The only predictable aspect about a day in the life of a school nurse is the unpredictability. Plans for health screenings are scheduled, vision checks are arranged by grade level and then an acute situation arises that takes precedence, and everything is on hold for a while.
This is the everyday life of school nurses in Ashe, Avery and Watauga county schools according to lead nurses Regan Perry (Ashe), Dawn Hicks (Avery) and Shelly Klutz (Watauga). Although their days are planned, some days the office of a school nurse becomes “a minor urgent care center,” according to Dawn. The nurse becomes a mini-doctor, acting as dermatologist, orthopedist, EMT and various other medical roles.
All three of the lead nurses have followed similar educational paths: RN, BSN, NCSN (National Certification for School Nurses). Although the colleges involved were all different, the final certification must be acquired within three years of a BSN degree, and this certification must be renewed every five years.
In addition to their own school-related duties, each of the lead nurses acts as the head of a team in each of the school systems. Shelly leads a team of 10 nurses in Watauga County Schools, while Regan in Ashe County oversees a staff of five. In Avery County Schools, Dawn has two additional nurses to split the duties among the elementary schools, the middle school and the high school.
But the health of the student population is not their only responsibility; these nurses must care for and train other faculty and staff within each of their school buildings. Some of this training occurs at regularly scheduled staff meetings or during faculty-staff in-service days.
Typical medical care that has become part of the routine for school nurses is handling medicine and treatments for students with diabetes, ADHD and asthma. Medications are dispensed with the parents’ permission, and then kept in a secure location within the school.
A more routine day — especially at the beginning of a school year — involves checks on students’ immunization records. There is a strong focus on Pre-K, kindergarten and then Grades 7 and 12, and nurses must document that certain vaccinations have been received. If a student has not been properly vaccinated, they have three days to comply, or they must stay home. This is enforced for the safety of all students and staff.
While the school nurses said they don’t have a certain uniform they wear, they do opt to wear their scrubs on certain days. Especially at the beginning of the school year, it’s important for them to be identifiable to younger and newer students. Many times attire that qualifies as business casual is more common.
In Watauga Schools, another aspect of the nurses position is to train all fourth-grade students in the use of the Heimlich maneuver (abdominal thrust) and all eighth-graders in CPR. Shelly says it is a big part of her job to teach the students to be independent care takers of their health. She adds that she’s “thankful for being part of seeing them thrive.”
Sometimes in the administration or regular duties, a more serious illness is detected. Regan in Ashe County recalls a time when a simple screening identified Hodgkin’s Lymphoma. Successful treatment was obtained.
The impact of the COVID-19 pandemic has certainly been felt by all the school nurses, delaying some of the more routine screenings. Although schools battled scheduling issues last year due to the pandemic, which interfered somewhat, regular vision and hearing tests are scheduled for students in Pre-K, kindergarten, first, third, fifth and ninth grade. Dawn says that dental health has become less school oriented in Avery County and that referrals are made to the High Country Dental Health Clinic in Newland. But Shelly at Watauga Schools has the ability to schedule dental clinics every six months through AppHealthCare. The results of all testing are shared with parents to assist with follow-up recommendations.
They were also able to test for and detect COVID-19 cases this past year. Nurses in Watauga County Schools have been able to use rapid testing and get results within 15 minutes. All nurses then assisted with tracing to assess the risk to others.
In Avery Schools, Regan said that in order to prevent the spread of COVID-19, classrooms at all grade levels have required seating charts for students. “We’re even trying to keep social groups together,” she says — such as in the cafeteria — in order to quickly determine contact information.
Last year Watauga County Schools conducted about 800 COVID-19 tests, and detected at least 40 positive cases. Shelly commented that most of the cases originated in the home, which then created quarantine problems within the family cluster. But once the vaccine became available, “cases decreased dramatically,” Shelly says.
Watauga County Schools nurses follow the motto of, “Healthy children learn better, school nurses make it happen.” This certainly applies to the nurses in all three school systems.
Regan said the job of a school nurse is a lot “more than just ice packs and (bandages).” That might be about the only predictable part of the job of a school nurse on a daily basis.