An Agenda of My Own
By Judith Dorward, RN

The mandates. These are the things that a school nurse is required, by law, to do. Mandates include vision and hearing screenings and referrals, checks for scoliosis, special education assessments and child abuse reporting. Then there are the other duties: arranging dental care for children with toothaches, counseling troubled teens, advising parents, finding funds for medical services and classroom teaching. The list is never ending.

As I drove to work one late April morning I experienced a familiar feeling. The school year was rapidly coming to a close and I hadn't finished all the mandates. It is an uncomfortable feeling. "Today," I told myself, "I will make a list of all the mandates I haven't finished and then I will start doing them! No interruptions! I will be task-oriented!"

I parked my car in an isolated spot in the parking lot where no teachers would find me. My plan to sneak into my office unnoticed was quickly thwarted as I discovered a ladder directly in front of my door and a large crowd gathered around it. "What's going on?" I asked.

"Manny was vacuuming up there and he found three condoms tied together on the light rod," the campus supervisor said. "He's gone to get some gloves and take them down." My curiosity was piqued. I climbed the ladder to investigate. Surely there couldn't be condoms, especially not up there. I spotted the objects in question. "I have a Master's Degree in Nursing," I informed the crowd. "And I'm qualified to tell you that these are not condoms. This is a vinyl examination glove." When I'm pressed I sometimes plop ice cubes into a glove and tie the end. It makes a nifty icepack. Someone had tossed his makeshift icepack onto the recessed lighting shelf. Disappointed, the crowd dispersed.

To work I went. The paper will fly! I'll get organized! I'll make that list and get things done!

My door opened and in came a student named Nick carrying his bike, out of breath and bloody. He had been in an accident and all of his fingers seem to be dislocated at every joint. After a moment of anxiety, I remembered Nick's congenital joint condition. His joints looked dislocated all the time. One finger, however, was a bloody mess, very painful and obviously broken. I helped Nick clean up, comforted him and called his mother who arrived shortly to take him to the emergency room.

Another student named Emily came in just after Nick with a pass from her teacher. "I have a very sore throat," she said in a voice that revealed a great deal of pain. I looked at her throat and it was about the yuckiest throat I had ever seen. "Let me take your temperature before I call your mother," I said.

Just then, two campus supervisors entered with a student named Rebecca and informed me that she was in labor. Now, it had been many years since I assessed a woman in labor--about twenty-five. I felt her stomach and there was a faint but very real contraction. Rebecca informed me that she was a week overdue. Another contraction came shortly after--they were five minutes apart. Emily, with a sore throat waiting for her mother to pick her up, looked on in horror.

"Where's your mother?" I asked Rebecca.

"She just dropped me off," Rebecca answered.

"She won't be at work for an hour."

"Why didn't you tell her you were in labor?"

"I just thought it was something I'd eaten--a little gas," Rebecca said.

I left a message on her mother's answering machine informing her to call me as soon as possible. I then left a message with her doctor's office staff. We continued to time contractions and phoned her boyfriend.

Rebecca's doctor called back and asked, "Is Rebecca in labor? I haven't seen her in over nine months. I didn't know she was pregnant. Maybe you should take her to the emergency room. I don't deliver babies." He offered no help.

Finally, Rebecca's mother called. "I have your daughter here," I said. "She is in labor. She is having contractions five minutes apart. Can you come and get her?"

She burst into tears: "No, no, no, it can't be!"

"Does your mother know about this?" I asked Rebecca.

She looked at the floor.

Emily, the girl with the sore throat, was then greeted by her mother who took her home. The brother of Rebecca's boyfriend, meanwhile, arrived in my health office and took her to the emergency room. The day was going by fast. Before I had a chance to grab a pen and begin a list of things to do, a student popped in and said, "I have to talk to somebody. Do you have a minute?" Then I got a phone call from a parent who said, "You sent a note that my child needs glasses. I don't have any money or insurance. What can I do?" Another student came in with an abscessed tooth. Next, a psychologist stopped in and said, "I really need you to look at a certain student today." Nick's mother called--he has a cast. Emily's mother called and let me know that Emily had mono.

I called the emergency room and discovered that Rebecca was just seven months pregnant. They gave her medication to stop her premature labor. They also gave her mother something to calm her down.

At 2 p.m. the school day had ended. Everybody left. I found a piece of paper. "LIST," I wrote.