By Kristen Miller
Helping students learn better is the main responsibility of a school nurse. However, there are many things that encompass that.
Annette Bohnsack, a school nurse for the Dassel-Cokato School District, is in her third year at the district, and much of her job is preventative and educational.
Preventative measures include screenings for such things as vision and hearing, along with making sure all students have the proper immunizations as required by state law.
Some of the day-to-day responsibilities as a school nurse include administering medication to students and providing first-aid as needed.
With four schools within the district, Bohnsack can’t be on site for every student when the need arises. To help her, each of the three schools has health assistants, with Bohnsack’s office at the high school.
Another part of her job is training teachers and staff of what to do if there is an emergency with a student, such as an allergic reaction or a seizure.
Though it’s important to keep medical records private, Bohnsack said that it can be just as important for students and parents to share information so that the school can properly react if there is an emergency situation.
“It helps us keep their students safe at school,” Bohnsack said. This is why students with health conditions such as asthma, food allergies, and diabetes have an emergency health plan.
Parents create an emergency health plan with the school nurse, which is then shared with teachers with their permission, Bohnsack explained.
As a district nurse, Bohnsack is responsible for paying attention to current legislation and ensuring the district’s policies are in compliance.
For example, new legislation makes it possible for school districts to stock epipens for students with allergies with the proper training and protocol in place. Previously, a prescription was needed.
Students are screened for vision and hearing every other year in the fall until 10th grade, following guidelines set by the Minnesota Department of Health.
Scoliosis screenings, testing for curvature in the spine, is done for fifth- and sixth-grade girls. Scoliosis is far more common in girls, Bohnsack explained, although only three or four students may be identified.
Some students may continue to be screened as a precautionary measure after sixth grade, Bohnsack noted.
According to the Minnesota immunization law, children must have the required immunizations in order to attend school unless they meet certain exemptions, such as a medical exemption signed by a doctor, or personal or religious reasons, which would require a notarized signature.
“The vast majority of our students are immunized,” Bohnsack commented.
Required immunizations include those for polio, hepatitis A and B, and the measles, mumps and rubella shot.
Added to the list for seventh-graders this year were two new shots, the meningococcal and the Tdap, a booster for tetanus and diptheria.
In addition to being trained on any emergency health plans, many staff members are also trained or certified in CPR. Coaches, physical education teachers and bus drivers are all required to be CPR-certified, according to Bohnsack.
The office staff are also certified in CPR and first aid, since they are oftentimes the first responders in such instances.
School nurses also do a fair amount of educating students in the area of health.
Recently, students participated in an educational activity led by Bohnsack on proper hand-washing techniques.
She also teaches the students about proper hygiene, and gives the “growing up” talks to fourth-, fifth-, and sixth-graders.
Dental health is also taught to first-graders, though Bohnsack said it’s more of a motivator for taking care of teeth.
“Overall, my job is just to help students learn better and be in school as much as possible,” Bohnsack commented.
What happens if a student goes to the nurse’s office
The following are the steps taken when a child comes to the nurse’s office while in school, according to Annette Bohnsack.
Our assessment of the child depends on how they present to the health office.
If it is an injury, we provide first aid, and if it is anything that warrants more than a BandAid or an ice pack, we call parents. We also always notify parents if a child has a hit or injury to the head.
If a child is sick, we always check their temperature first. If their temp is over 100, the child needs to go home. If the child has an illness like pertussis, chicken pox, strep, etc. there are specific school exclusion criteria.
My assessment as a nurse depends on the symptoms the student presents with: If they complain of an ear ache or sore throat, I take a peek with my scope to look for redness or other signs of infection.
If they are having trouble breathing or have chest pain, I check breath sounds, pulse and blood pressure. I can’t diagnose a problem, but I can collect information that is helpful for parents.
How we (health services staff) respond often depends on what we know of the student’s history- For example, if I know that a child has asthma and they are coughing a lot, I’m getting their inhaler rather than giving them a cough drop. If I know a child has diabetes and they’re acting sleepy, I’m offering a juice box, not a nap. If a child is allergic to peanuts and complains of a rash and “scratchy” throat after snack time, I’m looking for the epipen.
The better we know our students, the sooner we can recognize and respond to a health problem.
Parents share a lot of health information with us, and I’m grateful for that. They know their kids better than anyone, so good communication and a trusting relationship between staff and parents helps keep kids safe and healthy at school.