Thursday, March 27, 2014

Student's seizure highlights role of nurses and family

When a 9-year-old had a seizure on the playground Wednesday,  University Park Creative Arts School got an illustration of the importance of school nurses and parent communication.

When the child collapsed,  school staff rushed into action,  calling 911,  clearing the area of other children and summoning the teachers trained as "first responders."  The west Charlotte school,  which has about 400 students,  has a nurse only two days a week,  so trained faculty must fill the gap.

Davidson
After getting a dispatcher who provided medical guidance by phone,  Principal Janice Davidson says her staff called nearby schools in hopes of finding a nurse.  West Charlotte High's nurse rushed straight over,  arriving just after medics and firefighters,  Davidson said.

"I feel all schools need a full-time nurse  --  all day,  every day,"  Davidson said after the child had been taken to the hospital.

Teri Saurer and a group of Charlotte-Mecklenburg Schools parents have been lobbying for two years to get just that.  As my colleague David Perlmutt recently reported,  their persistence is making an impression on county officials,  who are thinking seriously about spending the $2.5 million it would take to meet that goal next year.

In this case,  the child's parent had recently informed the school about the medical problem and brought seizure medication.  It couldn't be administered,  however  --  not because a nurse wasn't present but because the paperwork from the child's doctor wasn't complete.

That's the second important lesson,  Davidson said.  Parents whose children have medical issues need to make sure schools are fully informed and authorized to provide assistance.  In this case,  she said,  once the authorization was complete the nurse would have trained the designated teachers.

Bolyn McClung,  who was doing volunteer work at University Park when the incident occurred,  says he was impressed by how well the school responded.  "If nothing else,  the staff knows how to handle an emergency,"  he said.

37 comments:

Anonymous said...

A nurse would have provided no benefit. Without an extensive array of hardware in schools a nurse will be no better than someone with first aid and cpr training.

But you say children are medicated with all sorts of pills and elixirs these days a teacher should not be responsible for medicating. And you are correct, it highlights the continuing cost of providing services to a few at the cost of everyone.

Wouldn't it be great if CMS could use that extra money to hire an AP teacher at Hough who actually cares about teaching and the students. Instead we hemorrhage more money on non-core services.

Anonymous said...

"Bolyn McClung, who was doing volunteer work at University Park when the incident occurred"

I recognized the name from reading this forum. Good for you sir, for being involved and trying to make a difference.

Anonymous said...

Calling a nurse from a nearby school sounds like a good idea, but not very practical. Unless the schools are in a cluster, the nearest school could be 20 minutes away, a response time that is likely much longer than an ambulance. And an ambulance has the advantage of having a siren and being able to travel at higher speed, run through lights, etc. Think if the nurse hurrying to the scene had gotten in an accident on the way... that would be a double disaster, and totally unnecessary.

Anonymous said...

a school nurse may be more valuable and helpful (essential?) at a school where the students have less access to medical care.

I don't see the need for one at my daughter's elementary school. Lots of scrapes, cuts and sick tummies. This would be a great volunteer position for parents able to spare a few hours to man the nurses station.

Bolyn McClung said...

.
MY OBSERVATIONS FROM BEING THERE.

CMS’ official position is that the safety of children is the number one responsibility. Until you’re in a situation where that has to be proved you never know.

The response by the school staff just wasn’t good, it was coordinated. Each person had a role. Those who were called-on did as they were told. If there was a weakness it was the inability of the school employees to give treatment other than comfort and the calls for emergency help.

Ann has reported that better written communications between the family and the school would have helped. This is where the County Commissioners can help. A school nurse is needed when the families bring-in records. That checking process insures future emergencies can be handled well.

I recommend that while the Commission discusses more school nurses that they include just not the need for them to be there in an emergencies but as the medical record analysts.

Bolyn McClung
Pineville
.

Carrie Merner said...

A nurse is an integral part of providing medical assistance to ALL of our children and guidance to ALL of our schools and overburdened teachers. Funding for school nurses comes from Mecklenburg County, not CMS.

