Abstract
Children and youth today face problems that many of us never dreamed of in our worst nightmares. All too often, their dreams are shattered and their futures are compromised because they lack the refuge and guidance of adults. In the busyness of the moment and our focus on other matters, it is so easy to ignore the children.
WHAT ABOUT THE CHILDREN?
In the United States today, 17% of children live in poverty; 12% are born to teenage moms; over 19 million of them live in a household where no parent has a full-time job; over 10 million have no health care insurance (Anne E. Casey Foundation, 2001); up to three quarters of their deaths are from preventable injuries (ChildStats.gov, 2001); sadly, 8% attempt suicide; 17% will carry a weapon to school (Centers for Disease Control and Prevention, 2001); and over 900,000 of them will be victims of child abuse this year (Anne E. Casey Foundation, 2001). These statistics are startling. These statistics are saddening. Yet research tells us that the presence of a caring adult can help children to pass safely through childhood and the gauntlet of adolescence. Surely we can remember the adults in our lives who gave us a good word, a pat on the back, or a helping hand. Without those people in our lives, where would we be today?
What about the children? We know about them and their many needs. We spend our days caring for them and our nights praying for them. We dedicate our profession to their health, but do we stop to consider who they really are and how they will navigate their futures? Would it be possible for us to form a partnership with children to ensure their safe passage into adulthood? I believe our children need partners.
PARTNERS WITH CHILDREN
Do you find this phrase incongruous? After all, partnerships are serious business. Partners support one another, trust one another. Partners are usually of equal strength. As school nurses, we are comfortable reaching out a helping hand, a holding hand, a firm hand. Can we trust children enough to reach out a hand of partnership?
Parents bring to school their most valuable treasures—their children. We examine and assess these treasures and identify all their risk factors. We soon learn that it’s not a few children at risk, but all children. But what if we stopped labeling them “children at risk” and called them “children at promise,” as Michael Carrera (personal communication, March 2, 2001) does? Every day of the school year, young people leave their homes and enter a world that has the potential to change who they are, what they believe, and how they will lead the rest of their lives. They encounter people who will scar them or nurture them. Each child is like a blank slate upon which everyone they encounter leaves a mark. What are the scribbles, words, and pictures we make on their slates? We must never underestimate the impact a school or a school nurse can have on a child.
Who are these children at promise? They are more than the facts and figures we recite from memory. They are more than the classifications we give them by gender, ethnicity, religion, or the clothes they wear. They are more than the risk factors we use to predict their future. Neither diseases nor needs are fair descriptors of the children we care for. Our students, the ones at promise, are Kim, Tisha, Tyrone, and Juan. They are individuals with hopes, talents, and needs unique to them.
School nurses are strong advocates for children and their health issues. We will go the extra mile for them. We’ll march to the hill for them. But sometimes I wonder if we truly represent them. What I mean is this: When is the last time we asked children what they want, what they need?
Let me share with you an example. Consider Maria, who is a 10-year-old girl with obesity and type 2 diabetes. If Maria entered our school today, what would be our first desired intervention? Dietary control. What would be our desired outcome? No weight gain. But what about Maria? We came to a conclusion about Maria’s needs without even knowing her. It may be that weight loss wouldn’t even make a Top 10 Priority List for Maria. In all our well-meaning actions, we may never learn that Maria yearns for a friend to sit with her at lunch, for a mother to stay sober on weekends, for a brother to return home from prison, and for relief from her fear of dying from asthma. When we make well-meaning assumptions, when we follow the statistics and the risk factors about a young person’s health without including him or her as a partner in care, we break trust with the very person we want so desperately to help. How well do we know these children? How well do we respect them as individuals?
It is time for us to allow children to become full partners in their health care. School nurses are role models in schools and communities. We are trusted individuals. So, if actions speak louder than words, what are we saying about relationships with children? When was the last time we invited a young person to participate in setting goals for his Individualized Health Care Plan or to provide input into her Individual Education Plan? When was the last time we taught a child to speak at a school board meeting? It is time to affirm the value of the child as a full partner.
Why do adults believe they hold the corner on truth? Isn’t it out of the mouths of babes that we often learn the real truth? Over the past months, I have been reading poetry written by children. When I was asked by a friend, “Why are you reading that stuff?” I explained, “I want to learn what kids have to say about life.” My friend responded, “I think it’s okay to advocate for kids and all that, but listening to them is another thing. They’re just children. They don’t have much life experience. What can they say that would be insightful?”
