School nurse keeps tabs on the health of students

Diedre Serene may be busy in the elementary school when a child gets sick in the middle school, so she has to rely on each school secretary to contact her when necessary and help care for students in her absence.

“They do a great job handling things appropriately when I’m not here-because I’m only part-time,” Serene said.

Her part-time job as USD 410 school nurse is from 8:30 a.m. to 12:30 p.m., Monday through Friday. In the afternoon, she works for the Marion County Health Department.

In her job with the school, Serene is responsible for immunization records, medication administration, office visits, bookkeeping, teacher training, parent education, and supervision of students with special health care needs in grades kindergarten through 12.

Supervising the administration of a student’s specific medication is another responsibility of the school nurse.

“We have to have doctor’s orders for those students who are on medications before we can administer them at school,” she said.

Over-the-counter medicines are not kept as a school supply.

If a student needs an over-the-counter medicine, parents must fill out an order form and provide the medicine. Even a student’s Tylenol is kept locked up and can’t be dispensed without a permission form.

Office visits can range from stomach aches to broken bones.

“Usually they send them to me, and then I notify the parents,” Serene said.

If the parents aren’t home, she tries to call an emergency contact to pick up the sick child. At enrollment, she asks each student to list the phone number of an alternate adult to be contacted in case of emergencies.

“But sometimes we can’t get anyone, and we have kids in the office for the afternoon,” she said. “That’s why it’s important for parents to leave an emergency-contact number or tell their child if they’re going to be gone that day and where to reach them.”

Students are sent home if they are obviously throwing up, have a temperature of over 100 degrees, have anything infectious such as chicken pox or pink eye, have a head injury, are constantly coming to the office with physical complaints, or have head lice.

Serene keeps a log documenting a student’s name, time they came into the office and the specific concern.

As well as record keeping, school nurses help with “blood-born-pathogen training” for the staff.

The Occupational Safety and Health Administration mandates nurses train school staff every year about using special precautions when handling blood, such as in the case of bloody noses and playground injuries.

“We need to wear gloves,” she said. “We just can’t wash the blood off and put a Band-Aid on.”

The school nurse is responsible for educating and notifying parents when there is any immediate health problem in the school population.

“We’ve had a lot of chicken pox lately,” Serene said. “We’re on our fifth round of those.” (See related story on Page 1)

Serene must also supervise students with special health-care needs.

During enrollment, students fill out a questionnaire detailing any medical concerns and medications. At the end of the year, Serene sends paperwork home with those students so they can take it to their doctor, get it filled out properly and return it to school for the next school year.

School nurses also work in partnership with the Marion County Health Department, which does the hearing, vision and scoliosis testing at each school.

Health department staff members, Anita Hooper and Jan Moffitt, come to the school to test students according to a comprehensive testing plan.

“Hearing screening is done in kindergarten, first, second, third, fifth, seventh, ninth and 11th grades,” Hooper said. “Vision tests are done in kindergarten, first, second, fourth, sixth, eighth, 10th and 12th grades.”

Scoliosis testing, to detect curvature of the spine, is done with fifth and seventh grade girls, and seventh grade boys, Hooper said.

As recommended by the state, all students with individualized education plans-those students who struggle in some areas in school and students in the gifted program-receive hearing and vision screening every year from the health department.

Serene also has the health department dispense flu shots to the school staff and hepatitis shots to the students.

Serene stresses the importance of hygiene in light of the biological warfare threats of terrorism and the approaching cold and flu season.

“Parents and students need to make sure they wash their hands real well,” she said.

Each year the health department also offers a series of three hepatitis B shots to students whose parents want them to be immunized.

“Hepatitis B is a liver condition,” Serene said.

“Once you get it, you may not be in the acute phase, but later in life it can possibly lead to liver cancer. So these shots are preventative.”

The cost is $15 for ages 11 to 17 and $5 for ages 10 and under.

Serene began her career at KU Medical Center in Kansas City, followed by a job in the hospital in Herington and then working as administrator at the Marion County Health Department. Seven years ago, when her son entered kindergarten, Serene took the school-nurse position in Hillsboro.

“I like working with kids, and I like being in a specialty area in nursing,” she said. “Having worked in the health department, I was already in that preventative health and immunization area. So there was a nice transition to the school-nurse setting.”

Other nurses in the surrounding communities are Janice Waner in the Marion School district, and Moffitt, who is contracted by the Peabody, Burns, Centre and Goessel school districts as well as OASIS.

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