Get to know Kathy Wallace, a Professional Registered School Nurse at Parkway Central Middle School in Chesterfield, Missouri. Hear about Kathy’s advocacy for both student health and for other school nurses.
MP3 Audio Podcast
Jamie Davis: Kathy, welcome to Nursing Notes Live and I always try to start off with my first question asking why you became a nurse and what was your career path to where you are today?
Kathy: Well, Jamie, I had a perfect high school job. I worked in a hospital in the dietary department and it worked out great with the hours of a high school student because I went in, got there about 4:00 with help. Put the foods on the trays and take it up to the patient rooms. So we were always done by 8:00. In doing that, started having contact with the healthcare staff at the hospital and the patients. The more I was there and observed, the more I found myself wanting to do. I think it’s that caretaker personality. So one case, in particular, there was a woman that was kind of at the end-of-the-hall and she was a cancer patient and was very ill. I just remembered that had such an impact just bringing her food tray into her, helping her arrange everything, seeing the smile on her face. I found myself wanting to do more. So I think, in my mind, that was probably sophomore year in high school through senior year, I kind of knew that was the path I wanted to take. As far as college, I went to the University of Missouri in Columbia, Mizzou. It was a BSN Bachelor’s program and I felt really strongly about that, about having that Bachelor’s degree, just to have that solid knowledge based to go forward in my career. So that was one of the reasons I chose a four-year program.
Jamie: So when you got out of school, what drew you to school nursing? Did you start out in more traditional path as a med-surg nurse or were you drawn to going back into the school right away?
Kathy: When I started, I stayed up in Columbia a year after I graduated. Worked at the University Hospital in a clinic. And I worked mostly NICU and Peds ICU. So I was always working with children. I then moved to St. Louis a year later and started working in a special care nursery and I was there for the next 16 years. So I started out in hospital nursing. When this opening became available, I had a colleague that also worked in a school and she said, “I think you really need to take a look at this and go in for the interview.” And as I sat and talked to the manager of health service, I found myself really drawn to it and curious about school nursing. It wasn’t until I actually accepted the position that I really understood the full scope of what that career means and I’ve been a school nurse now 13 years.
Jamie: You talked about the full scope or full meaning of the career of a school nurse, what has that come to mean to you?
Kathy: Working in a hospital, which I would encourage all new nurses to start out there to get down your basic assessment skills and triage, but when you step into the school setting, you are an independent practitioner. So you rely on yourself, your own assessment is so important. You can’t pick up a phone and call respiratory therapy and you can’t pick up a phone and call another colleague to come, “Hey, take a look at this.” So you really rely on yourself and your assessment skills which I think is so important. It’s a career that I feel is just taking off, it’s exploding. Because the changes in our economy are such, I can’t tell you a number of children and families that are impacted in such a negative way by the economy that they no longer have health insurance or they’re extremely underinsured. So sometimes the school nurse is their only access to any type of healthcare and that is just so important. It’s a proven fact that healthy children make better learners. So we are such a gatekeeper for the children and the families in our communities.
Jamie: And you’re really a springboard for healthy behaviors to go home and interact with the families as well so that you actually impact the overall healthcare in the entire community.
Kathy: You really do as a school nurse. It’s a profession that reaches beyond just the eight hours that you are in the school building. You work with families. It’s kind of a ripple effect I think. As far as children with asthma and allergies. I’m working with them in the home and giving them resources with Asthma and Allergy Foundation. Sometimes families just aren’t aware of what is available to help them and to help their children stay happy and be successful in school. That, in turn, then helps the family because they don’t have that worry. They don’t have that burden if they need help with the healthcare need.
Jamie: Now you really have to form a partnership with the parents and the family caregivers with the students. But as the student gets older, you need to form that partnership in their own healthcare with that student as well.
Kathy: Yes, you do. It’s really important. Working in a middle school, my whole goal is to teach self-care. We get these children after they’ve gone through their elementary years and now for 6th, 7th and 8th grade, we’re really working with them on “It’s your body. You need to take care of it.” And to prepare them then to head to high school where it’s going to be a different level of care for them. It’s all about self-care and about learning how to be healthy and stay healthy and getting the kids to make better choices: exercise, sleep, food. It’s just kind of an ever-reaching thing.
Jamie: What are some of the major issues that are facing school nurses today in your view?
Kathy: Wow, probably, the biggest issue I believe is the crisis that a lot of school districts are in with their budgets, our budget cuts. I’ve heard from a lot of nurses in some of the rural outreaching areas that they’re actually afraid of losing positions. Sometimes it’s such that nurses have to travel between buildings and then that is then they have to delegate care to a secretary. And that’s a very scary prospect for someone who works in a school with slightly under 1,000 students. I’m very fortunate that I stay in my building. But I know there’s other nurses that don’t have that luxury and I think that’s a big concern as administrators look at their budgets, the liability issues alone, you need to have a healthcare professional in the building and that’s one of the things with our National Association of School Nurses’ slogan is “Every Child Deserves a School Nurse.” And I think that’s really, really important. A lot of times it is lack of education on administration that they don’t realize the impact of a school nurse. We’re not just crackers and Band-Aids anymore. It’s just a profession that as we get more and more chronically ill children coming in to our schools it’s just going to grow and grow and grow every year.
Jamie: How does that the inclusion of students with more and more health problems in the school setting – in years past, a lot of students may have been put into special care settings or homeschool settings but with inclusion being such a big issue and big programs in a lot of school systems now, there are students that have very specific and specialized healthcare needs.
