School nurses race to keep up

Care-givers spread thin as more students need medical attention at Mountain View Whisman district

Bus drivers and maintenance workers aren't the only employees of the Mountain View Whisman School District who spend a significant portion of every day behind the wheel.

School nurses like Jamie Saxena also are required to travel from campus to campus -- often making multiple trips to the same school in a single day.

With only three nurses to watch over nine schools, and with a growing number of children with medical issues that require the regular attention of a medical professional, Saxena says it is a tricky balancing act.

There are many days that she and her fellow nurses "are barely able to tread above water," Saxena says.

All the same, according to Sue Barrie, the district's head nurse, her team of three nurses is lucky. If it weren't for a grant from El Camino Hospital, Barrie would be the only nurse for the entire district.

"We're actually very fortunate," Barrie says. "If I were the lone nurse it would be impossible to do this."

After shadowing Saxena for half a day it is clear: if her workload were doubled -- and certainly if it were tripled -- she would be unable to keep up. She makes regular cross-town trips between Crittenden Middle School, near the intersection of Highway 101 and Shoreline Boulevard, down to Bubb Elementary, which is located south of El Camino Real near Miramonte Avenue.

"Driving is a part of the job," Saxena says, hopping into her black sport utility vehicle and heading to Monta Loma Elementary after helping a group of students at Crittenden -- first with a set of vision and hearing tests, then with insulin injections.

At Crittenden, Saxena huddles with a group of diabetic students, supervising as one of the girls draws the appropriate amount of insulin into a syringe and gives herself an injection.

"We have a chart," Saxena says, explaining that her nurse's office often doubles as a classroom. She arrives at Crittenden at lunchtime and helps the students track what they eat. Then she supervises as they consult the chart and figure out their insulin needs based upon what they ate. "Ultimately, we want the kids to be independent."

On her way to Monta Loma, she stops by Theuerkauf to pick up a book of "color vision plates" -- circular drawings, composed of dots that vary in size and color. If a student cannot see the number within the circle, it indicates he or she has a vision deficiency in a particular color.

Many instructional materials are color-coded, Saxena explains. It is important to identify color blindness early, so that teachers can make accommodations for colorblind students and so the children don't get frustrated and confused if they are unable to perform tasks that require them to differentiate between colors.

At Theuerkauf, Saxena meets up with Barrie, who explains that she regularly has to bounce between schools, just like Saxena.

Barrie says that currently the school has many children with chronic conditions. There are five children with cancer conditions, six are the recipients of organ transplants, and there are also kids who are fed through a tube, require regular catheterization and, of course, insulin injections.

"We're having more children with more severe, more complicated medical conditions coming to school," Barrie says.

She says that she sees more diabetic children than when she started 30 years ago. Students with food allergies also appear to be on the rise -- the district has more than 50 students who run the risk of going into anaphylactic shock from eating certain foods, most commonly nuts.

Barrie is reluctant to speculate exactly why more children seem to be at risk for these conditions these days, but noted that in the past such conditions were less understood and under-diagnosed. On top of that, children who suffered from chronic conditions were often sent to special schools when she began her career. Now, more are brought into regular schools, or "mainstreamed."

Improvements in medical technology play a role, she says. "A lot of these kiddos, years ago, would not have made it through infancy."

When Saxena arrives at Monta Loma, she checks in at the office and after a quick phone call is rushing down the hall to Rayna Shah's first-grade class to administer the color vision screenings.

Sitting in a far corner of the classroom, Saxena speaks in hushed tones with the youngsters as they come up, one after another, and tell her what they see in plates. She marks down results on a sheet of paper as Shah continues with her lesson.

These are precisely the kinds of tests that the grant from El Camino Hospital was intended to facilitate, according to Barbara Avery, director of community benefits at the hospital.

"We're very interested in the health of the youth in our community," Avery says.

Before the grant -- which provides Mountain View Whisman, along with three other local districts, $200,000 annually -- local schools were having trouble simply meeting the essential needs of students with chronic conditions, Avery says.

Now, with a bit more breathing room, districts like Mountain View Whisman are able to conduct scoliosis, vision and hearing testing, and have more time to follow up with parents of students -- who very often need to be nudged to get their children to the doctor for appropriate treatment.

Avery says that the state recommends that there be one nurse for every 750 students. Though the grant has not made that recommendation a reality, it has helped.

"Every time I feel like I'm finally catching up, I get worried," she says, "because I know that is the calm before the storm."


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Posted by Sandra Gault
a resident of another community
on Apr 19, 2011 at 8:14 am

I am also a school nurse in California. I have 7200 students in an elementary school district of 10 schools, and there are 1.7 positions plus we have an LVN who helps us during lunch with insulin. It is tough to get everything finished, and I feel exactly like the nurse in the story. Most people do not know what a school nurse does, but this was a good portrayal of our day.

Like this comment
Posted by palo alto parent
a resident of another community
on Apr 21, 2011 at 10:20 am

School nurses are wonderful, I'm sure Ms. Saxena contributes greatly to the health of the students. I am curious why she is expected to administer scoliosis, vision and hearing testing rather than focussing on the health issues of the students (insulin shots, etc.) Yes, it would cost $$, but the screening could be done by an outside group allowing her to focus on the day to day medical needs of students. Are school districts required to administer medical care to students or is this something that MV does because it is the right thing to do?

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