri, 12 Apr 2019 03:31:17 GMT

@sidsmom wrote:
I couldn’t get past the 2nd paragraph.
Talk about a disconnect with your child.

“My teen can go there for advice and private help when he is too uncomfortable to discuss something with me," Chupp says of the clinic and its nurse practitioner. "I am fine with him seeking help from someone other than myself. It’s part of growing up."

I found this statement from the article to be a very positive and mature parenting position. I always felt the same with my son, once he reached high school age.

There are just some things that many kids aren't going to want to bring to a parent for a host of possible reasons. I always wanted my teen to seek responsible advice from a qualified or caring adult, even if it wasn't me or his dad.

I just couldn't let my parental pride get in the way of him getting what he really needed, if he felt he couldn't get it from us. I'd rather he get treatment, counseling etc. that might save his life, or help him see things in the proper light, than worry about me or us being the center of his universe. His health and safety first, regardless of how he felt he needed to come by it. After all, at some time, they all need to seek ways to solve their problems and take care of themselves without us.

Re: Health care at schools

Financialgrl — Fri, 12 Apr 2019 11:59:24 GMT

Our county has a lot of school nurses (probably about 60) but we have about 95 schools. They began building middle schools and HS very near each other and by doing so, many of the nurses now travel between the two schools. Not optimal but better than nothing. The other thing they did - all schools in the poor districts of the county got a dedicated nurse bc many poor ppl didn't have medical care. Many of those homes only had a single mother who had to work and couldn't afford to take off - oftentimes the school nurse is their healthcare.

Re: Health care at schools

sidsmom — Fri, 12 Apr 2019 12:11:06 GMT

@Mominohio wrote:
@sidsmom wrote:
I couldn’t get past the 2nd paragraph.
Talk about a disconnect with your child.

“My teen can go there for advice and private help when he is too uncomfortable to discuss something with me," Chupp says of the clinic and its nurse practitioner. "I am fine with him seeking help from someone other than myself. It’s part of growing up."

I found this statement from the article to be a very positive and mature parenting position. I always felt the same with my son, once he reached high school age.

There are just some things that many kids aren't going to want to bring to a parent for a host of possible reasons. I always wanted my teen to seek responsible advice from a qualified or caring adult, even if it wasn't me or his dad.

I just couldn't let my parental pride get in the way of him getting what he really needed, if he felt he couldn't get it from us. I'd rather he get treatment, counseling etc. that might save his life, or help him see things in the proper light, than worry about me or us being the center of his universe. His health and safety first, regardless of how he felt he needed to come by it. After all, at some time, they all need to seek ways to solve their problems and take care of themselves without us.

@Mominohio

When I originally read it, with the age of teenage-kid parents in mind,

it sounded like a ‘it’s not my problem let someone else handle it’

reasoning. I now see a different POV. Thank you. I wonder if the parents

are eventually told of the issue, tho....

Re: Health care at schools

Mermaid22 — Fri, 12 Apr 2019 12:36:52 GMT

School nurses- grossly underpaid and overworked. The HARDEST job I ever had as a Registered Nurse. JMHO - retired school nurse.

Re: Health care at schools

Financialgrl — Fri, 12 Apr 2019 12:47:10 GMT

@sidsmom wrote:
@Mominohio wrote:
@sidsmom wrote:
I couldn’t get past the 2nd paragraph.
Talk about a disconnect with your child.

“My teen can go there for advice and private help when he is too uncomfortable to discuss something with me," Chupp says of the clinic and its nurse practitioner. "I am fine with him seeking help from someone other than myself. It’s part of growing up."

I found this statement from the article to be a very positive and mature parenting position. I always felt the same with my son, once he reached high school age.

There are just some things that many kids aren't going to want to bring to a parent for a host of possible reasons. I always wanted my teen to seek responsible advice from a qualified or caring adult, even if it wasn't me or his dad.

