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

By Eileen DiFranco on Dec 18, 2014 01:31 PM

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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Comments (9)

Submitted by Lisa Haver on December 18, 2014 4:34 pm

Excellent article.  We need to make sure that everyone understands this, and that we don't see the administration suggesting that some kind of "partnership" providing inadequate services can take the place of trained and experienced school nurses.

Submitted by Deborah Grill (not verified) on December 18, 2014 10:37 pm

A school nurse who has been in the building every day over the course of several years knows the  students, their medical history and often the medical history of their siblings.  School nurses not only save the medical system money, but they provide students with a stable, caring health care provider.  In my 34 years in the school system, I have worked in schools whose students have had myriad serious health problems, and it was a relief to know that there was a school nurse in the building who know their medical history and was able to deal with any emergency that arrived.  We have already lost 2 children who might have been saved had there been a school nurseon the premisis who was familiar with their condition.  That should be enough of an example of the value of school nurses.

Submitted by Rich Migliore (not verified) on December 19, 2014 5:48 am

School nurses are an indispensable part of schools. I cannot believe that anyone in their right mind would think that it is alright for Philadelphia's schoolchildren to do without school nurses in every school. If "they" really cared about schoolchildren, "they" would expand the function of school nurses in schools and make our schools more in line with the "community school vision." Children in schools have so very many needs, physically, emotionally and psychologically.

Thank you Eileen for your dedication and advocacy. It is inspiring.

Submitted by Peg Devine on December 19, 2014 8:52 am

The SRC Strategy, Policy and Priorities Meeting on Monday January 5th at 6:00 pm in the auditorium at 440 North Broad St will be discussing Student Health Services: Building Capacity

Submitted by Anonymous (not verified) on December 19, 2014 9:32 am

I am an SEL at a school with a full-time nurse. Many of our students are assigned to our school because of her. She is an invaluable resource and these students - and others - would not be able to participate meaningfully in public education without her. I can't imagine how a school would run without one and I am in awe that so many students in this District attend schoosl where there often is no nurse. 

Submitted by Anonymous (not verified) on December 19, 2014 9:38 am

I am an SEL at a school with a full-time nurse. Many of our students are assigned to our school because of her. She is an invaluable resource and these students - and others - would not be able to participate meaningfully in public education without her. I can't imagine how a school would run without one and I am in awe that so many students in this District attend schoosl where there often is no nurse. 

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