In this month’s episode, Nursing Notes Live goes back to school with a look at school nurses. In our second episode this month we are joined by three school nurse leaders to discuss some of the rewards and challenges facing school nurses nationwide.
MP3 Audio Podcast
Jamie: I’d like to start off with you, Mary Ann Gapinsky, tell us a little bit about your background in nursing, how did you get started as a nurse and what drew you into the career path of school nursing?
Mary Ann: Well, I started as most nurses do with a background in clinical nurse in a hospital study. I worked a variety of nursing specialties as a hospital nurse. But my primary love and passion had always been public health nursing but I shared that with my expertise in pediatrics. It seemed logical that school nursing combine the best of both worlds for me. So when a school nurse position opened up in my community, I applied for it and was very fortunate to get the position full-time and it opened me up to a world that I had no idea existed in nursing. It’s such a broad continuum of expertise that’s needed. It’s from generalist to specialist. I found that all of my skills will be challenged and I had a great opportunity to work with large populations and have a ripple down effect from children to their families to the community in this role. I fell in love with it and I can’t think of a better position for a nurse to have.
Jamie: It’s amazing the impact that school nurses have on their communities beyond just treating a kid’s boo-boo in the classroom at the elementary level or helping a student deal with a chronic illness all throughout their school career. There’s really a whole lot more to it than that. Sally, tell us a little bit about your background. I know you’re the interim Executive Director at the National Association of School Nurses but you’re a nurse and how did you get started as a nurse and then what drew you into school nursing?
Sally: I came from a family that had a really deep connection with medicine and nursing. It was a very logical thing for me to become a nurse. I enjoy taking care of people and it really was definitely something that just fit my path and would fit with my personality. What I loved about nursing is just that you could get a medical diagnosis for something but then a nurse would help you learn how to live with that diagnosis and could really treat the whole person and I just love that aspect. School nursing appealed to me so much because I’ve always enjoyed having a real wellness focused to my practice. School nursing really gave me a chance to use preventative measures as a focus as well as educating people around me. It’s a very autonomous practice being a school nurse. You could be independent in what you do and that appealed to me. But something Mary Ann alluded to is I’ve always really enjoyed the relationship. A lot of times, if you’re in acute care, your patients come and go and you see them for a very short amount of time. In school nursing, you have the opportunity to create relationships over time and often you know the big brother of the student that you have and you’ve known their mom for years. What that does, is it gives you just this sense of trust and collaboration and it really enhances your practice. It makes it a very special thing.
Mary Ann: I’d like to add something to that Sally just mentioned is this seeing a child over a continuum of growth and development. It’s just an amazing opportunity for nurses. We’re probably the only specialist in a healthcare setting in general and even in a school setting that sees this child from probably day one of kindergarten until they get promoted to their next school level. So even the teachers in the school building and among those I see them on a year-to-year basis but it’s the school nurse in that building who is able to see that child from year to year and see continual growth or may be not growth.
Sally: Right. I had a student one time asked me, “Are you a real nurse?” Inspected my stethoscope around my neck and she was tremendously impressed by that I guess. I said, “Oh,” I said, “I’m a school nurse. I’m a pediatric nurse. I’m an emergency room nurse. I’m an occupational health nurse. I’m a psychiatric nurse.” I went through this whole list. I said, “When you’re a school nurse, you’re every kind of nurse.” And she just kind of sit there with her eyes wide open and I thought, “I think I got through to this one.” It was kind of a neat moment.
Sheila: Right, this is Sheila, I’d like to say that from my background as well it’s the same from the hospital setting and all that. But my focus was in the case management arena and then pediatric case management. That it brings it full circle when you’re in the school with the children, as both of you have mentioned, that you’re incorporating in, you might have the brothers or the sisters or the siblings or the involvement with the families and everything of that nature as well.
Jamie: It’s amazing the effect that you have from children at a very young age that you are their first contact. In many cases, you might be their initial primary healthcare provider. They may not have had a regular healthcare professional in their lives up to that point. And you have a very important role to help that child develop a positive lifelong health skills.
