December 18 — 1:31 pm, 2014

When to stay and when to leave? School nurses make the call

In his four years of being in high school, Terrell was never sick. So when he showed up in the nurse’s office at 8:30 a.m. on a half-day, I knew something was really wrong.

Terrell said his stomach really, really hurt. Juice and crackers for hunger pains and a trip to the bathroom for what I like to call “a morning constitutional” typically cure the vast majority of in-school stomachaches. But not this time. Terrell had a stomach virus and he needed to go home.

There is no magical cure that can be offered in school that will make a student with a stomach virus or the flu well enough to remain in school and concentrate on his/her studies. School nurses are trained to recognize the severity of illnesses and injuries and to treat or refer according to their assessment. Thus, school nurses need to be regarded as the backbone of the health delivery system to our schoolchildren.

In these days of scarce health resources and duplication of services, school nurses actually save the health system money by preventing unnecessary office and emergency room visits. In terms of health care delivery, they are a bargain. A student who has a stomachache in school usually needs to use the bathroom, not the services of a doctor.

I’ve been a school nurse for almost 25 years. What I have found is that for every hundred students I see, perhaps three are sick enough to go home and maybe one might be sick enough to require medical attention. The vast majority of student illnesses revolve around seasonal illnesses, like the flu, which are usually both mild and limited.

The very good news is that children are our healthiest population. School nurses know this because they work from a public health model, which promotes the health of children, rather than from a medical model, which sees a problem in every symptom that needs to be treated.

This is not to say that children do not have significant health issues while they’re in school. Some students have digestive issues that result from diet and elimination problems. Kids who don’t eat fruits and vegetables become constipated. Kids who are malnourished or follow a junk food diet often get chronic stomach pains and headaches. Many other stomachaches and headaches are a direct result of stress and mental health problems. Poverty does terrible things to children. School nurses manage a steady stream of these students every day and meet their needs through health education, referrals, and tender loving care.

This winter season, my days are filled with stomach viruses, colds, coughs, and sore throats, none of which require medical attention. Some, like Terrell, need to go home. Most, however, can take Tylenol for their headaches and sore throats and remain in school. I have several girls close to delivery who are having pre-labor contractions. I have my diabetics, some of whom can have very low or very high blood sugar at any point in time. I am monitoring the blood pressure of several students as their nurses are busy from the beginning of the school day until dismissal.

Several things should be perfectly clear. Certified school nurses have a proven track record of providing health services to Philadelphia’s children. They keep children in school when their health allows it and send them home when they are too sick to stay. All children in school are entitled to use the services of the school nurse. As two students’ deaths have sadly proven, schools without nurses are dangerous places for children.


Eileen M. DiFranco, R.N., is a certified school nurse who has proudly served the schoolchildren of Philadelphia for 23 years. She is a lifelong resident of Philadelphia.

The opinions expressed are solely those of the author.

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