For a child who comes to the school nurse with a headache once a year, a couple of pain reliever pills and a tall glass of water will probably do the trick.
But what about the student who has a headache every day? “This is a child who may have underlying health issues that could be related to a medical condition, or could also be caused by stress or environmental factors like lack of housing or access to food,” said Nicholas Herrick, RN, school health nurse supervisor at Children’s Hospital of Wisconsin.
By providing full-time school nurses at eleven Milwaukee Public Schools, Children’s Hospital of Wisconsin is helping schools and communities improve health outcomes for kids. Now in its 20th year, Children’s Hospital of Wisconsin’s School Nurse Program operates on the model of one nurse for one school — enabling nurses to get to know students, staff and community, develop trusting relationships and educate families.
“These relationships let us look deeper into what is going on with students,” said Herrick, “so we can work together with families and communities to keep kids healthy and find solutions when they’re not. And since kids’ health is so connected to educational success, we’re making a positive impact on learning.”
Stephanie Alberda, RN, has been the school nurse at Clarke School in Milwaukee’s Metcalfe Park neighborhood for nine years. On the first day of school, Alberda had already treated a child for pink eye, seen another child for a skin problem, met with several parents about their children’s medications and welcomed a class of incoming kindergartners who came by her office during their school tour — all by 9 a.m.
“Good morning!” she said, shaking each child’s hand and greeting them by name. “If you ever don’t feel good, you can come see me. I’m here to help you get better so you can be a good learner.” The children returned Alberda’s bright smile.
For Alberda, who worked as a volunteer nurse in a local clinic before taking the position as a Children’s Hospital of Wisconsin school nurse, community nursing is the key. “The education piece is so important,” she said. “Many of us don’t seek health care until we need medicine. With school nursing, we can have that up front impact — helping identify illness before a child needs to visit the emergency room, and educating families on lifestyle changes that can prevent illness.”
She cites the example of concerns about lead levels in Milwaukee neighborhoods. “As school nurses, we help make sure families are aware of resources they can use to prevent lead poisoning — such as lead abatement programs that help renters and homeowners.” Nurses also connect families to Children’s Hospital of Wisconsin community health navigators, who work in the same neighborhoods served by schools and help families get the resources they need — be it housing, job training or access to health insurance.
Alberda sees first hand how school nursing can have a far-reaching effect on families. “One student I cared for was referred by her teacher. She was taking frequent bathroom breaks, complaining of hunger and had put on weight.” Alberda recognized the symptoms of prediabetes in the child. In reaching out to the girl’s mother, she found that others in the family had similar problems.
Alberda referred the family to a Children’s Hospital of Wisconsin program that helps overweight kids by managing and preventing weight-related medical problems through individualized nutrition, exercise and behavioral support. “My work with the student helped her whole family adopt lifestyle changes that made a positive impact.”
The school nurses can also update a child’s electronic health record, which can then be used by a Children’s Hospital of Wisconsin provider in an urgent care clinic or primary care office. “It’s one more way we offer coordinated care — and it opens the lines of communication between us, clinic doctors and families,” said Alberda.
Bridget Clementi, vice president of Community Health at Children’s Hospital of Wisconsin, knows school partners see the value of nurses affiliated with a highly-respected health care organization like Children’s Hospital of Wisconsin. “Because our school nurses are connected to the wealth of providers, expertise and programs at our hospital, we can offer students and families a network of resources to support their health and wellness,” she said.
Through their daily work, Children’s Hospital of Wisconsin school nurses recognize needs and bring outside resources in to support student health. For example, school nurses partnered with the Smart Smiles program to offer preventative dental care to all students. Basic dental care makes a huge impact on children’s health, as dental cavities are a primary reason for missing school.
Children’s Hospital of Wisconsin nurses also helped schools partner with Prevent Blindness of Wisconsin, offering vision screenings and vision care to children. “Our school nurses work as integrated partners within their school communities,” said Clementi. “Our one nurse, one school model allows the school nurse to be part of the fabric of the school community. Our full-time nurses are invited to meetings and included in events — they are truly seen as partners, not only providers.”