A school nurse would have made a difference, and it's evident that this Principal who had first-hand knowledge of this situation thought so, as well. They handled this situation beautifully, but they should have had a nurse who is medically trained to provide important, real-time guidance and assistance. I'm grateful that this child's situation did not get worse or end in tragedy during that wait time.

Health Director, Dr. Plescia, stated in his presentation at the Budget Retreat in March to BOCC members that providing nurses in every school was the most cost EFFECTIVE and EFFICIENT way to counter/monitor communicable diseases, immunizations, epidemics, combat chronic diseases, mental health and school violence related problems, including abuse/neglect and domestic violence. In other words, it's an investment but the payoff for the County is in the prevention and well-coordinated program. Here's a link to his presentation (@ 1:16:
http://mecklenburg.granicus.com/MediaPlayer.php?view_id=2&clip_id=2574

A nurse in every school is a realistic and obtainable goal. The big picture is that 60% of other States in the US have a lower nurse/child ratio than we do. A good comparison would be SC, which has a ratio of 1 nurse per 789 children, which is very close to the CDC recommended 1:750. Interestingly, even if we got to the CDC 1:750 ratio, we'd only be ranked #17 in the nation. In other words, there are some states that put so much value in this area that their ratio is LOWER than that recommended by the CDC. We're not asking to be #1 in the Nation. The expectation of parents to hae a nurse in every school is reasonable and obtainable!

Interestingly, some BOCC members questioned whether 1-800# nursing lines and volunteers could be used in lieu of a full-time nurse. I think this unfortunate example illustrates Dr. Plescia's position that Nurses are needed and that anything other than a nurse would be there to provide additional medical support.

I believe having a full-time nurse in every school does support our teachers and all of our children. It should be considered a fundamental part of attending to the safety, health and general wellfare of ALL of our children.

Pamela Grundy said...

A fully trained nurse can do a lot more than someone trained in first aid when facing a complicated medical situation. As someone whose son suffered an out-of-the-blue anaphalactic attack at school, I am so thankful there was a nurse on duty when it happened. My son has been at schools with full-time nurses and without full-time nurses, and I can say from experience that having a full-time trained nurse who is thoroughly engaged in the school and its activities is a great asset to students and teachers in many ways, and is well worth the money.

Anonymous said...

NC is such a strange place!! Unless it has to do with Common Core, they will not care. Until someone dies.. Crazy NC

Anonymous said...

what does the AP teacher at Hough High School have to do with regards to a lack of a school nurse at another school, nothing.

Anonymous said...

Plenty of fat downtown to divert resources for a nurse in each school.

Look at the salaries and positions in some of the departments.

Wiley Coyote

Anonymous said...

Incorrect, a nurse would have provided no benefit in this case. The nurse would have done what the people on site did, provided comfort until transport arrived to bring the child to a facility equipped to handle the emergency.

The nurse is not going to tell the nearest child, go to the shadow of the far tree there you will find the clover of green. I will chew it and make a salve to cure the child. Quickly go now, time is of the essence.

Medical records? Administer drugs? Communicable diseases? Vacinnations? At that point contract with Minute Clinic and throw a doc in the box in every school.

Anonymous said...

How about the super making a deal with the county: "I will cut 2 1/2 fail lion worth of my bloated staff at central office and remove it from my requested budget, if the county will spend that 2 1/2 mil for nurses." See how easy that was?
As mayor of Chicago, Emanuel said he cut 20% of Chicago's perk central staff in order to serve more kids. How about Heath stepping up to the plate?

Shamash said...

It's unfortunate that we live in a society where it is easier (and probably more urgent) to put police in schools rather than nurses.

I can remember a time when we didn't NEED police in schools.

But that's the problem we're facing now, especially with limited funds.

Except for more central office workers, of course.

Not that there'd be anything like cronyism (or any other type of corruption) in Charlotte/Meck Co...

Shamash said...