I just couldn't let my parental pride get in the way of him getting what he really needed, if he felt he couldn't get it from us. I'd rather he get treatment, counseling etc. that might save his life, or help him see things in the proper light, than worry about me or us being the center of his universe. His health and safety first, regardless of how he felt he needed to come by it. After all, at some time, they all need to seek ways to solve their problems and take care of themselves without us.
@Mominohio
When I originally read it, with the age of teenage-kid parents in mind,
it sounded like a ‘it’s not my problem let someone else handle it’
reasoning. I now see a different POV. Thank you. I wonder if the parents
are eventually told of the issue, tho....

@Mominohio - Having worked at a HS, the nurses office at our school and ALL schools in the county have a sign that is posted in every nurse's office which says that anything discussed will be confidential UNLESS someone threatens to hurt themselves or others. A parent will be notified and until the parent can get help for the student our schools had psychologists would work with them until they could get an appointment with their own outside help. BTW, once a student hit 18, parents only had access to their grades and any issue if the student signed permission for them to receive that info and that was each and every incident - one note didn't cover all.

Re: Health care at schools

dex — Fri, 12 Apr 2019 13:22:09 GMT

We never had a nurse in schools in Canada.When I was young they did have a public heath nurse go to all of the schools to give vaccines and once in awhile they came to check for lice.i was really surprised whe we moved to the USA to find a nurse was at my sons high school and actually all of the schools.I found this out when I picked my son up from school one day after he called to tell me he was sick.I later got a call from the nurse who told me that she wasn’t consulted and she was supposed to give him permission to leave.I thought that I should be the one to decide that.

Re: Health care at schools

Trinity11 — Fri, 12 Apr 2019 13:56:21 GMT

Ridiculous that a nurse has to administer insulin. ALL kids with diabetes should be taught to manage their insulin intake from day one of their diagnosis. I have seen 5 year old children able to calculate their dosage. Having some nurse calculate an insulin dosage AFTER a child has eaten is terribly wrong. Insulin needs to be given before a meal not after to avoid hyperglycemia...

Re: Health care at schools

bathina — Fri, 12 Apr 2019 14:16:08 GMT

@Trinity11 wrote:
Ridiculous that a nurse has to administer insulin. ALL kids with diabetes should be taught to manage their insulin intake from day one of their diagnosis. I have seen 5 year old children able to calculate their dosage. Having some nurse calculate an insulin dosage AFTER a child has eaten is terribly wrong. Insulin needs to be given before a meal not after to avoid hyperglycemia...

Perhaps by "administer", the meaning is the nurse has the insulin and needles and has to be present while the child's takes the insulin. It wouldn't make sense for a 6-16 year old to be walking around school with a needle and a vial.

On another schoo/health related note, New York voted to provide free sanitary supplies to young girls in school.

I am so glad to see this. So many girls can't afford the supplies and end up having accidents in school. Mortifying for a young woman.

Re: Health care at schools

Trinity11 — Fri, 12 Apr 2019 16:10:19 GMT

@bathina wrote:
@Trinity11 wrote:
Ridiculous that a nurse has to administer insulin. ALL kids with diabetes should be taught to manage their insulin intake from day one of their diagnosis. I have seen 5 year old children able to calculate their dosage. Having some nurse calculate an insulin dosage AFTER a child has eaten is terribly wrong. Insulin needs to be given before a meal not after to avoid hyperglycemia...
Perhaps by "administer", the meaning is the nurse has the insulin and needles and has to be present while the child's takes the insulin. It wouldn't make sense for a 6-16 year old to be walking around school with a needle and a vial.

On another schoo/health related note, New York voted to provide free sanitary supplies to young girls in school.
I am so glad to see this. So many girls can't afford the supplies and end up having accidents in school. Mortifying for a young woman.

