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The nurse is in: School health professionals evolve to meet students' needs

Barbara Gant-Johnson has been a nurse in the Hempstead School District since the late 1990s and finds the job rewarding because she can see the difference it makes in children's lives. (Credit: Debbie Egan-Chin)

Twenty-first century school nurses are a far cry from the mythic lady in a crisp white uniform wielding a thermometer, ice pack and students’ home numbers. The profession has undergone enormous changes in recent decades. Elementary school nurses now help children manage diabetes, seizures and even anxiety. Secondary school nurses are called on to counsel teens about substance abuse and sexuality, bullying and mental health.

“Our office is a judgment-free and safe place where students can discuss anything and we will always help them,” said Arlene Longo, the school nurse at Locust Valley High School, which includes grades nine through 12. “I never know what will be coming through the door and always have to be prepared and ready for an emergency,” added Longo, who began her career 40 years ago as a critical care nurse at Glen Cove Community Hospital, now part of Northwell Health. Longo and Locust Valley Middle School nurse Jane Reilly work as a team, caring for more than 1,100 students.

Donna Hasan, a consultant for Western Suffolk BOCES who advises nurses about state law and health and education department guidelines, said, “School nurses are not and never have been the Band-Aid and/or ice pack brigade.” Hasan, who spent 30 years as a Mineola public schools nurse before retiring in 2012, offers nurses workshops, conferences and “a friendly voice on the other side of the phone.”

“School nursing is not an easy alternative to hospital nursing,” Hasan said. Mainstreaming students with disabilities means nurses care for “more medically fragile students,” she said, those with feeding tubes, mechanical ventilation devices, pacemakers and insulin pumps. Hasan said there has also been an increase in students diagnosed with traumatic brain injury, concussions, asthma, cancer and mental health concerns.

With the start of this school year, school nurses are also helping students and parents navigate new immunization requirements that eliminated nonmedical exemptions, she said.  

“Children can’t learn if they have to worry and concern themselves about their health and the management of their illnesses,” said Launette Woolforde, vice president of nursing education and professional development at Northwell Health, which recently launched a professional development and continuing education program for school nurses. There are 265 Long Island school nurses currently registered for training through the program, which Woolforde said is the only health system-sponsored program of its kind in the country.

Long Island school nurses are also supported by the New York State Association of School Nurses, a professional organization with Nassau and Suffolk chapters that offers presentations on such timely issues as substance abuse and LGBT awareness.  

New York State law does not require nurses in schools. Yet, according to the American Academy of Pediatrics’ 2016 policy statement “Role of the School Nurse in Providing School Health Services,” “School nurses … are in a critical position to identify unmet health needs of large populations of children and adolescents in the school setting.”

Indeed, the academy’s policy statement cites the work of Lina Rogers, the first school nurse in the United States, appointed in 1902 in New York City and credited with dramatically reducing absenteeism among the 8,671 students in the four city schools she covered.

On Long Island, Matthew Hamilton, a spokesman for New York State United Teachers, said the union represents more than 2,000 school nurses, including about 250 in Nassau County and 275 in Suffolk County, which together comprise more than 100 school districts. Their ranks include registered nurses, licensed practical nurses and nurse practitioners. Some nurses cover more than one building.

Power of laughter

Paula Saltzman’s office at Wood Park Primary School in Commack seems just what the doctor ordered for youngsters needing anything from a bandage to an insulin injection. It’s decorated with a menagerie of not-so-scary Halloween stuffed animals by a registered nurse with 40 years of tear-drying experience.

“When they cry, that bothers me very much,” Saltzman said at the end of a recent workday at the school where she's been 25 years. “So I’ll do something comedic, or I’ll say, ‘We don’t cry in here because I’m here to make you better.’”

A Disney Princess Band-Aid or an ice pack is often what’s needed by the 30 and 40 kindergartners and first- and second-graders Saltzman sees on a typical day — when lunch recess and playground time bring the most foot traffic. But she also helps students manage chronic health conditions.

“We have so many children with more complex issues these days, and both parents are working, so it’s harder to get the parents to come in if you need something,” said Saltzman, who is in her 60s and both a grandmother.

Saltzman’s office is stocked with six buckets of students’ prescription medications. She keeps a binder with the names and photos of children with allergies to peanuts and other foods, and a box of EpiPens ready for emergencies. When baby teeth come out, she has a supply of necklaces with a compartment to carry the prize home for Tooth Fairy pickup.  

Saltzman chose nursing though she was a healthy child and can’t recall ever missing a school day due to illness while growing up in East Meadow. The 1976 graduate of W. Tresper Clarke High School got a bachelor of science degree in 1980 from the University of Delaware School of Nursing in Newark. She worked as a pediatric nurse in Los Angeles and Philadelphia before settling into the school nurse role she loves.