Doc in a box?

H'mm. Sounds like an idea.

Maybe we need some Chiquita Banana type "incentives" to encourage pediatricians (or clinics) to put offices near schools.

(I mean, if we can favor a former mayors parking lot business and give nice jobs to certain well-connected church members...)

Anonymous said...

I am so sorry that you feel this way. My very healthy, rarely medicated 7 year old had a serious head injury at school. An injury that did require professional training as you can't expect to teach teachers and administrators about every possible scenario. With head injuries there is a window, called the lucid interval, in which the patient seems ok. It was this interval that delayed treatment for Natasha Richardson and she died. Luckily, my son's situation wasn't as serious. However, his symptoms greatly deteriorated and he required hospitalization. Additionally, another friends child suffered her first allergic reaction and was called to come get her daughter because she had chicken pox. Again, luckily it wasn't a life threatening allergy. I would argue that every student should have a nurse in his/her school - this is not an issue for the few. Also, the funding for nurses comes from the county not from CMS, so staffing nurses doesn't affect teacher staffing. Staffing teachers and administrators is a CMS issue.

Pamela Grundy said...

For example, if the seizure had in fact been immediately life-threatening, a nurse could have made a professional judgement that the seizure medication needed to be administered then and there, paperwork or no paperwork (just as the nurse at my son's school was able to administer epinephrine, even though my son had never had any kind of allergic reaction before, and thus had no doctor's authorization). In medical emergencies, a thorough understanding of what's happening and the various ways of dealing with it matters a great deal. In a non-emergency situation, an ongoing understanding of a child's condition, acquired over time, is extremely valuable. All our children deserve this kind of high-quality care, and I for one am happy to have my tax dollars pay for it.

Anonymous said...

Carrie, what is CMS' student/nurse ratio? Say it's 1:800 ratio, does that mean that Community house middle would have 2 FT nurses every day, and AK, Myers Park, etc... would have 3-4 FT nurses every day? Can't school staff, counselors, assistant principals take on some of the care? They could easily attend basic medical care classes. Probably 90% of medical issues at school are small concerns, such as scrapes, cramps, headaches and stomach aches.

Teri Saurer said...

There is really no way to explain how scary a seizure is until you see your child shaking in your arms. My daughter's eyes roll back and her body is so limp that you think she is dying and there is nothing you can do to make it stop. If emergency meds needs to be given it is RECTAL medication. A nurse is by far the best person in the school to treat a child having a seizure. Nurses do so much more than give out band aids these days. They treat children with life threatening conditions and respond to accidents and injuries every day! Children across the country have died when there was no school nurse, Please do not allow that to happen here. You cannot put a price on the life of a child. Don't our children deserve more?

Cornelia said...

Teri, I think our kids deserve more. Too bad Heath doesn't see it that way and give up some of his myriad of assistants on central staff for the sake of providing a nurse in every school. Alas, we see where his priorities are.

Carrie Merner said...

Thanks "Anonymous" for your question.

Currently, the CMS ratio is 1 nurse/1,124 children. I've taken this number from the Mecklenburg County Health Department. It is the Center for Disease Control and Prevention (CDC) that has created the recommendation of 1 Nurse/750 children, not me. Right now there are middle schools with over 1500 students and High Schools with over 2000 students, and just 1 nurse. In elementary schools, many nurses split their time between 2 schools and are there just 2 days/week.

A nurse in every school and the more comprehensive approach I described is also backed by the American Academy of Pediatrics as well as by our Health Director. I've posted the link above of Dr. Plescia's presentation so that everyone has the opportunity to watch his presentation to the BOCC and not just depend on my words alone or mischaracterizations of same.

A more comprehensive approach should not be mischaracterized as a "doc in the box". Right now a nurses's skills are underutilized due to the high student to nurse ratio and/or being at a school part-time. For example, I saw this article recently in Charlotte Magazine: http://www.charlottemagazine.com/Charlotte-Magazine/March-2014/Heroin-in-Charlotte/. This was a quote: Very little drug education is required in Charlotte-Mecklenburg high schools—just one semester of health for all four years. “That’s part of the problem,” says Deb Kaclik, director of arts, health, physical education, and pre-K-12 curriculum support programs for CMS."

