As Centre County families get ready for the start of the new school year, school nurses are preparing for their vital—and often misunderstood—role of being responsible for the daily health of hundreds of students.
“Sometimes the perception of school nurses is just handling a bunch of Band-aids and stomach aches, but we truly are a public health position, and our role is so much bigger in the community than people realize,” says Kim Hunter, certified school nurse at Easterly Parkway and Gray’s Woods elementaries in the State College Area School District. “I love building relationships with kids and their parents,” she says. “I love getting to know the students individually, what their health needs are, and supporting them.”
From making sure kids have the proper immunizations to screening students for medical problems to helping manage chronic health conditions, Hunter says, “Our goal is to create a healthy community.”
By the Numbers
State regulations mandate that every child of school age must have access to a licensed registered nurse who has gone through additional education to become a certified school nurse. In 2021-2022, the Department of Health reported that seventeen full-time and two part-time certified school nurses were employed in Centre County public, charter, and certain career and technical schools, working in more than forty buildings and responsible for more than 14,200 students. The certified school nurses were assisted by staff including five full-time registered nurses and ten full-time licensed practical nurses.
By law in Pennsylvania, one school nurse can be responsible for a maximum of 1,500 students, although the National Association of School Nurses recommends no more than 750 “healthy” students per school nurse. Lois Thompson is the nurse for about 850 students—both “healthy” students and those with chronic medical conditions such as diabetes, seizure disorders, and severe allergies—at Ferguson and Radio Park elementaries. “You can’t just look at the numbers,” she says. “You have to look at the acuity” of the medical conditions that students have. A healthy child might see the school nurse once or twice a year for screenings or mild illness, while a child with diabetes might need the nurse’s care every day for insulin injections.
In the twenty-five years Thompson has worked in school nursing, she says the biggest change she’s seen has been an increase in the number of children with chronic and acute medical diagnoses, from autoimmune diseases to autism to attention deficit hyperactivity disorder. In 2021-2022, for example, 5.17 percent of Centre County students had asthma, according to the Department of Health. “It’s a national and state trend,” she says. More students are being diagnosed with chronic conditions, and more are integrated into the general student population instead of being taught separately. “That puts more responsibility on us.”
During the last school year, Thompson’s two schools together had forty-three students with severe allergies to food or bees. “All these kids had to have EpiPens. All the teachers need to be trained. Some kids self-carry and have to be trained,” she says, with nurses responsible for that training. “Twenty years ago, stuff like that was completely unheard of.”
From Sprained Ankles to Screenings
Olivia Whitehill, who is starting her second year as the school nurse at Our Lady of Victory Catholic School, says, “Just like every other nursing job I’ve ever had, every day is definitely different and will keep you on your toes. The minute you might feel bored for one second is the second someone comes in with something brand new that’s a concern for them.”
Right after recess, she might need to assess a child for a possible concussion or apply ice to a sprained ankle. Throughout the year, she spends time tracking down students’ vaccination status, which can be particularly challenging when records have to be requested from other countries. Some days, it’s time for state-mandated vision, hearing, dental, or scoliosis screenings or to record heights and weights.
Whitney Summey, school nurse at Bald Eagle Area Middle and High School, says the screenings can be time-consuming. “That’s very tedious, but it’s pretty amazing how many referrals come out of that,” she says. “It’s rewarding when I send home a note that a student needs to see an eye doctor, and then the kid comes back and says, ‘I got glasses and I can see the board!’ That makes it all worth it.”
The Post-Pandemic Era
The COVID pandemic was “uncharted territory” for school nurses, who had to balance instructions from the Department of Health to “test everybody, vaccinate everybody” with Department of Education requirements for training, scope, and licensing, Thompson says. “Those three years in COVID were the hardest years in nursing I ever had.”
“COVID changed so many things, both positively and negatively,” says Rachel Griel, school nurse at Bellefonte Area Middle School and Bellefonte and Marion-Walker elementaries. “People are a lot more aware of the school nurse and the role of the school nurse. I think we were largely unthought of before COVID.”
