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By Jeanne R. Sievers, RN

It was the very first day at a new school for Sara and me. I was the new high school nurse and Sara was the new ninth grader from a small town. The size of this urban school and the large amount of students enrolled was a little overwhelming for both of us.

The first day started with several crises at once. The first visitor to my health office was a ninth grader. She had a history of grand mal seizures and was having a rather severe episode. She went into status epilepticus and an ambulance was called. Next, an assistant principal brought a male student to me who was very upset (his brother had attempted suicide) and slept in the dugout at the baseball field on campus all night. Another student was vomiting with a high fever. Then Sara and her mom walked into my office. This all happened at virtually the same time.

Sara was a beautiful young girl with long brown hair and beautiful brown eyes. In my office, she was in tears and clinging to her mother who was also in tears. Her mother was obviously in great emotional pain over her daughter's unhappiness. Sara seemed very young, very innocent and terrified to be at such a large and unfamiliar campus. Mother and daughter waited patiently as I triaged my patients. Finally, I was able to talk with them and assess their situation.

Sara's mother explained that she was recently divorced and had just moved to the city from a small town with a small school. Sara didn't want to leave her friends, her family and the comforts of her old home and school. The weekend before school started she was extremely depressed and tried to end her life with an overdose of pills. She ended up in the hospital that weekend.

When I looked at the desperation in the eyes of both Sara and her mom my heart was overwhelmed with compassion and concern. I explained that I would take care of Sara that first terrifying day. I told Sara it was my first day too, and we would work through it together. When Sara said she didn't have anyone to eat lunch with, I let her know that I didn't have anyone to eat with either. I suggested that she eat with me in my office and she reluctantly agreed. I assured her mother that Sara would be okay and sent her on her way home.

My nephew was also a freshman on campus and I knew a few of his friends. I asked that they befriend Sara and asked each of her teachers to be particularly sensitive to her situation.

Sara arrived in my office at noon and we had lunch together. I tried to make her feel emotionally safe with me. She was very quiet and withdrawn but seemed to be doing okay. I told her we would make it through today a period at a time and then we would take it a day at a time. I went on to encourage her and tried to be sympathetic to her situation. The second day of school we continued our regimen and she seemed just slightly better.

A day or two later, I was picking up my son at middle school when I heard a loud yell: "Hey, Mrs. Sievers!" I looked across the parking lot and there was Sara and her mom picking up her younger brother. She and her mom had big smiles on their faces! I waved enthusiastically and was fully aware that I had a smile on my face as well.

As the year continued, Sara improved both academically and socially. She became very involved and successful. She was my student aide, was a delightful young lady and blossomed into a beautiful woman both inside and out.

On the first school day of the following year, when Sara was a sophomore, she and her mother sent me a beautiful bouquet of flowers in appreciation of what I had done for Sara. They attached a card that read: "Please know that you will be in our thoughts and prayers today and many tomorrowsand also for all the new students like Sara was last year, full of fear and anxieties. I know the Lord will lead those to you who need your special touch. Thanks again for being there when Sara needed you. To look at her now, you would never imagine what she was like at this time last year.
Love, Karen and Sara."

The story does not end there. Sara and I had our first day at this high school in the fall of 1990. On the first day of school for the past twelve years every year since 1990I receive a glorious bouquet of flowers from these special people expressing their gratitude for the compassion and concern I showed Sara. I am so busy on that crazy first day of school that I am amazingly surprised when the flowers and special note arrive. My tears of joy and humility remind me of the incredible difference we can make in just one child's life. At the start of each year, this family's generous and appreciative hearts take me back to my first day on the job as the new high school nurse. From the moment those flowers arrive I am energized and encouraged to take care of "my kids" in whatever capacity I can.

Some days, in a school of 2200 students, my job can be extremely challenging and my patience can run thin. But when I think back to that very first day of school in 1990, I smile and say to myself, the next kid that walks into my office could be another Sara.

I am so grateful for Sara because she taught me so much about being a school nurse. It isn't just about taking care of physical needs, immunization laws and screening kids for vision, hearing and scoliosis. School nursing is about listening and genuinely caring for a child. As for Sara, she is now happily married to a wonderful man and has two beautiful children. We continue to stay in touch.

By Kimberly Toole, RN, MSN

As supervisor of a school nursing program and a former school nurse, I am fortunate to work with some of the finest school nurses in the country. Within the public school district that employs me, I hear about or witness extraordinary feats of compassion and mercy on a daily basis. The following is a story about a nurse named Linda who has gone well beyond the call of duty on behalf of children.

Linda is a school nurse at an inner-city elementary school with an overall poverty level of 90 - 100 percent. The children she serves usually come to school with a whole array of problems and Linda always considers the whole child. She considers not only their physical complaint or ailment, but also what may be going on at home with the rest of their family. The school's principal once said, "Linda practices holistic nursing, always considering the child's physical, emotional and psychological well-being, as well as their academic success." I couldn't say it better.