Mary Ann: Absolutely. It’s a great opportunity. I call school nurses sometimes that stone that you throw in the pond and you get those ripples that extend outward. That grows not only for the individual child and the effect that you have on that particular student but also that effect upon that individual within the community whether it would be the school community or their family or the greater community that they live in. That effect is just huge. It ripples out.
Sally: Right. Having the community partners involved – family, extended family, the local hospitals or organizations or other community services – is always a plus to this and you incorporate them in as that school nurse.
Jamie: Sally, one of the things that I wanted to make sure we touched on because we’re talking about developing lifelong health skills is the initiative that the NASN, the National Association of School Nurses, is developing or has developed called “SCOPE.” It’s the “School Nurse Childhood Obesity Prevention Education Program.” I was just recently on the Nursing Show talking about a news item that popped up on my radar talking about the positive impact of growing public awareness on obesity impacting childhood obesity. It was just released in the Childhood Obesity journal that BMI numbers seemed to be decreasing in relationship to the amount of education and public attention drawn to childhood obesity. This is a huge issue and I’m excited to see that the SCOPE program is out there, what has been the uptake from your membership of this program?
Sally: Well, the SCOPE program is really specifically designed for school nurses. That’s one of the beauties of the National Association of School Nurses is that we can target our educational programs directly to nurses that are working in schools. The program really provides an overview, first of all, about the problem of overweight and obesity. We look at BMI screening. We look at type 2 diabetes, blood pressure screening. Basically, what the school nurse role is as well as research about what’s really working to address the issue. School nurses are getting tools from our association that can really help them in addressing this issue not only with students but with staff and parents to make sure that we’re really promoting healthy weights in kids. Certainly what we really need to do is not just target the children but the family and the messages that the family gets. That’s when you can really create change. The other beautiful thing about SCOPE is that it provides letters and forms and referral guidelines and it also what we’ve been talking about is that it leverages that community collaboration and really helps to address this problem in a multi-faceted way. As you said, we are seeing some advances but I think there’s still a long way to go in this issue and we need to grow healthy adults and that’s one of the focus of this program.
Sheila: One of the things I kind of see going with this as well is because in the school setting our focus is not only the children themselves, as we mentioned too, the faculty of the school, the other employees there. They have us looked at wellness programs for them too as well because what we’re seeing is children are looking at us as those role models and people that are of importance there and expecting that as the saying has gone: “You’d do as I see and not as I do” and that kind of a thing. We want them to follow in the same footsteps. If they see that we’re also addressing it from our angle as the nurses and as the faculty of the school, it kind of does that ripple effect.
Jamie: When you look at the fact that these students aren’t the ones buying the food, what kind of tools do you send home, Sally, when you’re using the SCOPE program? How empowered do you think the students become when they are able to go home and impact maybe potentially their parents’ health?
Sally: Well, again, we not only have to work from the angle of the students but we do have to also work from the angle of educating adults as well. Students certainly can get excited about it and learn what great eating habits are and increasing their exercise. If they go home and they put in front of the television with the bowl of potato chips, then we have a problem. So we really need to make sure that we are really not only addressing it with the students but also with parents and with community members. I think another great thing in schools is that we’re seeing healthier and healthier school lunches. I think that’s another great way to model for kids what’s great about eating, what good eating habits, and what they should be thinking. I also really like another great new tool out there is the FDA re-did their food pyramid into a plate format and I was like, “Well, this is a little more understandable.” It sounds like someone else appreciates that tool as well.
Jamie: Yes, kids are showing up at the dinner table with the slight pyramid-shaped object that they’re supposed to dish themselves up from, right?
Sally: Right. Whereas if you give them a plate and show them how much should be on it, that’s really understandable and that’s a real quality tool.
Mary Ann: What the SCOPE program has done, as Sally has cited, is it gives school nurses the tools to work with on this initiative. And we know that taking and measuring BMIs in schools isn’t going to have an immediate impact. But like everything that school nurses do and what we’ve already talked about is this BMI initiative. It’s going to help break through some denials that some generations may have about the effect on obesity. That we’re going to incite change hopefully within not only the schools but within the communities and the BMI is a good factor to measure that change by. So it’s an exciting program that has created some great tools for nurses to again go out and impact not only the individual student and their family but future generations.
