The expanding role of a school nurse and its impact on community health.

 

 

Episode Introduction  

School nurses are now playing a critical role in community health.  In this episode, Jim Cagliostro, VIE’s Clinical Operations Performance Improvement Expert, interviewed Lisa Cagliostro to discuss the multiple demands on school nurses in the public school system, especially in communities where access to healthcare may be limited.  

 

 

Show Topics  

• A varied nursing career helps to be a better school nurse 
• The biggest challenge in school nursing 
• Identifying emotional and mental health issues in children 
• Contact tracing and implementing new policies 
• Interconnectedness during a pandemic 

• Support is vital to school nursing 
• School nurses are integral to their community  

 

 

04:22 A varied nursing career helps to be a better school nurse 

 Lisa said the transferable skills learned in a previous case management role in health insurance helped her to adapt to school nursing.  

‘’So of course lots of careers and jobs, you're always learning, and especially true in nursing, and so I think the more experience and the variety of experience that we can get just contributes to our growth and helps us to become more well-rounded. Having those experiences, when they come up again or something similar, it doesn't take you quite by surprise, you kind of have that muscle memory, you feel that all coming back and you can handle it with a little more wisdom, you have that experience behind you….case management was probably one of the jobs that probably stretched me the most. It was different than what I had ever done as a bedside nurse or in the hospital, and it was very challenging, but it did help to, I think, prepare me more for school nursing, because that is one of the areas that you see as needed in the school and in that nursing situation. A lot of the job or some of it was coordinating resources and finding resources. I remember just having to get familiar with what's available right here in our county and being able to point parents to, whether it was getting free immunizations, because they didn't have insurance or other resources, like even just an eye doctor, if the student needed to be referred and checked out further for any eye issues or same with hearing….. I think that case management job helped, because you have to have those assessment skills to do that, and then also having the knowledge and the resources to connect parents and guardians with that.’’ 

 

 

08:13 The biggest challenge in school nursing 

Lisa said the biggest challenge of the role is the unpredictable nature of every day.  

‘’Well, I would say for me, it's probably just the unpredictability of the day. You have your to-do list and there are things you got to get done, but of course you're there for the students and they're sometimes constantly coming in, and I just would never know how many students would be coming in or when. I mean, as you go through the school year and you get to know the student, you kind of start to see the rhythm, the routine. Yes, there are certain students that are coming at scheduled times and you kind of prioritize your day around them, and then you have anything and everything else coming in. So I know sometimes I just find myself getting a little frustrated, like, "Oh, I can't get this thing done, but okay, I'm here for the students. They're here, I need to be available to help them with whatever they need, whether big or small," because you kind of see it all. I don't have that emergency room experience, I kind of felt like that's more like what would prepare a school nurse for that. I know a lot of school nurses do have that experience, so yeah, just having that readiness, being prepared for the day and just not knowing, I would say, would be one of the challenges.’’ 

 

 

09:45 Identifying emotional and mental health issues in children 

Lisa said mental and emotional health issues were on the rise in children of all ages. 

‘’Especially in times where now there's more and more of that, even younger students, like elementary school age who have that mental health aspect and need. But with elementary school students, so I wouldn't say it's an outright ... okay, with middle school though, they're obviously going through some anxiety, they can tell you, like, "I'm depressed, I'm sad." Elementary school students, they may not be able to tell you as easily. You see a lot of the same students coming in sometimes with just general complaints, my stomach hurts or I'm tired, or just different things. So yeah, you got to talk to them in a way that they'll understand and asking the right questions. I mean, there were a handful of times where I remember students coming in just in a panic, breathing heavy. Something had happened and it was caused by that they were now anxious or upset, or just experiencing different symptoms that way. It wasn't necessarily a physiological medical thing, but more a mental health issue. So yeah, I would definitely say that's prevalent in elementary school students as well.’’ 

 

 

13:06 Contact tracing and implementing new policies 

Lisa highlighted some of the steps taken in schools in response to the pandemic.  

‘’Pandemic school nursing is all I've known, because I did start right when the pandemic started as my role as a school nurse, so I don't really have that frame of reference for what it was like before versus what it was like after COVID. Which may be a good thing, maybe not, I'm not sure. So as you mentioned, yes, COVID-19 has affected everyone, especially in healthcare and school nursing is no exception, like you said. So, I guess ways that it has definitely impacted school nursing is contact tracing. Of course that was never really a thing in the schools before COVID, and it seemed like whenever a student would come in with certain symptoms, we would always see them through that COVID filtered lens, looking at those specific symptoms that we've all been put into our heads over and over again. Different protocols were put into place that we were following regarding COVID and new policies. The district I'm in, we've got multiple nurses, it's a bigger district, and so I remember when I first started, we didn't even have students in the building till mid-October.’’ 

