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October 8, 2015 • Headline News
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School nurse: Allergies, diabetes, you name it she sees it

Mary Mattingly

(Editor’s note: First of a two part series.)

The days of the school nurse checking for fevers or updating immunization records are long gone. Today’s school nurse still does all that, and so much more. The nurse provides a gamut of medical services, from administering medications to coordinating health screenings to updating teachers on student health care plans. And, there’s always a sick kid with a stomachache who just needs tender loving care!

Appie Thompson Milan School NurseMARY MATTINGLY PHOTO
Milan School Nurse Appie Thompson oversees student Dalton Messer health status as he records the data.

It was actually in the 1800s when nurses became part of the school setting. They were needed to inspect students and identify communicable diseases.
In modern day, students with chronic diseases, mental health issues and high-risk behaviors have driven school nurses to gain expertise not only in public health but also in pediatric and mental health nursing. Additionally, the need for nursing services in the school setting increased with the passage of a public health law in 1975, requiring the mainstreaming of physically and mentally challenged students into the general student population. A later Supreme Court disabilities ruling required districts to provide nursing care, however, it didn’t provide funding.

Health clinics are undoubtedly one of the busiest places at school. Consider the numbers, according to the local school nurses: South Ripley Schools full-time nurse Marie Menchhofer and part-time nurse Mandy Rohrig at the junior-senior high sees 60-80 students daily; Milan Elementary, 40 to 80 by nurse Mandy Hughes at the elementary, and at the junior high-high school Appie Thompson sees between 80-120 students. Jac-Cen-Del’s Kara Huss sees 40 or more students between the elementary and upper grades. Batesville schools had a total of 31,536 visits to the school nurse at the four buildings last year, according to a recent report by the health services director Gayla Vonderheide.

Appie Thompson is Milan High School and Junior High School’s nurse. No other nurse for a school in the county has been at a school district nearly as long as she has. “I was the first school nurse they ever had in 1985. The county was just beginning to get school nurses then. It was kind of exciting because they didn’t really know what a school nurse could do, just immunizations and sick kids; so, I got to set up the whole program, K- to 12.” At the time, one nurse was responsible for 1,400 Milan students; however, about 20 years ago, Milan hired an additional nurse so there would be one for elementary and upper grades. Registered Nurse Mandy Hughes is responsible for the elementary students while Thompson oversees the upper grades. Milan Supt. Paul Ketcham said the school nurse role is “enormous” to the whole academic process. “It’s something we take for granted, that is, the student’s health. But if they are not feeling well it impedes the learning process so having a nurse in the building allows us to assist.”
On the job

The health clinic at the schools often becomes a mini-ER, minus the doctors. “It’s always a challenge!” Thompson said of her job, and no day is the same. Marie Menchhofer, South Ripley’s registered nurse, has been in the school nurse role for just five years, but whole-heartedly agrees. She left a hospital position, and while the pace is less intense, it’s far from dull. “I thought it would be much more laid back, and yes, I’m thankful no one is coding, but I see kids who pass out, those with severe asthma attacks, others with PICC lines. I’ve catheterized students and worked with feeding tubes. It wasn’t what I expected but I so enjoy it,” she said. The other day Thompson tended to a boy who broke his femur. She also dealt with lice cases, and she had two “cutters” students who physically hurt themselves due to mental health issues. She has also counseled a boy who punched a locker because he was upset over a girlfriend. And, this is all in between overseeing the constant slew of students who come in routinely for their medical care plans of tending to the diabetics, the asthmatic students, the ADD/ADHD students. At the start of the school year, the school nurse is making sure all students have the state required documentation of immunizations. “We really treat the whole person. Being there daily is important,” Thompson said.

In her 30 years, she’s noticed big differences among the students and the role of the school nurse. “The numbers of health problems have gone up, the emergency medicines have increased, and babies are living due to the advances of medical technology. A lot wouldn’t have made it years ago, but that can mean a lot of medical issues later.” She has six diabetics at the high school and middle school, four at the elementary, most having Type 1 diabetes. Milan’s not unusual, noting that Batesville High School has 10 diabetics, and South Ripley Elementary has four diabetics. It’s the nurse’s responsibility to train the staff on how to handle routine care for these students. Thompson makes sure EpiPens (for severe allergy attacks) and inhalers go on field trips and also for extracurricular activities. She participates with the teacher in the Individual Education Plan of students with special needs.

Schools have seen a big increase in the number of students with allergies, something rare when Thompson was a student. Case in point: All schools in the county are now “peanut free” due to allergies. Thompson noted other allergies Milan schools deal with: bees, latex, tree nuts, shellfish, certain fruits and spices. South Ripley has a student allergic to whey protein, which means Ranch dressing is off limits. One of the more unusual ones at Jac-Cen-Del, according to school nurse Kara Huss, is an allergy to cranberry. There are also more students diagnosed with attention problems who take daily medications, all which are overseen by the school nurse. Also, the number of students diagnosed with anxiety, depression or mental health issues have drastically increased over the past two decades.