@bathina It does make sense only because insulin is the difference between life and death for a Type 1 diabetic. All children should be versed on how to use an insulin pen or how to use their pump. They should always carry some kind of meter, glucose tablets and supplies on them at all times. Also when there is a diabetic in a classroom, it is always good for at least someone in the classroom that understands what to do if a diabetic starts to go too low. Thankfully, I was blessed with great teachers who sometimes would start a conversation with the class about having a diabetic in the classroom. The outpouring of interest and kindness was so inspiring to me at the time. I was also allowed to administer my own insulin without any kind of issues with the nurse's office. And this was long before meters and pens were available. (Please excuse the rant, this subject is dear to my own heart having lived with Type 1 diabetes since my teens)

As far as distributing sanitary supplies? Bravo!! It makes me proud of my home state.

Re: Health care at schools

bathina — Fri, 12 Apr 2019 16:26:09 GMT

@Trinity11 wrote:
@bathina wrote:
@Trinity11 wrote:
Ridiculous that a nurse has to administer insulin. ALL kids with diabetes should be taught to manage their insulin intake from day one of their diagnosis. I have seen 5 year old children able to calculate their dosage. Having some nurse calculate an insulin dosage AFTER a child has eaten is terribly wrong. Insulin needs to be given before a meal not after to avoid hyperglycemia...
Perhaps by "administer", the meaning is the nurse has the insulin and needles and has to be present while the child's takes the insulin. It wouldn't make sense for a 6-16 year old to be walking around school with a needle and a vial.

On another schoo/health related note, New York voted to provide free sanitary supplies to young girls in school.
I am so glad to see this. So many girls can't afford the supplies and end up having accidents in school. Mortifying for a young woman.
@bathina It does make sense only because insulin is the difference between life and death for a Type 1 diabetic. All children should be versed on how to use an insulin pen or how to use their pump. They should always carry some kind of meter, glucose tablets and supplies on them at all times. Also when there is a diabetic in a classroom, it is always good for at least someone in the classroom that understands what to do if a diabetic starts to go too low. Thankfully, I was blessed with great teachers who sometimes would start a conversation with the class about having a diabetic in the classroom. The outpouring of interest and kindness was so inspiring to me at the time. I was also allowed to administer my own insulin without any kind of issues with the nurse's office. And this was long before meters and pens were available. (Please excuse the rant, this subject is dear to my own heart having lived with Type 1 diabetes since my teens)

As far as distributing sanitary supplies? Bravo!! It makes me proud of my home state.

Thank you so much for the information! Very interesting- I went to the American Diabetes Association site and there are actually state laws which regulate how this all happens. Some laws are different than others, but i didn't see any states which prevented students from carrying their supplies with them or prevented students from administering their own insulin. It makes perfect sense from your explanation and I stand corrected. No need to apologize for the "rant". You live it and I'm glad to learn something new!

Re: Health care at schools

chrystaltree — Fri, 12 Apr 2019 16:53:23 GMT

Most school systems don't have anything that even approaches that type of care. The schools in our town don't even have full-time school nurses. The two school nurses rotate, there's a nurse at each school for a couple of hours a day.

Re: Health care at schools

RollTide2008 — Fri, 12 Apr 2019 17:53:12 GMT

My child’s school has a clinic operated by the local hospital system. There is CNP on staff during the day and an athletic trainer on staff after hours to service the student athletes.

Re: Health care at schools

blackhole99 — Fri, 12 Apr 2019 18:45:05 GMT

I live in a rural area and all our schools have school nurses, they are plum jobs and you have to be connected to get one. That being said, it doesn't mean our kids are getting the kind of care they should for our tax payer dollars. I don't know what we should or can do about it, but I know when my son was in school, I wanted to be called if he was sick at school and I worked full time. I didn't worry so much when he was in high school, but kindergarten through 6th grade was a concern.

Re: Health care at schools

missy1 — Sat, 13 Apr 2019 00:04:45 GMT

School nurses here make hardly anything, so they let emt's work.

Re: Health care at schools

hckynut — Sat, 13 Apr 2019 07:33:37 GMT

@feline groovy

I quit reading USA today years ago for a reason. Your Copy/Paste reminded me why. Here I thought health care was private enterprise not funded by!

hckynut