Griel, who has worked in school nursing for twelve years, says, “When I started, I mostly was in the nurse’s office, passing out Band-aids and evaluating whether students needed to go home or not.” During the pandemic, parents frequently emailed her to relay symptoms and ask if their child needed to stay home, a practice that has continued post-pandemic as more parents reach out for information. “Now people seek me out for a lot more advice,” she says. “They feel comfortable, and I’m able to help them with formulating the right question for their primary-care provider. I’ve worked really hard at making the school nurse a resource for the community.”
For Bald Eagle’s Summey, that’s especially important because she says currently there are no doctor’s offices in the school district. “I want parents to know that we can help you figure out what urgent care can do, what offices are around here,” she says. “We can connect them with health resources.”
Another lingering post-pandemic effect is increased stress and anxiety in children, says Allison Snyder, school nurse at Park Forest Middle School. “We were all covered up with masks, and they were able to hide behind them,” she says. “Once those masks came off, it was a big transition for kids. I feel like, socially, the kids are a little more withdrawn.”
That’s why Snyder decided to have her goldendoodle, Lucy, certified as a therapy dog. Now Lucy comes to school with Snyder one or two days a week. “It’s amazing the healing and the love that she brings to everybody,” Snyder says. “The kids just pet her and open up, whether talking about their [parents’] divorce, or their identity, or understanding middle school life.”
Today’s Challenges
The topic of gender identity or sexual orientation comes up more often today than it used to, says Snyder, who has been a school nurse since 2006. “I have such a passion for those students, because I’m someone they can feel safe and secure with to talk about that,” she says. Continuing education offered through school districts and nursing associations helps school nurses stay abreast of this and other evolving topics related to their jobs.
The use of medical marijuana, which Pennsylvania legalized in 2018, is one of those topics. The Department of Health permits a parent, guardian, or caregiver—but not a school nurse—to administer medical marijuana to a student at school. Bellefonte’s Griel says she did have one inquiry about medical marijuana for a student, but ultimately the family decided to administer the medication at home. If the student would have needed medical marijuana during the school day, she says, the school would have had to provide a private space for the parent or guardian to administer it.
One of the most difficult aspects of being a school nurse, several report, is dealing with suspected child abuse or neglect. “That’s a sad part of our job, having to get Children and Youth [Services] involved,” says State College’s Thompson. School nurses are mandated reporters of possible abuse, as are teachers and other school personnel. The question might arise when a nurse sees “odd bruising” on a child, or when a student mentions that “Daddy laid on me,” Thompson says.
Bald Eagle’s Summey confirms that, “Sadly, it happens. You get very invested emotionally with these kids, and you want to help them. It’s frustrating if it’s not the best result,” such as when CYS decides after an investigation that a child should stay with their family. “You just provide them with a safe place to be between eight and three each day.”
Many nurses provide that space of refuge for all students, for any reason. “They tell us more, sometimes, than they tell their counselor,” Summey says. Sometimes students talk about medical issues, she says, “but sometime the kids just need an adult they feel like they can talk to.”
“I try to always encourage the middle-school kids to know you can come here anytime,” says OLV’s Whitehill. “You don’t have to tell me why you’re here. If you just want to sit here and have space for a mental health break, or I’m also willing to talk if you need to. I want the health room to be all about health of every kind.”
Parents: Fill out the Forms!
As the school year begins, Summey emphasizes to parents the importance not just of filling out the initial health form but of keeping the school updated throughout the year about changes in health and medication. “A lot of parents forget to update us as the year goes on,” she says. “Then a student comes in and says they’re dizzy, and we find out they started a new medication.”
It doesn’t happen often, Summey says, but when she has to call an ambulance for a student, “the first thing we’re doing is providing the crew that responds with the health information we have on file.” Outdated records can hinder emergency care.
Griel agrees. “Sometimes it feels like we’re hounding them for paperwork,” she says. “We want parents not to see us as an adversary but as an ally.
“We’re working together for the health and safety of their student so they can learn to the best of their ability.” T&G
Tracey Dooms is the editor of Town&Gown.
