Nurses with class

Cynthia Scurry has spent most of her 27 years as a nurse in operating rooms. But when her daughter started school seven years ago, Scurry decided that being a school nurse was a better fit.

"I thought it was going to be a little piece of cake, and I found that it's about as challenging as the OR," said Scurry, school nurse at Kemp Elementary School in Powder Springs. "I'm dealing with diabetes, asthma, food allergies, epilepsy and accidents on the playground that require splints, pressure dressings or eye washes. Unlike the hospital setting, where you can immediately bounce something off a colleague or get your hands on a doctor, in the school, you're it."

She's grown to love the autonomy and "her babies," as she calls her students. She has also improved her assessment skills, because children don't describe symptoms like adults do.

"They say, 'I feel funny' or 'My neck hurts,' and you have to figure it out, because it could be serious," said Scurry, RN, BSN.

Serious as a heart attack, sometimes. When a school secretary suffered a heart attack at school, she just wanted to lie down and rest. But Scurry sent the secretary to the hospital, where she ended up having heart bypass surgery.

"School nursing isn't Band-Aids," she said. "People don't think of the school nurse's office as a clinical setting, but it is. We have medications to give daily and controlled substances. You can't just give seizure medication or insulin and not know what could happen.

"It's time school nursing gets the respect it deserves and that school nurses are compensated as they should be."

Scurry feels fortunate to work in a county "on the forefront of school health." Cobb County has a licensed nurse budgeted for seven hours a day in all 113 schools, plus six consulting nurses, 13 special-education nurses and two itinerant nurses who fill in when they are needed, according to Anne Coyle, RN, BSN, NCSN, nursing supervisor for Cobb County.

"Things have improved. We used to have the nurses budgeted for only five hours a day," Coyle said. "We have good support administratively, and principals understand our value more and more, as they see us in action. Since there is hardly a school that doesn't have a child with a serious illness, there is a great need for school nurses."

Coyle's goal is to maintain the quality of care while increasing the visibility and role of school nurses. Consulting nurses provide training, answer questions and help write care plans for school nurses.

Coyle also holds four professional learning days a year to update nurses on new medications, treatments and school health issues. Because there is no funding for learning days, she asks speakers to donate their time.

School nurses are constantly learning and sharing what they know. Keeping school staffs and communities informed is part of the job.

"I publish a newsletter and have a Web site to educate the community," Scurry said. "School nurses are the biggest advocates for school health. I'm always telling people to use us, use us; we have a wealth of knowledge."

Setting standards

Because of her experience in pediatrics and administration at Grady Memorial Hospital, Lynne Meadows, RN, BSN, MS, was recruited by Fulton County Schools to establish policies and procedures for its student-health services program in 2000.

"With more kids with chronic and acute illnesses in school, the county needed some standards," Meadows said. "There isn't money to put a nurse in every school, but our model works very well. The kids are safe and healthy."

Getting to work with mostly healthy, smiling children and seeing positive results are her rewards.

"When a child has a vision problem and gets new glasses, then he can see and starts performing better in the classroom. Knowing that we help kids function better keeps me in this job," Meadows said.

School nurses, she said, "talk the talk and walk the walk" of former Surgeon General Joycelyn Elders, who said, "Kids have to be healthy to be educated and educated to be healthy."

Fulton's school system has about 80,000 children in 88 schools. Meadows' team of 17 nurses, 11 cluster nurses and five special-needs nurses train, oversee and support the clinic assistants who work in each school. Each lay person is trained in CPR, first aid, common childhood illnesses and defibrillators.

"Our nurses serve as case managers, and while it's nice if they come with pediatric experience, it's most important that they have the right personality for the job. They have to be able to transfer what they've learned from the hospital to a school setting," Meadows said. "School nurses need great communication skills to get a health care agenda across in an education setting."

Juggling priorities

They also need stamina. As a cluster nurse in the John's Creek area of Fulton County, Trish Vacarella, RN, NCSN, is responsible for seven schools and about 8,500 students. She spends a lot of time juggling and prioritizing, depending on student needs.

"I get calls if there's an injury, an unusual number of children out sick, or someone needs a second opinion on a rash," Vacarella said.

"Our goal is to keep kids in school whenever possible, so I can intervene and do an assessment to see what's going on," she said. "If there's a hint of a communicable disease, it can turn your day on a dime."

When that happens, Vacarella puts on her detective/epidemiologist hat to assess the situation and inform the principal. "They've grown to appreciate our quick response."

She's also the chief health educator/trainer for her clinic assistants, school staffs, students and parents, training people how to give vision, hearing and scoliosis screenings, perform CPR, use a defibrillator, create an emergency response plan, recognize disease symptoms, and care for people with a spectrum of chronic or acute illnesses.

"One teacher had a little boy present with hives after lunch and knew it was probably an allergic reaction," Vacarella said. "She brought him to the clinic immediately, and they called 911.

"He was having respiratory distress by the time he got to the emergency room, so it could have been a lifesaving situation, but, because of her trained reaction, it had a good outcome. The education we do has an enormous impact."

Last year, when school nurses were in danger of being eliminated from the Fulton County budget, Vacarella was gratified to see support from parents and school administrators who recognized their value, and the budget crisis passed.

"We help take away the medical barriers that would keep children from learning, and every day is different," she said. "This has got to be the most fun, exciting and rewarding job I've ever had."

Vacarella knows she could make more money working in critical care, but she wouldn't have the summers off and she wouldn't have the same sense of satisfaction.

"As a cluster nurse, I get to follow kids up through the grade levels," Vacarella said. "When I see a child with chronic health issues graduate, it's awesome."