Kathy: Oh, very much so. I think with the reauthorization of the IDEA act, every child is deserving of a free and public education and that’s where our role is taking off. These children are in schools now where maybe 10, 15 years ago, they would never have made it into the front door. So we’re dealing with children who have central lines and have chemotherapy, who get tube feedings. We’ve had students in the past who have been “Do Not Resuscitate.” We’ve had students that are awaiting a heart transplant or a lung transplant and are so severely immunosuppressed. It’s just an ever-changing world and I think that’s why it’s so important for people to understand the impact and the value of a school nurse. We are the healthcare professional for the entire building. These children won’t be able to attend school if it weren’t for having that professional in the building to oversee their care and to keep everybody healthy.
Jamie: What’s one of the initiatives right now that you’re really excited about? I know the National Association of School Nurses have several programs that they are involved with but is there one that you really believe is an initiative that’s really fitting in with your practice and the way you care for your students?
Kathy: We started just last year working with the Dairy Council on “Fuel Up to Play 60” and it’s one of the programs also sponsored by the NFL. We’re really excited. Just teaching kids that just 60 minutes of exercise per day and what an impact that has. We’re in an age now where there’s video games and there’s the Wii. There’s games that teach us how to bowl electronically rather than just going to a bowling alley and picking up a ball. Our world is very different. So it encourages the kids to make better food choices and to be active and it doesn’t mean running a marathon. It just means be physically active, walk around, do some calisthenics, ride your bike, go outside and throw a ball. So we started that program last year and one of the initiatives we did here at school, we had a salad bar makeover and we had the kids take ownership of that and they decorated the salad bar and the cafeteria and painted pictures of fruits and vegetables and we had a tasting where the principals put bright-colored aprons on and went around with trays and have the kids get little carrots and celery and low-fat ranch dressing just to kind of get them thinking that there’s a whole other way that they should approach eating. It’s not just getting some pizza and some French fries. That there’s some colorful vegetables they need to be exposed to. So it was really a fun program and we’re going to continue that this year.
Jamie: Yes, obesity in our youth, I’ve seen new articles and research about it every single week it seems in the course of my duty as a journalist and I wonder programs like that, have you seen positive effect even after just one year?
Kathy: I have. And I think it’s great when you hear kind of the chatter that’s going on among the students. That, “Hey, did you see they had spinach on the salad bar today?” It’s exciting for them and it also carries over through their health class and their physical education classes. We have Cardio Day. There’s equipment now that is offered in a physical education class that - 20 years ago we played dodge ball and now they have stationary bikes and treadmills and they get the kids outside and it’s just – there’s a whole movement toward health and I think that’s so important.
Jamie: As we get ready to close out here, I just like you to share maybe words of encouragement to nurse that’s listening to this or even a student nurse, what you would recommend to them if they’re looking to transition into the role of a school nurse at some time in their future career.
Kathy: I think I would say to them, it is an extraordinary career choice and it’s one that I’ve never regretted for an instant. You certainly won’t get rich doing it but the rewards are ten-fold. You will be a multitasker and triage will be number one in your assessment skills. You never know what’s going to walk through the door. Every day is different. You may have a child having a diabetic issue and the next minute someone comes in from PE and, obviously, you’re going to have to send them for care because they need stitches or a broken bone. You may have the phenomenon that we’re seeing a lot unfortunately with cutting. There’s so many psychological aspects involved as well where you have to work in concert with your social worker and your counseling staff. So I could just go on and on. The rewards are incredible and it’s a tremendous profession but one that you need to be prepared for because it’s a very independent profession.
Jamie: Talk a little bit more about that. What kind of skills should a nurse work on developing before they go out and have that independent role?
Kathy: I think their assessment skill is number one. The fact that even just sitting talking to a student you’re assessing – you’re looking at their color, you can assess their breathing, you can assess skin tone, their eyes, their pupil. There’s so many things that with some experience in maybe a general med-surg background that you have built up those skills so that you can trust your assessment. That you can tell about how someone’s breathing just by how their speaking before you even put a stethoscope on their chest. So I think you really have to be comfortable and confident in your skill and just the basics skills. School nursing is just a little bit of everything. It’s almost like in ER. We are community health nurses. So there’s that whole community health component. One part that we really even haven’t discussed is just the immunization compliance at the beginning of the school year. So every school nurse right now is probably at their computer entering all these immunizations because we get audited and children have to be compliant in order to attend school. So there’s just so much that’s involving that I think multitasking and being prepared to hit the ground running would be my best advice.
Jamie: Yes. I think we’ll be talking a little bit about immunization compliance with our panel in another episode this month but certainly that’s a huge issue and kind of brings in that whole community health, that public health nurse aspect of school nursing.
Kathy: Very much so. Yes. There is a definite link. And just with the – well, H1N1, and that whole issue. It was the first time in history that school nurses were asked to provide immunizations in the school setting. And that was the CDC saying, “You know what, you are community health nurse, you can reach the greatest number of the population by vaccinating.” So we did vaccinations here. We set up a clinic in the building and during the school day, we vaccinated all the children that the parents had filled up the appropriate consent forms. So I can see that and as we move on in the future with healthcare, that may be we’ll be called upon even more to have that type of public health role.
Jamie: Well, Kathy, I want to thank you so much for being on the show and taking some time with us to share something about your career as a school nurse.
Kathy: Well, thank you so much. I’ve enjoyed speaking with you.
Make sure you check out the entire August, 2013 issue of Nursing Notes, looking at ways school nurses impact the health of our children and communities. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month bringing you a panel discussion on school nursing with Marie DeSisto, Director of Nurses and District Coordinator at Waltham Public Schools in Waltham, Massachusetts. and Carolyn Duff, a nationally certified school nurse and current president of the National Association of School Nurses. You’ll find this and other podcast episodes at the Nursing Notes by Johnson & Johnson Facebook page, and in the podcast area in iTunes.