To me, drug education is one of many coordinated programs that a nurse could be utilized to reach out to our children through education and even identifying those that may have mental health issues. Again, a effective and cost efficient approach with far reaching benefits to the County as a whole.

As someone that has worked with foster children and children that have been abused/neglected, a child that comes to the office with a "tummy ache" doesn't always have an illness. Our elementary school nurses aren't there daily and record keeping is a problem. The so called "repeat offenders" in a nurses office might have more going on than what appears to the eye. A nurse can catch this.

As Mr. McClung points out, a nurse acts as an important medical liaison between children's families and staff. Not only in obtaining appropriate medical records, but education and training. For example, a child with a food allergy requires much more than knowing how to handle an epipen. The majority of effort for a child such as this is in the prevention. If that fails, it is in recognizing the sometimes murky symptoms of recognizing anaphylaxis in time and then administering the epinephrine.

Yes - nurses do benefit children with chronic conditions. The founders of our country decided long ago that public education benefited society as a whole. Moreover, thanks to civil rights, the Rehabilitation Act of 1973, the Americans with Disabilities Act and the IDEA, children, even those with disabilities, are entitled to a Free Appropriate and Public Education.

Additionally, chronic conditions are rising. There are 1 in 13 children with a severe, life threatening food allergy and over 11,000 children in CMS. It's an epidemic doctors don't understand. Asthma - over 17,000 children in Mecklenburg County suffer from this. Over 8,000 children have mental health conditions. Over 300 children with Diabetes. I believe Epilepsy is approximately 2,000. Thankfully for these parents and children, our medical technology is life saving. Comments above mention that nurses would be just for the "few". Well, these are large numbers and educators that care for these and ALL children do need help and support.

I think this is good discourse and enjoy batting around ideas with the intent of bettering our Community. That's why I want to sign my name and stand by my positions, although I'm open to listening to others.

Thank You,
Carrie Merner

Anonymous said...

I just read that both the previous two mayors, while they were products of CMS, they chose to send their kids to very expensive private schools. Charlotte needs leaders who have a vested interest in this school system! Talk is cheap!

Pamela Grundy said...

Thank you, Carrie, for your great, fact-based comments.

5 p.m.: It is unfortunate that our recent mayors sent their children to private schools. It is equally unfortunate that so many of our community's business leaders send their children to private schools. Public schools are indeed strongest when they serve the entire community, and when the entire community is thus aware of and personally invested in what happens in public schools. I wonder how many of the state legislators who passed the "Read to Achieve" act, which has wreaked such havoc in third grade across the state this year, were the parents or grandparents of second or third graders in North Carolina public schools.

Teri Saurer said...

I appreciate good healthy debate on these topics but am certainly a strong supporter of a nurse in every school. Just so people are aware, as Carrie stated, nurses in Mecklenburg county are NOT paid for through CMS funding. The funding comes form the Health Dept and they get it from the county. The people to write to if you want more nurses in our schools are the county commissioners. We would be grateful if this is something you support that you go to our website at www.ncpash.weebly.com and go to the "How to Help" tab and cut and paste an email to our elected officials! They will prioritize the health and safety of our children if they hear from their constituents! Healthy children learn better and parents have the power to bring more nurses to our schools!

Anonymous said...

Training the art teacher in first aid doesn't provide the assessment, interventional and education skills an educated registered nurse would bring to a school. Your child's school may have 99 bumps and bruises every school year, but the 100th kid who falls may be the one who sustains a head injury that won't be recognized by the social studies teacher, ond the one life saved would be worth the cost of every school nurse in the system. I wouldn't expect a nurse to teach math, and it's not fair to expect the math teacher to be a nurse.

Wiley Coyote said...

Buckets of money.