A couple of years ago, a child moved to this city with his mother, two older siblings, his grandmother, his aunt and his uncle. The grandmother was the head of the household, but was morbidly obese, very ill and unable to leave her home. She ruled the family from a bed, was very argumentative and difficult to communicate with. Nobody could convince her to obtain medical care for herself or the children. She and the other adults in the family were illiterate, mentally challenged, very low functioning and very suspicious of outsiders. With extreme patience Linda gradually developed rapport with the family and was finally let into their home.

While the older siblings were enrolled in school, the youngest child was kept at home. He was extremely hyperactive with dysmorphic features and was not potty-trained. He was ill kept and seemingly alienated. It was evident that the family treated this child differently than the others. During Linda's home visits, the child sat alone in a dark back room. Very concerned with this situation, Linda contacted children's services with the hope of bringing the child aid. When help was declined because the child's situation was not considered severe enough neglect, Linda decided to take matters into her own hands.

Linda convinced the family to allow her to enroll the child in kindergarten. She managed to find a developmentally handicapped classroom for him, which happened to have a very loving and patient teacher. Linda also assisted in getting the child a wrap-around instructional assistant for one-on-one assistance with toileting and hygiene. The child grew to love school and blossomed. He was still not treated right at home, but always looked forward to going to school. School was his "safe haven," and he knew he could always count on his teacher or his school nurse, Linda.

Linda also made referrals to the Bureau for Children with Medical Handicaps (BCMH) so that the child could get a thorough diagnostic evaluation from both a genetics clinic and a pediatric gastroenterologist. The geneticist said that the child should have been seen years ago and found that he had a rare genetic disorder. Linda also made sure that the child had regular care at a nearby health center. Although he had lice and toilet accidents, she drove him and his mother to all of his appointments and served as interpreter for the mother. The physician put the child on medication, which helped his hyperactivity and behavioral problems. Linda also helped the family apply and obtain public assistance, medical coverage, homemaker services, and services from the Department of Mental Retardation and Developmental Disabilities (MRDD). Since the family was illiterate and distrusting of strangers, all appointments, applications, information, and other paperwork had to go through Linda or the mother would not follow through. Linda made numerous home visits and even helped the entire family eradicate lice. She also helped one of the siblings who had chronic throat infections, enlarged tonsils, and sleep apnea by applying to BCMH so he could have a needed tonsillectomy and adenoidectomy.

Linda gave this family, like others, her all. It is difficult to say what would have happened to this family, especially the youngest child, if Linda hadn't intervened and been his advocate in almost every aspect of his life. If not for Linda, he may still be sitting in a dark corner somewhere in his grandmother's apartment.

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.

By Cynthia S. Perry, CPNP, MSN

The phone call came in that morning and it wasn't good news. The city budget was being voted on by our City Council in 24 hours. Included in this budget was the elimination of some school nurse positions. I was one of the supervisors of this department and was told that the cuts were inevitable. Our city health department provided the school nurses to a large intercity public school district, and already our human resources were stretched well beyond the recommended ration of one nurse to every 750 students. I've worked in the school nursing field for over 16 years, both in direct care and management, and I was well aware of the city's needs. The reality of the job is that there are never enough resources to accomplish the many needs of our schools and now we were going to have even less to work with.

The other supervisor and I met and talked that morning about how we would handle the situation. We considered which nurses we could juggle and which schools would no longer get nursing services. We also talked about how we could keep morale up for a dedicated staff that gave so much to the children of our community: hardly ever taking lunch without interruption, putting together programs on their own time and spending their own money to buy things for kids who needed so much. Many were making less money than they made before coming to us and put everything they had into their job because they believed in the value of a child. All morning we tried to come up with plans to deal with the impending situation, but neither of our hearts were in it. The truth was that we wanted to fight for our budget, but we were told that it was futile to do so.

Sometimes the strength to do what seems impossible comes in a totally unexpected way. I found strength that day while at lunch at a fast food restaurant. A young woman in her twenties was the manager of the restaurant, aptly named Angel, as I needed an angel at that point.

The young woman walked up to me and said, "Ms. Cindy, do you remember me? I just wanted you to know I'm doing good. Thank you."

I remembered the woman as a young teenage mom who came from a family with a lot of struggles. She was always getting into some type of trouble and tended to skip school as often as she came. She and I had some spirited discussions about her future and I never thought she heard what I was trying so hard for her to hear: that she deserved better. With that "thank you," I realized she had heard me in her own time. I made up my mind right then and there that we were going to fight and somehow we were going to win.

We sought community support for school nurses and it came in well beyond our expectations. In less than 24 hours, our city council members' offices were inundated with thousands of telephone calls from principals, teachers and parents on the need for school nurses. Our budget wasn't cut that year and within the next year it was actually increased.

Sometimes you have just got to believe that people are going to hear what you are trying so hard to say. This time they did, and the children of our community won.