Most of what impacts kids’ health takes place outside the doctor’s office. If we really want to keep kids healthy, we need to be engaged in their schools and communities.” Children’s Hospital of Wisconsin makes a nearly $1 million annual investment in the program, part of Children’s Hospital of Wisconsin’s impact outside its hospital and clinic walls. “Last year, there were more than 19,000 visits to our school nurses,” said Clementi.
Research shows that a school nurse, on average, saves school staff time every day — 60 minutes for principals, 20 minutes for teachers and 45 minutes for support staff. “That means school staff can focus on their jobs, while we meet the health needs of kids.”
Children’s Hospital of Wisconsin donors, too, recognize the value of the program. “Without the support of individuals, foundations and corporations, the School Nurse Program would not be what it is today,” said Clementi, “and donor support is critical to our ability to expand the program.”
Helping kids manage and understand chronic health conditions is an important piece of the School Nurse Program. Up to 20 percent of Milwaukee students suffer from asthma, and more than 60 percent of students who visited the school nurse for a chronic disease were seen for help controlling their asthma.
School nurse manager Herrick says that Children’s Hospital of Wisconsin responded to this challenge by developing an asthma management program from the ground up. “Our emergency department was seeing a lot of kids for asthma related problems that could have been prevented by proper management,” he said. Now, school nurses work with the asthma management coordinator, another Children’s Hospital of Wisconsin nurse, to help students understand what triggers their asthma, how to avoid those triggers and how to property treat an asthma attack — with the goal of keeping kids out of the emergency room and in school.
“Students at Clarke take 6–8 week classes to help them learn to manage their asthma,” said Alberda. “It makes an impact when kids understand asthma triggers and know how to use their medications to manage their asthma. Helping support these kids is just another piece of the puzzle.”
It’s not just students’ physical health that benefits from the Children’s Hospital of Wisconsin School Nurse Program. Diana McGuan, RN, has been the school nurse at Benjamin Franklin Elementary School in Milwaukee’s Amani neighborhood for eight years. She cares for sick kids and develops and manages Individualized Education Plans (IEPs) for students with special health needs. But she also brings her passion for mindfulness to school each day, and recently won a grant from Healthy Classrooms Wisconsin to bring even more resources to this work.
“Some of our kids come to us with anger and hostility, many kids are dealing with stress,” she said. “When we can teach kids to focus and give them practice quieting their minds, it helps with learning and makes school a better place to be.” Last year, she began offering yoga classes to interested teachers and their students, and this year, she will offer a mindfulness workshop to teachers and lead mindfulness mini-classes in each classroom. Her work, and that of other Children’s Hospital of Wisconsin school nurses, supports a district-wide initiative throughout MPS emphasizing mindfulness for the 2017–2018 school year.
McGuan’s work with teachers and students focuses on breathing, movement and meditation, using kid-friendly activities such as making a “glitter jar” to help with focus, or using a expandable toy ball to teach kids deep breathing skills.
On the first day of school at Benjamin Franklin, a group of students stopped in McGuan’s office to greet her. “My, you have all grown so much!” she said. She asked the children if they would like a hug, to which they all eagerly agreed. Later, their teacher stepped into McGuan’s office to thank her for the help she had given him the previous spring when he had been struggling with a health problem. “I just wanted to tell you how much I appreciated your support.”
McGuan agrees that being in one building full time makes all the difference in developing trusting relationships with students and staff. “The staff trusts us more, so they are willing to learn from us and work with us for the betterment of their students. They see that we’re passionate about what we do, and we see the same in them. There’s a great deal of mutual respect.”
The Children’s Hospital of Wisconsin one-to-one school nurse model has proved successful, and the program is expanding to meet the needs of a growing number of Milwaukee Public School students. This year, the School Nurse Program expands to the south side neighborhood of Clark Square where a nurse will care for the students of Longfellow School, one of the largest elementary schools in the state.
“When we see a child who might be acting out in school, or having trouble focusing, we need to ask the right questions,” said Herrick. “It’s not always ‘What is the diagnosis,’ but might also be, ‘What factors are influencing this child’s life?’ Are they worried about basic needs, or can they just be a kid?”
And it’s Children’s Hospital of Wisconsin school nurses who will continue to ask these questions — one office visit, one caring smile and one child at a time.