Notes From a School Nurse

From asthma to AIDS, her role has undergone a revolution


During this past academic year, St. Paul public schools employed nearly 50 full-time nurses; about 16 of them split their weeks between more than one school, explains Ann Hoxie, interim administrator of student wellness for the district. Assignments are based on the number of kids in a school and their needs; schools can also decide to spend part of their budget to have a full-time nurse on site. Of course, Hoxie and the School Nurse Organization of Minnesota wish that St. Paul, and the state as a whole, had more school nurses, but funding is difficult to come by, as budgets tighten and everyone is expected to do more with less.

To be licensed in Minnesota, school nurses must be registered nurses with a four-year degree, and they must have a certification in public health. It's essential, Hoxie says, that school nurses have adequate healthcare skills, but they also need to understand health in the context of school and learning. "We're a big part of the safety net," she explains. "We're the only person in the school with a health footing, but we also look at things differently than our healthcare colleagues."

Sue Will checks the blood pressure of senior Markeia Johnson, who had a stroke last fall
Richard Fleischman
Sue Will checks the blood pressure of senior Markeia Johnson, who had a stroke last fall

Will, 54, knows firsthand about the importance--and the evolution--of the institution. She first became a school nurse in 1969, and went on to hold a variety of positions in Minneapolis, Stillwater, and St. Paul schools. In those early days, the issues Will addressed were more along the lines of teaching four-year-olds not to pick their noses than of creating daycare centers for children of adolescent mothers (a task she took on later in her career). In 1993 Will accepted an administrative job working on environmental-health issues with the St. Paul school district. In 1999 she returned to the schools as Central's nurse.

"There was more of everything when I came back," she says, chuckling. As the only nurse for Central's 2,300 students (a ratio three times as high as that recommended by the National Association of School Nurses), Will finds herself busy all day, playing a number of roles. She's often the first to diagnose a student's illness. Or the person who ends up plugging a hole for families with no health insurance, recommending ways for them to get coverage or find low-cost clinics. Or her work is preventive, from tracking immunizations
to promoting healthy behavior. Or she is helping to manage chronic health problems.

In recent years, Will has noticed an increase in mental-health concerns (she sees numerous teens who are depressed, sometimes even suicidal). And she has also marveled at the rise of individualized planning to accommodate kids with special needs, including those with permanent medical conditions. During the span of Will's career, the law has changed to require schools to provide accommodations for kids with disabilities and health conditions. Plus, advances in medicine and technology make it possible for kids who once would have been homebound to go to school.

"Kids live when they wouldn't have before," Will says, matter-of-factly. "And the healthcare industry, they don't keep sick people anymore. These kids are right back in the community in a day or two. Kids are back to school much sooner. We need to be aware of what a child needs to manage himself medically at school--and be safe at school."


Markeia Johnson pulls out two photo albums. The first is filled with her senior pictures. In them, her long black hair frames her broad forehead and grand, toothy smile. Johnson looks at the photos and laments that after they were taken, she lost her hair; it has only just started growing back. The second album is filled with snapshots from last fall, when she lay in an intensive-care unit, comatose, connected to too many tubes to count.

Johnson was never sick until her junior year. She had had no contact with the school nurse, recalls her mother, Shellene Johnson. But then, in 2000, Markeia was diagnosed with a severe form of lupus, a disease that can cause pain, fatigue, sometimes death. The diagnosis brought the family in contact with Sue Will. Shellene Johnson was impressed by how the school nurse tracked her daughter's medication, organized a special education plan for her classes, and arranged transportation from the front door of her Lauderdale home to the high school.

One morning last October, Johnson went to wake her daughter. Markeia's eyes were dilated, her speech slurred. Shellene Johnson recognized the signs of a stroke. Paramedics took the girl to Regions Hospital, where Markeia lay in a coma for seven weeks. "They said she was brain dead," Shellene Johnson remembers. "She was paralyzed. She wasn't going to make it.

"I called the school right away," she continues. "Sue came that very same day."

Each year several of Will's students have catastrophic, crippling emergencies, from serious car accidents to emergency surgeries. But if you ask her about the worst health crisis she's faced in her career, the answer comes quickly: Markeia Johnson. "The physicians," she confides, "didn't expect her to survive."

Will visited Johnson three times a week while she was in the hospital. "The connection with the school needs to be maintained during the acute phase of the illness," she explains. "It helps me to know what's going on and what we need to do to take care of her."

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