“It’s extremely fulfilling, and personally and professionally what I want to do,” said Saltzman. In May, Saltzman received the New York State Association of School Nurses Suffolk County award for excellence in recognition of her nursing ability as well as organizing an after-school workshop for parents, starting a Walk to School fitness program and running the annual Toys for Tots and holiday food drives.

She takes pride in the crayon drawings, no matter how simple, from thankful ex-patients. One child drew two stick figures, one slightly taller than the other, on a sheet of white paper. When Saltzman asked why the drawing was so simple, the boy said, “That’s you and me!” She said right away: “That’s perfect, don’t add anything.”

In her father’s footsteps

Barbara Gant-Johnson, the registered nurse at the Marshall School in Hempstead, followed both the footsteps and advice of her father, local dentist and prominent civil rights activist Dr. Raymond Gant, by taking up a health care career.

“He was a very civic-minded person, and he always stressed to my sister and myself, at some time in your profession you need to give back to the community,” said Gant-Johnson, 62, of Hempstead.

After getting a bachelor of science in nursing from Long Island University in Brooklyn, Gant-Johnson heeded her father’s call to public service by working in the 1980s as a medical-surgical nurse on the AIDS floor at St. Luke’s-Roosevelt Hospital in Manhattan. “We were pioneers in accepting AIDS patients,” she said. In a hospital elevator she met her future husband, Reginald Johnson, now a nurse in a Brooklyn hospital. They have a grown son.

At Hempstead School District’s pre-K and kindergarten building, Gant-Johnson dresses in scrub pants, a blouse and sneakers because “it’s kind of intimidating to children if you’re uniformed up.” With her office décor, she aims to mirror the popular “Doc McStuffins” Disney TV series whose animated heroine is a 6-year-old African-American girl who cares for stuffed animals.

Gant-Johnson’s many duties include vision and body mass index screenings, the latter representing a new role for nurses in fighting childhood obesity. “We emphasize to the parents, let’s get them to stop watching TV and using the iPad. Let’s get them to go outside and throw some balls and ride some bikes,” she said.

Although she cherishes her work with kids, Gant-Johnson may one day be caring for older patients. She’s continuing her education toward a nurse practitioner degree specializing in gerontology.

First stop: Hollywood

Hollywood came calling early in the career of Sandra Poshka, 64, of Farmingville, the nurse at North Coleman Road Elementary School in Centereach.

After graduating from Dorothea Hopfer School of Nursing-Mount Vernon Hospital in 1978, Poshka worked as a nurse from 1980 to 1983 at California Children’s Hospital of Los Angeles in Hollywood. There she met celebrity visitors Lucille Ball and Richard Chamberlain (of “Dr. Kildare” fame) and helped care for one of the era’s child TV stars.

Poshka also worked in clinical settings at North Shore University Hospital in Manhasset and in Freeport’s Lydia E. Hall Hospital, which closed in the 1980s.

She’s been at North Coleman Road for the past 17 years. Nowadays, she said, “Our office is like a mini emergency room or trauma center.”  

With a school population of 400, she said, “We have children in wheelchairs, we do tube feeding, we have a student who had a colostomy, and we have a lot more kids with allergies that require EpiPens and schoolchildren with asthma and nebulizer treatments.”

There are also daily emergencies: “who feels nauseous, who skinned their knee in the playground.”

At the end of a busy day, Poshka said, school nurses can “feel invisible, that most people don't understand the job that we do.” When she hears from a long-ago student who entered the nursing profession, Poshka said, “I like to hope that I had an impact on them.”

Healing with kind words  

Anxiety is common among the children at Drexel Avenue Elementary School in Westbury, where Barbara Jacobowitz has been a school nurse for eight years.

“We have a huge immigrant population,” said Jacobowitz, 64, of Syosset. She said that many of the children have been traumatized by “immigrant horror stories of how they got here” from El Salvador and Honduras. Jacobowitz listens — with help from a Spanish-speaking assistant — and tries to ease fears with comforting words. “If there’s a bullying issue, I will speak with the school psychologist or the guidance counselors,” Jacobowitz said. “A lot of kids just need reassurance that things are OK.”  

Jacobowitz, a registered nurse who grew up in Flatbush, Brooklyn, got a bachelor of science in nursing at Cornell University-New York Hospital School of Nursing in Manhattan. She prepared for school nursing career with health care positions at a Manhattan hospital and in home care on Long Island.

Like other Long Island school nurses, Jacobowitz has her hands full helping students manage such conditions as asthma, seizure disorders and diabetes.

“You don’t give any medication without doctors' orders," Jacobowitz said, adding that there are 20 children in the school who take prescription medications.

Occasionally, it’s a grown-up instead of a child walking through the door. “If the teachers have any medical problems, they come in,” Jacobowitz said. “Your eyes are on the children, but you’re also aware of the staff needs.”

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