HEAVY DUTY: SCHOOL NURSES EXPECTED TO DO MORE UNDER LAW

Gone are the days when a school nurse's role consisted mainly of checking for fevers and placing bandages over playground scrapes.

Although fevers and bandages remain, today's school nurses have a much heavier workload that includes keeping up with daily emergencies, record keeping and health screenings. In addition, they handle complex medical problems that may include installing catheters and dispensing medications so powerful they must be kept under lock and key.

Some said they have seen many changes in their roles, especially since a Supreme Court ruling two years ago mandated that schools provide nursing care for children with complex medical problems.

Court changes roles

In 1999, the Supreme Court was asked to clarify a provision of the Individuals with Disabilities Education Act (IDEA) -- which requires school districts to provide "a free and appropriate education" to children with disabilities -- that exempted school districts from providing medical services.

The Supreme Court expanded the statute to require schools to provide nursing care to accommodate students' medical needs. Justices wrote in their opinion that federal law was written "to educate handicapped children with non-handicapped children whenever possible."

Since the ruling, nurses said they have seen more of their time has been dedicated to managing medical problems that range from dispensing medications for behavior disorders to assisting with tube feedings.

"You ought to see my medicine drawer. I give close to 50 doses of medicine a day," said Linda Brotherton, nurse at Jefferson Elementary School. "Years ago, they probably would have been kept at home just because of the health risks involved for them. But because the nurses are here to take care of those needs, they can be here."

Managing care

Brotherton said her decision three years ago to become a school nurse was based on a desire to work with children and to have a job that allowed her more time with her family. Her decision was one fewer nurses are willing to make because of low salaries and complex workloads.

"There are some times when we don't have extra nurses," Brotherton said. "If we are sick or need to go to a meeting, we may not always have someone to fill in when it's probably necessary to have someone here."

To assist with coverage of health issues, the Cape Girardeau School District employs a full-time nurse in each of its nine schools. In addition, Lisa Johnston serves as a "floating nurse" who substitutes for other nurses or assists them with various duties when necessary.

And Christy Sprengel, a public health nurse at the Cape Girardeau County Public Health Center, assists nurses at each building in conducting student screenings in vision, hearing, head lice, height, weight, scoliosis and blood pressures. Sprengel also helps with classroom education on hygiene, first aid and CPR training.

"She's able to extend what we do, since a lot of times we see so many kids and we can't always get into the classrooms as much as we like," said Johnston.

Brotherton said having additional help means school nurses can do a better job of monitoring medical, educational and even social concerns in students. For example, Sprengel assists school-based social workers in home visits to educate parents about head lice and other issues, she said.

"All kinds of things affect how well kids will do in school," said Brotherton. "This just helps us do our part better.".