School nurses do much more than wrap wounds and treat colds—and Tia Campbell ’08 is helping them transform their roles.
Deborah Zeller ’10 saved a life by clearing the obstructed airway of a choking child. Norma Bergey ’10 helped a parent understand the symptoms of a potentially fatal allergic reaction to potatoes. Tia Campbell ’08 worked closely with a family whose first-grader was diagnosed with Type 1 diabetes, giving them the peace of mind that a qualified nurse would care for their child at school. “What I love about school nursing is seeing the dramatic difference you’re making for a family,” says Campbell.
These Master of Science in Nursing (MSN) graduates and experienced Virginia school nurses are seeing more students with significant medical needs and chronic illnesses. Children come to school with a range of conditions, including asthma, autism, diabetes, and potentially fatal allergies. Some days, the school nurse’s office seems more like a small-scale hospital emergency room—a long way from the traditional image of a nurse who checks a child’s temperature or bandages a scraped knee.
“Sometimes parents don’t know what school nurses do because they haven’t spent much time in the office or don’t have children with frequent health issues,” says Campbell, who worked as a school nurse in the Hanover County Public Schools and Richmond Public Schools for more than 11 years before becoming a school health specialist for the Virginia Department of Education (VDOE) in 2005. “Parents who have students with chronic illnesses realize the high level of care their children receive during the school day.”
Today, families rely on school nurses to offer care that enables their children to attend class and learn. And yet, this community perspective of nurses’ duties still does not fully detail their responsibilities. What’s more, school nurses beginning their careers may not receive the training they need to prepare them to meet the laws and regulations that govern their work.
Campbell vividly recalls her own start in school nursing. “I was shown an office and equipment, and then I had to learn everything on my own,” she says. “School nurses start their careers with no idea that they’re supposed to do anything beyond see the child who walks through the door. I slowly came to understand the local policies and state laws.”
Campbell knew she had to make a change. She didn’t know at the time that her positive impact would spread through the state of Virginia and play an integral role in her earning Walden’s 2012 Outstanding Alumni Award.
After beginning her research, Campbell discovered that her own introduction to school nursing was all too typical. “There was everything from ‘Welcome to your office, have fun’ to much more thoughtful programs where you’re assigned a mentor or can shadow someone,” she explains. Across the state, “most orientations were brief. I felt I needed to help make a positive change in school nursing.”
Campbell, a longtime leader in the National Association of School Nurses (NASN) and its current vice president, started writing tips in a notebook, creating a month-by-month calendar of tasks and deadlines for Virginia school nurses. When she became a Walden graduate student, her notes evolved into an online orientation, featuring practical information and advice to help school nurses succeed. Ultimately, she transformed those notes into her capstone project, “Online Orientation for School Nurses.”
“From the minute I started my master’s program, I knew this was going to be my capstone project,” Campbell says. “A child needs to be healthy to learn. That’s why having a school nurse with the most current knowledge is important.”
Her orientation consists of short modules introducing the history, practice and professional standards, and legal requirements of school nursing. It also covers the immunizations and medical exams students must have before they can enroll in school.
Campbell designed the program in modules. “Nurses can do small snippets at a time or stop and start as needed,” she explains. “I opted not to include a test; it was more important for people to have access to information.” The training also includes a video and a PowerPoint presentation so nurses can download additional information.
Campbell has published an article about the project in The Journal of School Nursing and presented information to packed rooms at state and national conferences. School nurses throughout Virginia now use the program, and some school districts have made it mandatory. It’s also become a model for leaders in other states, who have adapted the training to their districts.
Next, she plans to add and update modules to reflect recent changes in school nursing practice and Virginia law. In the meantime, she leads face-to-face sessions to keep school nurses current and continues to field inquiries from other states. Campbell also spreads the word about school nursing in her career as a school health specialist for VDOE by responding to questions from teachers and parents and providing technical assistance to school nurses.