(Editor’s Note: School nurses sometimes catch some serious health problems. See next week’s Osgood Journal.)

In wake of Oregon school shooting...
Schools armed with emergency plans

Mary Mattingly

Last week’s mass shooting at a community college in Oregon was another reminder to school safety officers, administrators, law enforcement and the general public, that such a tragedy can happen anywhere. “We can’t take the approach that it can’t happen in my neighborhood,’" Randy Proffitt, spokesperson for Ivy Tech, said. “It can and it will, anywhere and anytime.”

Ivy Tech campuses in nearby Madison, Lawrenceburg and Columbus all have police officers on site. “Nothing like this has happened. But it certainly makes you step back and take pause,” Proffitt said. “Is it enough? Should we do a drill next week to make sure what we have in place is effective.”
He’s reacting much like other school administrators and officers probably did upon hearing of the news of another school shooting. Newsweek reports it’s the 45th school shooting in 2015.

While it’s debatable on how to prevent such violent acts, most agree the least we can do is to be prepared, to have an emergency safety plan in place, practiced and updated regularly. Brent Casebolt, Jac-Cen-Del’s school resource officer, agrees no one or group is exempt, and it can happen at the mall, a theater, the workplace or a rural school. He advises people to put away cell phones and stop texting, to notice your surroundings, and who is nearby. “I’m sorry we live in these times, but we do,” he commented. Just about every public school in the country has a police presence; all do in Ripley County. Noel Houze started last year at Milan High School as the School Resource Officer (SRO); Brent Casebolt is the SRO at JCD, Jeff Thielking is at South Ripley and Mike Manus at Batesville schools. All these officers either are retired from a career in law enforcement or are associated with current agencies.
In Indiana, each school must submit an updated emergency safety plan to the Indiana Dept. of Education in October, and a copy is given to the police agencies in the community. The two work together.

While our rural schools do not have the problems associated with the larger inner city schools where they might have metal detectors at the entrance they are not lackadaisical on their approach to safety. South Ripley spent a good amount of money for a keyless and buzz in entry at all of the buildings for the start of the school year. They also have about 63 cameras in place in the buildings. Thielking monitors two large screens in his office daily. If there is something questionable he can review, download and save it to the hard drive. The doors to the schools can also be controlled remotely. Technology has benefited schools in this respect, he adds. Likewise, Noel Houze said Milan staff now has a cell app of their emergency plans “so it’s at their fingertips.” Teachers don’t have to scramble looking into a handbook. He also said they go over it a few times a year, and he’ll sometimes use the school’s 30 minute teacher in-service on Wednesdays for safety training. “A lot of thought goes into these safety plans,” Thielking said, adding, “A locked door will slow down a person, but it won’t necessarily prevent the person” from entry.

Emergency response all changed with the high school shooting at Columbine in 1999. It was dubbed the deadliest mass shooting at a high or grade school, until Sandy Hook occurred in 2012 where 27 were killed by a lone gunman. “We used to rope it off and wait for the police to come. Today, the closest officer goes in toward the shooter. You don’t wait.” Thielking said. Local school officers also follow the “Run Hide Fight” philosophy, with the thinking to get away from the intruder. Safe evacuation zones are established for each building. “Fighting is the last resort,” Houze added. Coincidentally, last week South Ripley students heard a program based on the life and writing of Rachel Scott, the first victim of the Columbine school shooting. (See Supt. Rob Moorhead’s column on Page 4 for more about this program.) Proffitt at Ivy Tech said staff has accessible panic alarm buttons to signal security. “We try to find the safest area to be in, and call upon law professionals to arrive quickly.” They also have a text system to communicate with students when there is a danger or if it’s clear. Brent Casebolt mentioned that the four schools and local law enforcement in Ripley County are part of a safety commission that meets regularly and reviews their threat assessment plans. As Houze remarks, “When I was a kid the safest place to be was either at home or school.” Schools are still safe, but could be seen as vulnerable, which is one reason safety plans have been put in place. “Yes, our schools can be a target because many know our kids are sacred to us,” said Casebolt.

At the meetings, they discuss recent safety and tech trends, the latest news, such as the Oregon shooting and any lessons learned from it, and establish or update programs. “The school region will help out too. If Milan needs to evacuate here, or South Ripley, of course we will help,” Casebolt said. Safety does not come cheap, as Houze commented, but it is hard to put a price on children or staff. “Control access costs a lot of money, and corporations have to plan for it,” he said. The SRO and administrators often consider grants for specific safety measures or programs. While the SRO’s No. 1 priority is safety, they also spend a lot of time on building student relationships. Houze said it’s much like officers do in the community, but on a smaller scale. They want students to feel comfortable so they will approach them to share their feelings or concerns about others. Staff is also made aware of signs to look for that might indicate a troubled child, one that might act out with violence. There is ongoing debate about the cause of mass shootings and how to stop it, but in the meantime, be assured that all county schools have a thorough response plan in place.

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