School nurses key to BPS kids’ wellness

Ayanna PressleyAyanna PressleyI used to hide out in the school nurse’s office. There was rarely anything physically wrong with me.

Throughout middle school, I would feign a headache or upset stomach and get permission to visit my school nurse. At the time, I couldn’t verbalize why I was hurting. I couldn’t talk about what was happening in my home, what was being done to me, and how that made me feel. I’d sit in class, at once both desperate for help and terrified to admit I needed any, and wonder if everyone knew my secret. Until I couldn’t take it anymore and had to escape.

There was one person I knew would make me feel better - my school nurse.

The school nurse of popular culture is a kind-hearted woman who puts on Band-Aids and checks for lice. Today, on National School Nurses Day, it is time to retire once and for all that outdated and misleading portrayal and get real about the critical role nurses play in strengthening our schools, communities, and families. In 2014-15, there were 381,673 student visits to Boston Public Schools (BPS) nurses who encountered an average of 414 students each month. Therre were 741 occasions when they referred a student to urgent care or call 911. Of the 911 calls, 54 percent were for mental health emergencies.

BPS nurses administered 115,466 scheduled doses of medication, of which 67 percent were psychotropic. The record shows that 10,724 students had asthma; 933 had a seizure disorder; 2,201 students had been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD); 1,085 students had reported being diagnosed with an autism spectrum disorder; and some 1,600 students had been diagnosed with depression, anxiety, obsessive compulsive disorder and other mental health conditions.

Those are the facts. But even those startling numbers don’t tell the full story of what our school nurses encounter on a daily basis. Domestic violence. Eating disorders. Hunger. Homelessness. Trauma. Sexual assault. Substance abuse.

It’s a chaotic, complex, and seemingly hopeless situation. In other words, a job only a nurse can handle.
For the last seven years, I have been meeting with our school nurses and working to support the essential role they play in Boston’s public schools, and, ultimately, in the education of our children.

Today, there are 110 full-time BPS nurses. All are certified by the state and must have three prior years of nursing experience. Three of them have PhDs in nursing, and another 73 have a master’s degree. All BPS nurses are involved in continuing education programs including those focused on LGBT students, mental health, nutrition, and oral health. They also lead regular trainings for BPS teachers and staff on a variety of issues including allergies and use of Epi-Pen, CPR/AED, and seizures. As part of the recently passed opiate bill, nurses will be responsible for performing student substance abuse screenings starting next year.

And, yes, BPS school nurses still treat skinned knees and check for lice.

It is important for everyone to understand the reality of what today’s school nurses do in the schools because nursing nostalgia continues to inform policy-making and budget decisions. We now recognize the impact that social-emotional health can have on student performance, but our recognition means little if we don’t actually ensure that all students have access to a school nurse.

There is widespread consensus among education experts that students who are present and healthy are best prepared and able to learn. Numerous studies have demonstrated that the presence of a school nurse improves student health, reduces absences and early dismissals, and allows teachers to spend more time on curriculum. There is also a documented economic benefit: A 2014 cost-benefit analysis of the Massachusetts Essential School Health Services Program revealed that every $1 invested in full-time school nursing services yields $2.20 in overall savings – in teacher education time, caregiver work productivity, reduced medical care costs, etc. – to communities.

Boston is on the right track. The Boston public schools, under the leadership of Superintendent Chang, is the first in the nation to appoint an assistant superintendent for social emotional learning and wellness. This new office is working to build student support teams at every school, and school nurses are essential members of those teams. It’s time we fund a full-time nurse (and, dare I say it, a social worker) in every school.

While I was hiding out in my school nurse’s office, I never told her I was being abused. I didn’t need to. She figured it out on her own. When I was young, I received the help I needed. Shouldn’t every child?

Ayanna Pressley is a Boston City Councillor-at-Large.