School nurses met in Chapel Hill last week for an intensive two-day workshop focused on getting them up to date with the newest trends.
School nurses met in Chapel Hill last week for an intensive two-day workshop focused on getting them up to date with the newest trends.

By Rose Hoban

One day last week, four kids showed up in school nurse Frances Tutterow’s office at Courtney Elementary School at the same time. All of them had been stung by bees.

“I had to focus on one, who said she was allergic and the mother had not signed the paperwork,” Tutterow said. “I had the doctor’s order, but I was waiting on mom to send the Epi-pen, so I had to call really quickly and get mom there.”

More than 500 nurses came to Chapel Hill for two days of intensive classes last week. Here, an overflow crowd takes notes in a class on kids who harm themselves.

Tutterow said the situation worked out and the child only needed some Benadryl to stave off an allergic reaction. But that kind of situation happens often, she said, situations where many children need help at once.

Tutterow is a school nurse in Yadkin County, where she oversees the care of about 850 children at Courtney and Forbush middle schools.

“I’m really fortunate,” she said. “I have the lightest load in the county.

The Yadkin County average is one school nurse for every 1,100 students, Tutterow said – a bit better than the state average of one per 1,204 students.

Tutterow joined about 500 other school nurses last week at the Friday Center in Chapel Hill for their annual school nurses conference, where many of the speakers and displays focused on caring for children with chronic diseases.

Organization is key

“At the beginning of the school year, the most challenging student is the student with a food allergy,” said Cheryl Herberg, incoming president of the School Nurses Association of North Carolina. Herberg oversees the care of more than 1,700 students in two Union County schools in the Charlotte suburbs.

“We have to really make sure that everybody’s very aware of the student’s allergy plan, where they can sit, what they can eat, what the emergency plan is if they do eat something, do they have medication at school, is that medication going to come to school, is it here yet, where is it …”

“When you only work in a school two days a week, you lose a lot of control over what happens when you’re not there. So you spend a lot of time just organizing everything.”

Herberg paused for breath.

Herberg said the ratio of children to school nurses began to improve about seven years ago, when the state committed to improving the situation.

“The recommended ratio is one nurse to 750 students,” Herberg said. North Carolina was until recently at about one to 1,200 kids, she said, but began to slide, now closer to one for every 1,300 students.

“With the recession, the first thing to go is school nurses,” Herberg said.

Ratios for school nurses range widely in North Carolina, from one to 316 students in Pamlico County to one to 3,117 in Davidson County. Wake County has a ratio of one nurse to about 2,600 students.

Teachers often fill the gap when the school nurse is off site.

“We train teachers to be first-responders for when I’m not there,” Tutterow said. “Sometimes they call me, we talk through it; sometimes whoever is the closest nurse goes, or we call 911.

“That’s a big part of what the school nurse does, is to train the staff, how to handle emergency situations and how to deal with things when the nurse is not there,” she said.

And more students are needing to have a nurse around, according to Ann Nichols, the school health consultant for the Department of Health and Human Services.

“Many children present with chronic diseases – diabetes, allergies, asthma – complicated health issues,” Nichols said. “Our children reflect the society; there’s a growth of chronic diseases across society, so these children present with similar issues.”

According to statistics gathered annually by the school-health unit of DHHS, nurses in schools carried out more than 114,000 doctors’ orders during the last school year; many of those were orders for administration of daily medication.

One reason for holding the annual meeting, Nichols said, is because school nurses can feel isolated.

“They’re the only health care provider in the school,” she said. “You can’t just go to the next bed and ask the opinion of the nurse there. You have to be very well prepared to meet the needs that are facing you when you’re by yourself.”

Mental health a preoccupation

Handling mental health problems in students was high on this year’s agenda, with sessions on autism, tobacco use and self-injuring behavior.

Heads nodded vigorously during a lecture given by Jeremiah Hopes, a counselor who works near Charlotte with young men who are locked up in the juvenile justice system.

“How many of you know a kid with ADHD?” Hopes asked during a session about diagnosing attention-deficit/hyperactivity disorder. Nearly every hand in the room went up.

“How many of you are thinking of a boy?” he continued. Most of the hands stayed up.

“Because a kid’s behavior is out of line, it’s ‘easy’ to give them a diagnosis, and then medicate them,” Hopes said.

He went on to detail the process for diagnosing ADHD, a process that he said is difficult to do correctly, and can take up to six months of gathering information to get right.

Hopes also spoke about prescription-medication abuse and identifying the signs of a problem.

“They’re called Generation RX, because of this rise in the use of prescription medications,” Hopes told the group.

“In the past, people who got heroin, or cocaine, you needed to go to Skid Row,” he said. “But now, you only need to go to Grandma’s pocketbook, or to the medicine cabinet.”

Hopes reminded the nurses that people in the 12-to-25 age group have the highest rates of prescription-drug abuse, even though the death rate is higher in people in their 30s.

“That’s why school nurses and other professionals are so important,” he said. “As professionals, we need to be aware of the signs and symptoms.

But not only do we need to be aware, we need be to able to act.”

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Rose Hoban

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...