by Susan Sommerfeldt

In March 1992, the Green River District Health Department saw a need to become more involved in school health. It began the school nurse program in Owensboro Public Schools at Estes and Foust elementary schools because of their high population of students from low-income families.

The city school system found that the nurses made a difference -- when children’s health care needs were met, they were better able to learn.

Since then, the program has expanded to the county and Catholic school systems and is considered an integral part of the community’s health care system. Nurses report that school health rooms are often the primary care or medical homes for some children and families who are uninsured or underinsured.

The nurses’ services are not limited to students from low-income families, however. “It is a fallacy to believe that the private schools and more affluent children do not utilize the health services at the schools,” said Kathryn Crowe, registered nurse for Owensboro Catholic Schools. “I see the same types of issues in our system and the need for education is great.”

Funding now comes from several sources besides the health department, including Owensboro Medical Health System and the school systems themselves.

Nevertheless, some local health and school officials say that the program does not have enough nurses to meet the needs of all students, particularly given growing rates of childhood obesity, diabetes and asthma.

The American School Health Association recommends that school systems have about twice as many nurses as the Daviess County systems have currently – one for every 750 children. The rate here is about one for every 1,400 children.

In addition, local schools at times have to scrape together funds to keep the nurses they have. One year, Daviess County Middle School teachers and staff voted to contribute their school’s “reward money” for student achievement on the statewide CATS test to retain registered nurse Anita Owens.

The registered nurses are assisted in many schools by health technicians whom they have trained. The health technicians are not licensed, nor are they required to have formal medical training. That means they can provide only limited services. However they are able to take over duties that once fell to teachers and staff members with little or no background in health care.

In the days before school nurses and health technicians, Debby Neel of OMHS remembered, “Children would come to the (school) office to get their meds, and school personnel would be asking what color their medications were since they were so unfamiliar with the drugs. With several children needing morning medication, the potential for error was tremendous.”

Today, nurses and health techs are called on for an array of services, some of them complex. Besides monitoring students’ medicines and dealing with injuries, they support students with chronic illnesses which may involve feeding tubes, insulin pumps, tracheostomy (breathing tubes) care, urinary catheterizations or intravenous medication.

Dr. Lee Clore, a local pediatric allergist/immunologist, said the school nurse program helps carry out the plans that doctors develop with their young asthma patients. “We send these kids to school with meds like inhalers with instructions. These ‘asthma action plans’ allow the school nurses to have a structured approach to the treatment of the asthmatic student. They are a valuable part of the health care team.”

There’s also a tremendous need for education about preventive health care, said Wendi Morgan, a registered nurse for the Daviess County Public Schools.

But for the most part, Morgan doesn’t have the time for it, she said. “I oversee four schools, with almost 1,900 students. We’ve got much sicker kids in school now, which requires training the teachers and staff on the kids’ illnesses in addition to overseeing the health techs. It doesn’t leave much time to get into the classroom on a regular basis.”

Here’s how the school systems are staffed now:

1. One registered nurse (employed by the hospital) oversees the four Catholic schools and about 1,400 students. The system also has three health technicians.
2. Owensboro Public Schools has four registered nurses (two employed by the health department and two employed by the school system) and three health technicians for 10 schools and about 4,000 students.
3. Daviess County Public Schools has seven registered nurses (four employed by the school system and three employed by the health department) and 15 health technicians for 17 schools and about 11,000 students.

The approach of the school systems to health care issues has evolved over the years. Last year, for instance, the Daviess County Board of Education developed a more comprehensive health education plan. The Healthy Student and Staff Initiative resulted in bimonthly parent health programs, expanding the school resource officer program, the production of a healthy food booklet for parents and staff, and replacing vending machine items with 50% healthier choices. One middle school in the system volunteered to pilot 100% healthy vending choices.

Copyright ©2005 Public Life Foundation of Owensboro

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