 

 

15:14 Interconnectedness during a pandemic 

Lisa shared some positive outcomes of the pandemic.  

‘’So I know there'd be days, sometimes I'd be getting ready to go home and then I'd get a phone call or an email from a parent regarding their child had tested positive, and then of course they'd been in school that day. So back when we were really closely contact tracing, that would set me back. I'd have to stay, I'd have to figure out who was where, and work with my principal to try to figure out, okay, who should we call so that we're not scrambling in the morning to tell these parents don't send your kids in because they were exposed to someone who tested positive? So, that was a big thing. So yeah, I guess a lot more communication with parents and guardians, and also I would say with administration. Between school nurses and administration, at least in our district we would report at least weekly the total counts, but as they're coming in, we would be emailing administration about staff, about students who had tested positive and who all that was going to affect. So I feel like there was definitely more interconnectedness, you just thought how one person having this virus would affect a whole class, would affect a school at times. So we were dealing with a lot of that, and in a way though, like I mentioned, certain things have come out of it that have been good, that may not have come out if COVID had not come around and impacted healthcare.’’ 

 

 

18:17 Support is vital in school nursing 

Lisa shared how invaluable support from other nurses has been in her new role 

‘’….Just being new to the school nursing field, it's been invaluable to have that support from other nurses. Especially in the district I work at, there's a head nurse and then various other nurses, I think there may be eight or nine of us total. So just drawing off of their wisdom and experience just with regular school nursing, and then being able to brainstorm together. Because we could each bring something different to the table, and something that I might not have thought of, someone else has thought of and brought out and we can say, "Hey, that's a good idea. Let's incorporate that into what we're doing in schools. So yes, having them and being able to just pick up the phone and be able to ask them a quick question, we would do that all the time. "Hey, I have this situation." Especially with COVID, "This person's positive and now it affects this person and this person. Oh, by the way, they have a sibling in your school in the middle school." So, we'd have to talk with one another a good bit anyway just for communication and contact tracing purposes…... sometimes you just need that person to confirm what we already know, right?’’ 

 

 

21:27 School nurses are integral to their community  

Lisa said that for some students, the school nurse is the only healthcare professional they see  

‘’It's something I come to realize, which I think I knew anyway, but for some of these students school nurse may be the only healthcare professional that they see you in the year. So, unfortunately parents don't always have the time or the resources to go and have their child checked annually by their physician. They may not have a home physician, they may not have health insurance, it's just that kind of thing. If they don't have enough food eat, that's what their concern is rather than the annual well visits for their child. Of course students are spending a majority of their time during school year in school, and so school nurses can detect things that maybe no one else has seen or had the opportunity to have seen in this student. So being able to first assess that, detect that, and then bring it to the parents' attention and provide them with the resources and the help that they need, that's a huge thing for a student.’’ 

 

Show Links

Connect with Jim Cagliostro on LinkedIn 

Connect with Lisa Cagliostro on LinkedIn 

Check out VIE Healthcare Consulting 

 

 

You’ll Also Hear: 

Lisa’s varied background experience as a nurse, from a heart and vascular care unit in Hershey Pennsylvania to her current role, via nurse case manager for a health insurance company.  

 

Why building relationships with parents helps to identify signs of emotional distress in children. ‘’After talking to parents, most of the time I did feel a little more at ease, because they're like, "Oh yeah, okay, they always do this, or this is what happens when this happens. When they're experiencing this, this is what it is and this is what we do. I know a lot of times they would appreciate a phone call.’’  

 

The pressure of the pandemic: navigating a path through COVID-19, from virtual weekly meetings to anticipating school supplies and learning a new way to interact. 

 

Highlighting the role of the school nurse: how the pandemic revealed the value of school nurses and how some areas struggle without them. ‘‘I know there's still even a fight just to get one school nurse per school. That's just not even a reality for some districts or for some schools and areas, which is really a shame. So, I think it's kind of brought to light the importance of having a school nurse in each school as well.’’ 

 

Making a difference, how the experience of school nurse can transform the health of a student with asthma. ‘’… You take it to the home level and it can change the home environment, not just for that student, but also for others going there …. That can have huge impact on the community in general.’’  

 

 

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