Six-year-old Cassidy Molinaro has to go to the school office every day.
It's not that she causes trouble or needs a bandage. But her health — and possibly her life — depends on that daily visit.
She needs Andrea Hamrick, RN, the school nurse at Kennesaw Elementary, to check her insulin level and give her a shot of insulin. It's part of the little girl's daily maintenance of her Type 1 diabetes.
Cassidy is not alone in schools across the nation.
One in every 400 to 500 children and adolescents has Type 1 diabetes, according to 2002 figures from the American Diabetes Association. Type 1, known for years as juvenile diabetes, is insulin-dependent, meaning the body is not able to produce sufficient insulin.
Without the insulin shot, Cassidy might go into insulin shock and lose her kidney function.
That fact isn't lost on the school nurses in Georgia who deal not only with insulin-dependent students, but also with those who face other life-threatening conditions.
"I know of middle schools in Cobb that have 10 to 11 children with Type 1 diabetes," said Alison Ellison, RN, PNP, school nurse consultant/liaison for community health development at Children's Healthcare of Atlanta.
Although Cassidy was diagnosed early in her life, many children are diagnosed in adolescence, when hormones kick in, Ellison said.
Having so many children with insulin-dependent diabetes in one school is a concern, especially if there's not a school nurse on site to help them with their insulin, Ellison said. (Cobb's school board requires a registered nurse in any school where students require some medical intervention.)
Rosemary Steinheimer, MSN, APRN, BC, FNP, is the nursing supervisor in Cobb County. She oversees the 104 Cobb County schools, making sure a registered nurse is at each school site that has children with special medical needs.
The program has 57 registered nurses and 32 licensed professional nurses, plus unlicensed personnel. School nurses are integral in helping these children remain healthy, she said.
In children like Cassidy, school nurses are needed to administer insulin shots. But even children with continuous insulin pumps need the assistance and expertise of the school nurse, Steinheimer said.
"Whenever they eat, they'll get a little extra boost of insulin to cover that meal or snack," Steinheimer said. "[The school nurse] will ask what they ate, to see how many carbohydrates they took in, and do a mathematical calculation to program their pump to administer the insulin. The nurse always double-checks the calculations."
Diabetes is just one of the health conditions school nurses help students deal with on a daily basis.
In a Children's Healthcare of Atlanta survey distributed in November to more than 125 school nurse leaders, 60 out of 189 school districts that completed the survey listed a compendium of conditions and diseases they see daily. The list reflects both the medical advances that enable children with potentially severe health problems to attend school, and the school nurses' increasing responsibility to these children.
Conditions reported include asthma, autism, childhood cancers, brain tumors, cystic fibrosis, heart disease, seizure disorders, severe allergies, sickle cell disease and those who were technology-dependent, needing special health procedures such as tube feeding, catheters or trach care.
Caring for these children during the school day is a concern to both school nurses, teachers and parents. It's estimated that almost 30 percent of about 1.5 million school children in grades k-12 in the state have some special needs — from requiring daily medication to having catheters checked. Much of this requires the expertise or the supervision of a registered nurse.
Funding for school nurses in Georgia is again under the microscope this year, as state legislators look for ways to shore up Medicaid deficits with $30 million from the tobacco settlement allotted to the statewide nursing program. Although Gov. Sonny Perdue has promised school nurses that the program's funding will remain intact, there's concern that effort will be overidden in this year's legislative session.
During a school nurse leadership conference in November, Kathy Sheriff — Georgia Association of School Nurses president — and Lynn McIntyre — legislative chair for the Georgia PTA — urged school nurses and the school communities they serve to contact their legislators and explain to them the need for registered nurses in schools.