Sheila: Yes, definitely. The SCOPE program, it’s a wonderful program. I attended some of the informational sessions about it myself. One of the biggest challenges that we see, as we all know, are factors to do with cultural issues or even the area that you’re involved in as far as – if it’s urban versus suburban versus rural. We have a lot of challenges ahead of us in this but as school nurses we’re ready and willing to be out there on the forefront to help in this whole obesity challenge that the nation is facing.
Jamie: You know, it’s amazing just to see and you talked earlier about you’re every different kind of nurse when you’re a school nurse. I’m excited by opportunities like the SCOPE program and others that really there are opportunities there for the school nurse to be involved as a nurse researcher as well. To be gathering data and building upon the changes that they’re enacting in their schools and contributing at a national level to that positive change and being able to help in tracking that as well.
Sheila: That’s one of the things I look at and when I talk to different school nurses that I converse with the things here in New Jersey is that you got to document it. You got to document it. You got to have those numbers to show the justification of your job and what it is that will allow you then to get new tools and new equipment and/or whatever else you may need to progress in your job. That research area is highly important on the scope of the individual school nurse and county or even to state level up to the national level. We need to justify the position and why we’re doing what we do and why we need to do what we do and why a kid does a need a nurse in every school.
Sally: As school nurses, we’ve got a whole lot of data locked up in our file cabinets in our offices. This is something we need to unlock and really leverage an access because there is so much that we can do when we can present data because that then helps us, helps guide evidence-based practice. We need to so be careful and be sure that as school nurses that we’re using evidence-based practice in our everyday contacts, in our everyday care.
Mary Ann: The data that school nurses have in regards to the management of chronic diseases is huge. What has been successful in both prevention - primary and secondary prevention - in these areas and the data that school nurses can collect on prevalence and surveillance and incidence of these in schools and among children is just huge. The impact could be so great in terms of research in this area if, as Sally said, if school nurses were to unlock their file cabinets and reach this out, broaden out the research to other people too.
Sheila: We did kind of see this with the H1N1 a couple of years back that they realized that our data and information is very helpful to the Department of Health and, overall, CDC, everyone as a whole that they came to us and asked us to do more surveillance and that do more data and entry information and that. It’s just one little area but, as Sally and Mary have mentioned, this is definitely an area that does need to get out there and get known as to what we are collecting and why we collect it and hopefully it does do an impact, have an impact on the community.
Sally: Well, we’re going to really be able to create change when we have strong data to back up what we know is true.
Jamie: You know, the schools are really ground zero for a lot of illnesses going through a community. If you want know what stomach bugs are out there, you just need to talk to a teacher or a school nurse. They know when there’s something going through the community.
Sally: Well, when H1N1 was discovered, that was a New York school nurse who first identified that there was a new strain of flu. So school nurses are totally on the front line.
Jamie: One thing, Mary Ann, I’d like to touch on really quickly because I think this is important to note. In that realm of school nurses having a hand in every aspect of healthcare with their community, one of the challenges that you mentioned in this month’s newsletter was the challenge that more and more we’re seeing students with specific special health needs and as they’re being integrated in the mainstream school populations. Could you maybe talk a little bit about how that is impacting some of the specialized training and care that a school nurse provides?
Mary Ann: Well, we know that children with complex medical issues all have equal access to education. Now this children are attending school on a daily basis but they need the expertise of qualified school nurses to be able to derive the care that they need to be successful in school and to be able to become as successful in life as they possibly can be. Without the expertise of qualified school nurses to oversee this care and to provide the assessment and the evaluation of the cure that’s being given on a daily basis to this children and school study. It sometimes makes for the child to be less successful and less healthy than they can possibly be. Schools have become the focus of healthcare for children in this country, that’s where it’s being provided. You rarely hear about long-term hospitalizations and longer for chronic diseases among children. These school children are now all attending school and all this care that is being provided to them is being given by school nurses. It’s very vital that these school nurses have the competence and the expertise in this area to provide this care. One way in which we measure that is through national certification. National certification of school nurses promotes that expertise, their knowledge and their commitment to providing this quality care to children in schools.
