Back To School Nursing

Children washing their hands before lunch. Tak...
Children washing their hands before lunch. Taken at the Penasco school in Taos County, New Mexico, United States. (Photo credit: Wikipedia)

School nurses are an important—and often overlooked—part of our health care safety net. RNs at our nation’s schools handle medical emergencies, provide episodic and chronic care (including for the increasing number of children with Type II diabetes), track communicable diseases, connect children with needed insurance and health care providers, promote healthy behaviors, and screen for conditions that negatively affect learning—such as poor vision. They do all of these things mostly independently, while juggling sometimes competing and conflicting demands, rules, and laws of the educational and health care worlds. And now that Michelle Obama and the USDA have successfully added fruits and vegetables to school lunches, our school nurses are extra busy encouraging millions of school children to eat them. Some nurses must be responding to skeptical and creative students with, “No, you are probably not allergic to broccoli—only Justice Scalia is allergic to broccoli.” Given that the average school nurse in the U.S. is responsible for 1,151 students at 2.2 schools, school nurses are an important, overlooked, and overworked workforce.

Lina Rogers Struthers was the nation’s first school nurse. Part of Lillian Wald’s community nursing group, Struthers was employed by the school system of New York City in 1903. The year before she was hired a total of 10,567 children were excluded from NYC schools due to health reasons. The year after the introduction of the school nurse program only 1,101 students were excluded from school for health reasons.

On April 23, 2009 school nurse Mary Pappas in Queens, NY altered the local health department of an unusual outbreak of flu-like illness in her school. The CDC was called in to investigate and it was found to be the first documented outbreak of H1N1 influenza in the U.S., triggering a national response. This past spring in my home state of Washington, school nurse Becky Neff alerted state health officials of an outbreak of pertussis (whooping cough) in Skagit County, north of Seattle. Ms. Neff is the only registered nurse in her 3,700 student school district. (see NYT article “Cutbacks Hurt a State’s Response to Whooping Cough” 5-12-12, by Kirk Johnson) School nurses don’t just help keep students healthy: they help keep entire communities healthy. We need more of them.


Robert Wood Johnson Foundation, Unlocking the Potential of School Nursing: Keeping Children Healthy, In School, Ready to Learn. August 2010

National Association of School Nurses (interview with Linda Davis-Aldritt, President NASN on preparation needed for being a school nurse)

CDC’s Division of Adolescent and School Health

Fun video clip about the work of Vermont school nurse Mandy Mayer, “I am a nurse, I am a leader” (won this year’s ANA award).

Of Flyswatters and Public Health Nursing

Earlier this month I was in NYC and stumbled upon an amazing exhibit “Activist New York” at the Museum of the City of New York (runs through the end of the summer). In between the Quakers and Gay Bob (the world’s first gay doll), was an entire section on Lillian Wald and the Henry Street Settlement. The overview placard reads:

“In 1893, two young nurses, Lillian D. Wald and Mary Brewster moved into a Lower East Side apartment to offer medical services to poor immigrants living in tenements nearby. Out of their initial effort grew two institutions, the Henry Street Settlement and its public nursing service, which later became the Visiting Nurse Service of New York. When Wald moved into 265 Henry Street in 1895, the city had a handful of settlement houses; by 1911 it would have at least 70. Wald became one of the nation’s most recognized social activists. Her urban nursing service helped create the field of public health nursing. Henry Street became a nerve center for causes ranging from labor arbitration to the abolition of child labor to racial integration and world disarmament (…) The activism of New York City’s settlement workers and visiting nurses thus helped to define social welfare and urban liberalism in 20th century America.”

I read this with great pride and wanted to jump up and down and tell everyone in the (quiet—it is a museum) room to come look at what nurses had done. Then I spied a strange arrangement of items in a glass-enclosed case, beside a life-sized statue of Lillian Wald. I looked closer and it was the (dreaded to me!) black leather bag of the public health nurse and a wooden collapsible flyswatter with Metropolitan Life Insurance written on it. The black bag I knew well from my own clinical rotation in public health nursing in a previous century. But a fly swatter?

Turns out that Lillian Wald formed a partnership with the Metropolitan Life Insurance Company, whereby they contracted with her visiting nurses to care for ailing policy holders in their homes—and the Metropolitan Life Insurance Company had a huge public health campaign against flies/contagion and tuberculosis and the visiting nurses gave out free fly swatters wherever they went.

Somehow this part of the story started to make me feel unsettled and I wondered if Lillian was a sell out to corporate America….

Still, I highly recommend this exhibit if you are in NYC this summer. Where else in the world can you find early Quakers and public health nurses and Gay Bob dolls all in one room?