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School nurses are administering more medications to students than in past years. Some of the more commonly dispensed medications include:
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And although there is nothing unusual about students who need to take medication during the school day, the types and amounts of medications are increasing.
'There are more inhalers for students with asthma and more students with allergies,' Urmson said.
The increasingly complex ailments make more work for school nurses.
Gone are the days when nurses largely performed the tasks of bandaging skinned knees and taking temperatures.
In addition to state-mandated vision and hearing screenings, today's school nurse is faced with managing the care of students with chronic conditions such as asthma and diabetes. Nurses also spend a great deal of time giving medical care to special-needs students.
'The job they do every day they do well,' said Richard McGarvey, spokesman for the Pennsylvania Department of Health. 'They have to be there when someone has an illness in class. It's not the easiest job in the world.'
School nurses are dispensing more prescription drugs to students than ever before.
'School nurses are telling us that not just the amount prescribed or given is increasing but the variety (is increasing),' McGarvey said.
The health department is starting to collect information on the medications administered by school nurses. No statewide data is yet available, McGarvey said.
But during the 1993-94 school year, North Allegheny School District nurses dispensed 23,058 doses of medication to students. During the 1999-2000 year, that number had more than doubled, to 51,380 doses.
'I give out about 30 medications a day,' said Charity Istone, a North Allegheny nurse.
Of the 30 doses, about 22 are Ritalin or other medications for attention deficit hyperactivity disorder. Istone also administers medications for conditions such as asthma and diabetes.
School nurses also are spending time teaching children how to manage their illnesses.
'We assist kids in dealing with their chronic illness,' Istone said. 'It's part of our responsibility to work with them to deal with the issues.'
The issues for children today range from asthma to attention deficit disorder to diabetes.
Dr. Gilbert A. Friday Jr., allergist and immunologist at Children's Hospital of Pittsburgh in Oakland, said the incidence of asthma is increasing.
'There is more asthma out there,' Friday said. 'We're not sure why.'
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Friday said 10 percent of children have asthma. About half of those cases are severe.
'In many cases kids need to carry aerosols (inhalers) and use them before exercising,' Friday said.
Allergies in children, particularly food allergies, also are on the rise, Friday said.
Common foods that children are allergic to include peanuts and seafood.
Children who have allergies need to have medicine administered immediately after an allergic reaction to counteract it.
Diabetes is another medical condition that school nurses and other school personnel must monitor.
'We are diagnosing more cases,' said Linda Siminerio, coordinator for the diabetic education program at Children's Hospital. 'We are diagnosing many young children, preschoolers.'
Siminerio, who also is the director for the Diabetics Institute at the University of Pittsburgh, said that last year Children's Hospital diagnosed 150 youngsters with diabetes.
'That is higher than previous years,' she said.
Siminerio said all school personnel - including teachers, aides and cafeteria workers - need to be educated in managing a child's diabetes.
'There is at least one child with diabetes in every school,' Siminerio said. 'Good control prevents problems.'
Children with diabetes need to have their blood-sugar levels monitored. Also nurses at times need to administer insulin and do catheterizations.
'The school nurse must be cognizant of all factors,' Siminerio said. 'They need to help those kids.'
The inclusion of more special-needs students into the school setting also is placing added responsibilities on school nurses and teachers, said Joan McMahon, chief of the infectious diseases program at the Allegheny County Health Department.
'(Special-needs students) are unable to verbalize their complaints,' said Bebe George, certified skilled nurse in the Bethel Park School District. 'So we have to use our nursing assessment skills to assess their needs.'
And one nurse can be responsible for administering care to children in several schools.
The state Department of Health requires districts to have one nurse for ever 1,500 students. That's double the 1-750 ratio recommended by the National Association of School Nurses. Some states, however, set no requirements.
Also, most districts do not permit students to carry prescription drugs or over-the-counter medications during the school day. All medications must be registered with the nurse's office.
And students must have written directives from physicians and parental permission to take medications during the school day. These requirements put additional burdens on the school nurse.
'I've always felt there are more medications in (students') possession than we are aware of,' Urmson said.
That concerns Urmson, who said students don't realize the danger of sharing medication with their classmates.
'They think they're invincible and nothing will happen to them,' she said.
The increased needs of children in schools coupled with a shortage of nurses across the country creates a formidable challenge for health care practitioners, said Jan Towers, director of health policies for the American Academy of Nurse Practitioners in Washington, D.C.
Rosalie Chuberko, nurse at Gateway High School, recognizes the increased workload on nurses but is undaunted by it because she is confident she can do the job.
'I wouldn't care if I had 500 medications here,' she said.
Karen Zapf can be reached at kzapf@tribweb.com or (412) 380-8522.