CMS gets about $355 million from the County, so if the County provides funding for nurses, does it matter if the money comes from the Health Department? It's still the County.

We the people will be paying for it no matter which bucket of money it comes from.

School Nurse
Student Services Job Description


http://www.ncpublicschools.org/docs/work4ncschools/employment/jobdescrip/nursejob.pdf

The average monthly salary from the NCDPI website for a school nurse is $3,880 per month, or for 9 months $35,000.

159 schools in CMS, it will cost about $5.6 million per year (average).

Seems like a bargain to me for the benefits gained.

If my numbers are off base, let me know. I used the NCDPI 2013 salary chart.

Anonymous said...

I have followed this school nurse debate for the last two years. While I understand the parent and child side of it, from personal experience, I'm not so sure a story or two here and there sways my taxpayer role.

And to correct an earlier poster, the debate to start public education actually came from the fear of the rising numbers of catholic schools. Politicians sensing this rise of this one demographic to a better lifestyle than others, started all these reasons for public education. Years ago, Ben Bernake, former Chairman of the Federal Reserve, said the reason for the increasing gap in income was because the upper class figured out what beyond a classroom education was needed to get ahead in the world. It is just an opportunity gap.

But, before you launch off any more posts, what we have now, is a far cry from public education. It is only big government indoctrination.

While I have disagreed with the budget treatment of the NC public education system the last 8 years or so, we had been put in a bind by Washington and the courts. Our exploding Medicaid budget has sapped the economic engine of this state. Additionally, just like those that pine for forced integration to return to CMS, many believe the textile, tobacco and furniture businesses will return to NC. Not going to happen.

Lastly, only for tonight, educators and educrats have done themselves no favor in this state. They continue to dream for yesteryear when they could teach and graduate non-readers. When the state would give more money to schools, educrats loaded up central offices and dreamed up new curriculum they then could travel about and consult other school systems about depleting their budgets.

Charles Chan said...

Agree, we should be thinking of the overall health and learning of ALL our students. The American Academy of Pediatrics also recommends a total of 2 hours of screen time per day for ALL children and later start times for teenaged students. Both of these items are not supported by CMS.

We hope the nurses can get behind these "causes" as well, as they affect the health and learning of far more CMS students than get cuts and bruises.

Shamash said...

Pamela wrote:

"Public schools are indeed strongest when they serve the entire community,..."

The public schools were not created to serve the "entire community".

They were started as a way to deliver SOME education to the "poor".

So don't be surprised when the rich and influential send their kids to private school.

That has ALWAYS been their privilege (and usually their choice).

Private schools existed in this country long before public schools were created.

Shamash said...

Anon 11:02pm...

"And to correct an earlier poster, the debate to start public education actually came from the fear of the rising numbers of catholic schools. Politicians sensing this rise of this one demographic to a better lifestyle than others, started all these reasons for public education."

Yep.

But not just a better lifestyle as much as access to public money.

Just look up Horace Mann and the battles between Protestants and Catholics for government funding of schools in the early 1800's.

The public schools (or common schools) were basically founded to keep Catholics from getting public money.

And now with the further "secularization" of public schools, Protestants now want public money for their religious schools, too.

You can see that in a few of the Charter schools out there with somewhat religious influences.

A lot of the recent (say last 40 years or so) move away from public schools was due to fear of "human secularism" in our public schools, among other things.

Even though, officially, religion (prayer) was removed from schools in the 1950's, it still remained in many schools in the South through the early 1970's (and is still accessible today through "clubs").

But now, it's moved even beyond religion into other areas of "social" concern.

I'm not so sure the "rich and influential" in THEIR private schools worry so much about these types of things, though.

They have bigger (or maybe smaller) fish to fry.

(Like all the rest of us commoners...)



Anonymous said...

Now that the job role has been further defined it has already moved out of the nurse and on to a minimum of nurse practitioner and at schools with high incidences of mental health and complex health issues a doctor and a psychologist.