“For those without resources, my orientation provides a beginning. Seasoned school nurses have also taken it to refresh their knowledge,” she says. “The orientation helps people feel more comfortable in their role. It’s made them more mindful of the regulations and practices of school nursing, which makes students safer.”
Campbell’s work on the orientation for public school nurses also inspired a similar program for private institutions. Zeller, a nurse at St. Andrew the Apostle Catholic School in Clifton, Va., and president of the Virginia Association of School Nurses (VASN), developed her own orientation and turned to Campbell for mentoring and guidance. “Tia’s orientation provides the core framework for someone coming into school nursing. It is a starting point for continuing professional education,” says Zeller.
Campbell has also been a mentor to Bergey, who is the school nurse at George W. Carver Intermediate School in Chesapeake, Va., an adjunct faculty member at Hampton University College of Virginia Beach, and VASN past president who nominated Campbell for the Outstanding Alumni Award. Bergey says, “We’re so proud of Tia. She’s a changemaker. Her project has made a tremendous difference for school nurses.”
Training is only one challenge school nurses face today. The financial strains on schools and families nationwide have also impacted the school nurse’s office. Budget cuts have made fewer school nurses available to students. Campbell notes that NASN recommends providing one school nurse for every 750 healthy students. But schools aren’t meeting this goal, even as the number of students with more serious health issues continues to rise.
“Any momentum we had in maintaining the ratio has been stymied,” says Campbell. “In Virginia, we average one school nurse for just under 1,000 students. We’ve ranked 18th to 25th nationally. Our biggest ratio is one nurse for 3,200 students.”
That leaves school nurses with too little time for individualized attention, community education, and preventive care. “We have a wealth of information, but we’re busy reacting to what comes through the door,” Campbell says.
Some schools don’t even have a registered nurse in the building. Campbell reports that school districts are hiring licensed practical nurses at a lower cost but who offer a more limited range of practice. In states without a mandate for school nurses, other staff members may serve as substitutes. “The person in the school nurse’s office may not be a nurse,” Campbell cautions. “It’s important that the office is identified appropriately, and parents know what level of healthcare is provided.”
There’s good reason to have highly qualified nurses in schools. “School nurses are the access point to the healthcare system for many students,” Campbell explains. “Parents rely on the school nurse to say it’s time to see a physician or that you can wait this out.”
“A lot of parents do this because they don’t have health insurance, can’t afford a copay, or can’t take time off from work,” Bergey adds. “In this economy, they don’t have a lot of resources.”
The alumni remain confident that school nurses can overcome today’s challenges as well as others that might arise. “School nurses are self-starters,” Zeller says. “We have an excitement and a passion to help kids. Every day is challenging, but you really make a significant impact on the lives of students.”
Like many school nurses, Bergey, Campbell, and Zeller started out in another aspect of nursing. Bergey was a nurse in a hospital intensive care unit and both she and Campbell worked in an emergency room. Zeller was a critical care nurse for many years and also worked in psychiatric nursing, home health, and community health. Each was attracted to school nursing for the same reason, one that’s common among nurses in this setting: They wanted the same schedule as their children. Only later did they discover school nursing involves much more.
“My mother was a school nurse, and I thought she had the easiest job. Then I realized a school nurse takes care of the child, the family, and the community,” Bergey says. “I’ve been a nurse for 31 years. Being a school nurse has been my hardest career, but also the most enjoyable one.”
Campbell found that school nursing offered the same adrenaline rush she’d felt in the emergency room. “You need assessment skills and communication skills,” she says. “You have to know the latest healthcare practices and laws. You always have to be prepared because you never know who will come through the door.”
Zeller views her role as a generalist, specializing in the care of children in school. “School nurses really are community educators who ensure individual and population needs are met,” she explains. “You have a very broad practice. You have to know about acute and chronic care, public health, and one-on-one pediatric care. You’re a community educator. Your role is to help parents better advocate for their children’s health and education.”