Sheila: We think about section like 504 how we really make an impact as far as the American Disabilities Act in children that are recognized under the 504 and/or other child study team, IDEA needs. Nurses have to be there. We have to be at that table when they’re having those meetings and all that to understand and give our inputs from the medical aspect as to what the school needs to do for accommodations and other types of things of that nature – emergency processes. We all can be integral into this and it’s very important that we’re there.
Sally: Well, I’m hoping that as part of the Affordable Care Act that school nurses are really seen as a vehicle for care delivery to the pediatric population because children don’t have to go to the doctors, they don’t have to go to the dentist. But they do have to go to school and school nurses are where the children are all day, every day. This is just an amazing part of our healthcare system. I think it needs to be recognized and I think funding needs to be applied to it and I think that we can create and sustain a lot of great things for children if that is really looked at carefully. That we can get school nurses right on that front line of supporting academic success.
Mary Ann: School nurses are valuable not only to the healthcare delivery system but also to the public healthcare delivery system but in addition to that to the educational system. There are three major systems in our country that are very impacted by the care and the quality of school nursing services. That has to be recognized by our country and by those who are stakeholders in this care and success of our children. It just can’t be missed.
Sally: When I think at times public health says, “Oh, but they work in education.” The educators say, “Oh, well, they work for health.” And we need to just make sure that somebody solidly own school nursing and that really provides that strong foundation for it and I think that’s something that school nurses can work towards to make sure that our voices and our values are heard and seen.
Mary Ann: I absolutely agree with you, Sally, that is such an important comment. I think for too long school nursing, unfortunately, has been funded from education dollars and we need to start looking at that funding. Education dollars should be spent on education. School nursing provide healthcare and we need to start looking at how we can better support from a healthcare point of view, school nurses and their practices in school.
Sheila: It kind of led us to the point of they’re not being school nurses. The ratio is number one. In addition to not being school nurses, nationally set up in all schools that will get us to that level of care and meeting best practices for all this children. It’s definitely a factor that comes into play here.
Sally: NASN did a study in 2007 and found that 45% of students had a full-time registered nurse and that’s one – it’s wonderful that 45%, but that’s less than half of our children. And 25% of the nation’s children don’t have success to a registered nurse at all and that needs to change.
Jamie: Sally, is there any method or is there any push to connect school nurses more closely with, say, their public health nurses in their communities to help coordinate some resources maybe perhaps grants or whatever that needs to bring more health resources into the schools?
Sally: I’m really proud of the work that NASN and all of our board members and all of our members are part of everyday and, of course, we’re addressing this. One thing we’re doing that is absolutely vital is we have a Student-to-School Nurse Ratio Improvement Act of 2011 that we’re encouraging our representatives to get behind. This act, it’s basically a demonstration act, a demonstration study to really get some data. We’re talking before about how data drives change. And this would give us the data to show that when you have strong school nursing services and strong access to a school nurse, the children are going to be able to be in school more often and it’s going to improve educational outcomes as well as health outcomes. So we’re working really hard to see if we can get – and it’s House Resolution 2229. We’re really working hard to see if we can get that strong data that will prove what we know to be true and then we’ll be able to have that much more of a foundation to talk to others about how important the value of a school nurse is and making sure that there’s one in every building for every child.
Mary Ann: Well said, Sally.
Jamie: We’ve seen so many studies out there that have looked at prevention dollars and money spent on prevention turns into real dollar savings down the road in healthcare costs. And it would seem to me that it is a perfect setting here to say, “Money spent on improving the health of our children reduces long-term healthcare costs,” but it also reduces – it seems to me that it makes sense that we could tie this into other things. If the children don’t stay home from school, parents don’t miss work days. They don’t have to get special child care setup because the day care won’t take sick kids. Everything the school nurse does have an impact that - again, that ripple effect that - the ripples on the pond kind of scenario that was talked about earlier. There are so many ways that school nurses affect and it seems to me this is just an opportunity to again collect that data and prove how much of a real impact on a community a school nurse program has.