It's nice to think the average nurse will be able to save the edge cases. Do something as simple as taking your average nurse in suburban doctors office and drop them into the ER of a major city on a Friday night. Reality won't reflect the ideal.

It's fun to throw numbers around and
then applaud it as fact based. Most of the numbers are self regulated and administered without any nurse. The better numbers would be for what conditions is a qualified medical person required for the successful administration of the drug or procedure.

The US is no longer willing and to some extent able to afford these nice to haves at the expense of other students. Too long has the average student been ignored while money is lavished on the current pet project being present as but its for the children.

It's great there are those who can post their name, but for us others who have dealt with CMS and know the petty games principals and teachers play I am glad to still be able to comment anonymously on Ann's blog.

Anonymous said...

Huh...Wiley Coyote, your post looks remarkably similar to a reply I got from a Republican Commissioner. Any relation?

Anonymous said...

Buckets and Buckets of money... so let's divert the funds as was done last year from school nurses to Imaginon. That's a much more worthy cause.

Anonymous said...

Nurses provide essential medical coverage during school times. Accidents can, and do, happen every day. Yes, these can be minor cuts, scrapes and bruises. But, they can also be significant such as concussions, broken bones, or worse in the event of more severe situations.

Not to mention, increasingly more of our children are suffering from conditions that require daily medication or safeguards to protect them in other ways. Many of these children need help remembering or administering their medication - teachers and staff are not qualified to take on this burden. Nor should we accept having a teacher stop teaching an entire class in order to give medication to every child in their class who needs it when they need it.

These physical, emotional, and systemic conditions can happen to anyone at any time. They are not qualified by ethnicity, gender, socio-economic strata or anything else. Any child can find herself in need of a nurse's aid on any given day.

If your child hasn't needed a nurse's attention, count yourself lucky. But, that's all that it is. Just luck.

The nurse is more than a caretaker of skinned knees. He/She is a critical component of the care our children recieve while in the care of the school. It has long been the responsibility of our schools to do more than 'school' our children. They are fed in schools. They are transported by the schools. In these respects, we demand that our children remain safe.

Having unqualified school personnel administer potentially-fatal medication is not safe. Having untrained school personnel
be responsible for recognizing complex medical situations is not safe. Having nurses on-site for only some days and not others...is not safe.

This should not be an issue of politics, big government vs. small, or budgets. There are minimun standards that we should expect for our children. This is one of those.

Carrie Merner said...

The last time I'll weigh-in here, but I just want to refer everyone back to the link that takes you to the article written last Saturday. This isn't a partisan issue and neither side should be villainized. Take a look at comments from Commissioners on both sides of the aisle.

Yes, I like facts. I think it's good to understand an issue.

I don't have the power to define what nurses are or can be. That power will rest with the Health Department. I only know what I've experienced elsewhere and know from that first-hand experience what our NC children are currently doing without.

Thanks to everyone that continues to support this issue. It will continue to get my support, as well.

Teri Saurer said...

Studies show that nurses keep kids in school as well. When kids go to the health room, secretaries or volunteers send them home if they are unsure what to do. Nurses keep them in school when appropriate. They also are on the front lines for epidemics like H1N1. Nurses can assess for substance use, suicide and provide prevention. They can do all this in addition to care for emergencies and other medical needs if they are given the time to do so by being at one school. Healthy children learn better. We cannot continue to deny the link between health and academics. Parents will continue advocating to prioritize the health and safety of our children. Thanks to those also supporting this cause!

Shamash said...

Anon 2:32pm.

"It's great there are those who can post their name, but for us others who have dealt with CMS and know the petty games principals and teachers play I am glad to still be able to comment anonymously on Ann's blog."

The "thought police" don't like it when you post anonymously.

They want to be able to locate those with dissenting opinions.

In case "re-education" becomes necessary.

Wiley Coyote said...

3:58

I'm not sure what the point of your post is.

I am sure you haven't received an email from a BOCC rep outlining spending on school nurses.