School nurses at front line of children's health issues

Sunday, November 28, 2004

NEW YORK -- School nurses do a lot more than tend to cuts, bruises and the occasional bloody nose.

Those playground wounds are all part of the job, says Karen Tremblay, the nurse at East Taunton Elementary School in Taunton, Mass., but so are the more serious and life-altering insulin injections, wellness programs, asthma education and allergy monitoring.

Tremblay also spends a good part of her day caring for and helping to assimilate medically complicated children into public school classrooms.

And that's just at a K-4 school. In middle and high schools, school nurses also might be on the front line when it comes to mental illness, drug or alcohol abuse, or teen pregnancy.

An annual school nurse training program even added bullying and terrorism fears to its curriculum.

"School nurses are front-line people," says Gail Gleason Milgram, director of the Johnson & Johnson School Nurse Fellowship Program. "Kids feel comfortable coming to them with more private and confidential issues because their offices are usually separate. They (nurses) usually know who the kids are who have problems because those kids come in and see them."

Milgram recalls an incident when teachers and coaches at a school were not so quietly whispering if a formerly outgoing and successful student had turned to drugs when he became withdrawn, but the nurse was able to identify from her interaction with him that he was actually in shock, the result of a car accident.

School nurses who address wellness issues -- which often piggyback on self-esteem issues -- are also providing students a valuable service because children with healthy attitudes and strong coping skills usually perform better at school, says Milgram.

But while school nurses are often intimately involved with students, many schools don't put them on their crisis teams, which Milgram, who also is the director of education and training at the Center of Alcohol Studies at Rutgers University, thinks is a mistake.

"These are the professional health care people who should be the primary resource on crisis teams. ... School nurses are one of the few people parents actually talk to and know at a school because they get the calls. They know the nurse is caring and concerned for their child," she says.

East Taunton nurse Tremblay was one of the nurses who went through the Johnson & Johnson program, and she's adopted a proactive agenda at her suburban school located between Boston and Providence, R.I.

"I've been a school nurse five years and I was an ICU nurse for 20 years before that. My thoughts of what a school nurse did was picked nits, looked for head lice and took care of scrapes and bloody noses," she says. "That's part of what I do but my role is so much bigger."

Tremblay, after noting that 16 percent of her school's students were considered overweight based on the federal guidelines and another 21 percent were at risk of becoming overweight, has made the fight against childhood obesity her pet project.

Tremblay applied for and received a few small grants, using it as seed money for her new Fun and Fit Club. She bought T-shirts and light exercise equipment, such as jump ropes and balls, that students can use two mornings a week before school.

She also bought a variety of nutritious foods for kids to taste so that they can go with their parents to the grocery stores and help make smarter decisions about the meals they eat.

"The Fun and Fitness Club is not a diet. It has nothing to do with limiting or restricting food, it's about learning to make healthy choices," Tremblay says.

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