SCHOOL NURSES' FUNCTIONS HAVE EXPANDED WITH TIME

In the last five years, Jeanne Heise has made a complete turnaround in her nursing practices at Central High School. Heise, a registered nurse, has been working for 17 years in the district.

School nurses don't just take temperatures and bandage cuts anymore; today, the job requires a combination of preventive health care, counseling, and child-advocate roles.

"There is so much going on with kids in the '90s," said Jan Davis, a registered nurse for the Scott City School District. "Their bellyaches are legit."

Nurses used to just administer Coke syrup for stomach aches, check temperatures and bandage skinned knees; now they see students with severe handicaps, illnesses and chronic diseases.

"Just around the corner is the child with AIDS," Heise said. Nursing isn't just about Band Aids and aspirin anymore. "It's social work."

There are only a few nurses available to treat hundreds of students at area schools. Some smaller school districts don't even have a full-time nurse on staff.

In many districts, teachers have been trained to give out medications for students on prescriptions. In Jackson, teachers have been trained to distribute medicine when a nurse is not available. However, the district's written policy states that no medicine should be dispersed at school.

Although teachers and secretaries at Scott City are trained in first aid and CPR, Davis administers all prescription medication. She sees about 50 students daily to treat diabetes, asthma and administer medications like Ritalin, which is used for attention deficit disorder.

Usually another 40 to 50 students come in with ailments that range from stomach aches to bumps and sores. But Davis doesn't often give medications other than those prescribed by a child's doctor.

Although Davis is busy with routine chores, she makes time for every student who comes through the door. "It's a lot of communication," she said.

Davis likes to talk about what is happening in the classroom or at home so she can find the root of the problem. "They might have a spelling test and they didn't get to go over the words at home," she said. Older students come to her with problems about teachers, classwork and parents.

"The scope of nursing has changed," she said. "It's about education."

School nurses teach health and hygiene lessons and do height, weight and vision screenings.

"It's communitywide," Heise said. "We evaluate and assess. We have a lot that come to us and never see a doctor. They might have a broken arm and their parents want an opinion on whether they should see a doctor."

Nurses often make referrals for students who need to see a doctor. "We beg and borrow the money so that we can pay for the medical expenses," Heise said. "It's the people who fall between the cracks and get no assistance."

There is a division among school districts in the area about who is qualified to fill the nursing positions. Most school nurses are RNs. However, there has been a controversy in the Cape Girardeau district about whether to hire RNs or LPNs. LPNs only have one year of education and usually work under the direction of a registered nurse.

LPNs are excellent nurses, but there is a concern about whether they can handle all the problems that school nurses face, said Barb McKeon of the regional chapter of the Missouri Nursing Association.

The Cape Girardeau Board of Education will discuss the school nursing program at its meeting Monday. The board meets at 6 p.m. in room 214 of the Vocational-Technical School.

When the nurse at Scott City is absent or attending a conference, a substitute RN is hired. "We have been able to get substitutes every time she's out," said Superintendent Roger Tatum.

But smaller districts like Oran don't have the funds to hire a school nurse. The district has never had a nurse, said Superintendent Tom Anderson. If a student gets sick during the school day, the building principal handles the problem. Distributing medicines is avoided, he said.

Zalma and Leopold school districts hired their first nurse two years ago as part of a grant project with the Nursing Association at Southeast Missouri State University. Until then neither district had a nurse to treat ill students.

Oak Ridge and Nell Holcomb schools are sharing nurses. The two nurses alternate days at each school so that there is always a nurse at either school.