Sally: Well, you really hit a nail on the head because so often when people are talking about health prevention strategies, they’re talking about things like colonoscopies for people over the age of 50 or when a woman should be having a mammogram. But we need to change the thinking back down to our children and our youth because when we can get the great health habits into our children, we’re not going to have to be worrying about the prevention strategies in middle or – let’s stick with middle age, I’m in that age group, I’d like to leave it but [unintelligible] age how to help your – but the Department of Health and Human Services has just released a National Prevention Strategy and we just need to keep making sure that our voices are heard talking about the value of prevention for our children and youth.
Jamie: And Mary, you’re involved in public health in Massachusetts I believe but is there a real importance to have a more of a nursing representation in state and federal public health agencies to make sure that nursing focus is maintained there?
Mary Ann: Oh, I think it’s essential. You’re talking, as Sally said, with the future of our country when you talk about the children and the care. And primary prevention is going to become a major issue in our country when we try to begin to control healthcare costs. How does that begin but with education, children at the earliest ages? Who’s doing that in schools but school nurses? This is going to have a huge impact. We are already seeing this in again in Massachusetts from a public health point of view with our obesity initiative that our school nurses are involved with. We have already seen changes in BMI points coming down in these schools where school nurses have initiated programs for not only good nutrition but physical activity, doing parent and community education around these issues, working with the local pediatricians and other healthcare providers in the communities to look at this initiative. This is all primary prevention beginning at kindergarten and even earlier in those schools that have pre-school children that they work with. We’ve already seen it here in Massachusetts and the impact – and school nurses have been the leaders of that ever since we’ve begun this initiative.
Jamie: I’ve already talked to Sheila about what she would give an advice to school nurses in her segment so if you are listening to this and you haven’t heard Sheila’s full segment as our Get-to-Know nurse this month, you should listen to that. But I’d like to offer that opportunity to Mary Ann and Sally as well. I’ll start with you, Mary Ann, could you give some - maybe a piece of advice to a nurse that’s considering becoming – a school nurse moving in to that career path or perhaps even a student nurse or someone thinking about entering the career field of nursing and thinking, “You know, I’d love to be a school nurse and involved.” What kind advice would you offer to them as an idea on how to get started down that path?
Mary Ann: I think because, as Sally has already mentioned this, the autonomy and the independent practice that is required to become a school nurse, have to recognize that the school nurse is the lone healthcare provider oftentimes in a non-healthcare setting. So your clinical skills need to be very strong. You need to be able to focus on a general practice rather than a specialist practice because you’re going to impact everything from chronic diseases to behavioral health to prevention services to health education in the school. To become a competent school nurse, you need to have strong skills in every aspect of nursing so that if you’re looking for that kind of environment to work with and to practice in that manner, I think school nursing is the field that you should go into.
Jamie: And Sally your final thoughts for our prospective school nurses that might be listening to the show.
Sally: But also I like to encourage the nurse to have some, as Mary Ann said, some broad experience before she becomes a school nurse because you really need to draw on that. But NASN has such a great library of resources for people. We have a textbook on school nursing that gives an overview of all the major issues involved with school nursing. We’ve got a fabulous new diabetes toolkit that has basically one-stop-shopping for knowing what you need to know about diabetes, to care for children in school and our list goes on and on. But I think knowing the scope and standards of school nursing is vital for any school nurse but I think I would say: be experienced, get the tools and the resources you need and then be prepared to have the job of a lifetime because it is a job to love, to be passionate about and it’s just an amazing way to know that when you put your head on the pillow at night, that you’re making a difference in the world.
End of panel discussion.
Don’t forget to check out the entire August, 2011 issue of Nursing Notes, featuring school nurses. This month’s Nursing Notes newsletter includes articles focusing on initiatives combating childhood obesity, mainstreamed kids with special needs and a link to our Nursing Notes Newsletter survey.
You can read the entire issue online at www.discovernursing.com and don’t forget to catch our other Nursing Notes Live episode this month featuring a panel of school nurse leaders and how they are working to improve healthcare one child at a time. You’ll find this and our other podcast episodes at www.NursingNotesLive.com, the Nursing Notes by Johnson & Johnson Facebook page, and in the podcast area in iTunes.