I can tell you that I have learned much from the verses of children. They speak sincerely and eloquently of who they are and their dreams for the future. They ask us to look closely at who they are as individuals. Their thoughts are precious; their thoughts are insightful. They see the world as we will never see it again. One of my favorite children’s books is The Polar Express (Van Allsburg, 1985). I’m sure my son, Kurt, can recite it word for word, as I insist on reading it every December. For those of you who don’t know the story, it speaks to the magic and mystery of childhood and believing. It reminds us that when we were children we could truly hear Santa’s sleigh bells, but as adults we have become deaf to the sound.
Like you, I’m sure, I can think of countless days when nothing was going right at school. Then into my office would come some child who would give me a muddy hug or hand me a wilted flower, and suddenly my day would brighten. There is a saying, “The soul is healed by being with children.” Isn’t this a good beginning for a partnership?
We have much to learn from our partners. Leo Frangiopane (1998) tells the wonderful story of children at a Special Olympics game. These children weren’t as bright as you and I—they had Down syndrome. They came to the Special Olympics to compete in a race. So, they lined up on the blocks. When the starter went off, they all started running toward the finish line—except for one. One little girl tripped and fell. Now these children weren’t as bright as you and I, because when this girl fell, the others didn’t keep on running. Instead they went back, helped her to her feet, made sure she was okay, and then they all took off running again. Now I ask you, who is wise among us? Which one of us will bring wisdom to our partnership?
Children are unique in our society. I believe they may be the last minority within the United States that has no voice and no rights. We are so busy protecting, educating, and controlling them for their own good that we trample on their rights. Society has constructed laws and rules with double standards. In our good intentions to protect our young people, we sometimes punish them far more severely than adults with the same offenses. How can we justify state laws that criminalize adolescent behavior that is acceptable in adults? These children have no voice.
School nurses are strong advocates. Yet I believe stronger advocacy will occur when we help children to speak for themselves. It is time to give more than voice to our advocacy. We need to stop speaking at children and start listening. It is time for school nurses to reach out a hand in partnership.
In an article in Pediatric Nursing, Karlene Kerfoot (2000) made an interesting observation about health care. She wrote, “Health care has been very responsive to customerizing the health care experience of birthing a baby. Parents now come to the hospital to deliver in ‘suites’ that look like they belong in a home and not in a hospital” (p. 218). She goes on to describe this personalized experience, then notes that elsewhere in patient care, we have not “customerized” our care. Humanizing the birthing process allows families to have ownership and control. What about the school setting? For whom do we design our offices, our practice? For our administrators? For ourselves? What about the children? It is so easy to ignore them.
Several years ago my district was building two new elementary schools. I was designated to move into one of the new schools, and I was quite offended when I wasn’t asked about the design of my new office. Imagine that! Administrators and architects designed my office. I was incensed! But was I incensed that no one consulted with the students about their playground? Their cafeteria? When was the last time we asked a child about his or her medication regime? Would Lee rather miss part of recess or part of lunch to do a treatment? When was the last time we asked children before we spoke for them?
Florence Nightingale based our nursing practice on the needs of patients. Do school nurses continue in the pathway envisioned by our founder, or have we lost the child’s perspective in exchange for efficiency? Our fundamental goal is to help a child achieve optimum health so he or she can meet with success in the classroom setting. But how does the individual child measure his or her success? Have we expanded our school nursing knowledge to the point that we ignore the wisdom of a child? It is time to get back to the essence of our practice and move forward with children in hand—as partners.
School nurses know the importance of being culturally sensitive and the value of diversity. I’d like to ask you to consider some new cultures—the cultures of children. Consider the culture of the 3-year-old. In this culture, routine is highly valued, finger foods are diet essentials, and going to bed without being tucked in leads to nightmares. What about sensitivity to the 10-year-old’s culture? In this culture, it is believed that adults are wise; that pizza is good for breakfast, lunch, and dinner; and that life without recess is not worth living. Or consider the culture of the adolescent—a culture we have all lived in but have little desire to return to. Members of this culture accommodate to hourly hormonal changes, question the wisdom of adults but accept the word of peers, and believe that they are invincible. Each of these cultures includes children with unique gifts and talents, needs and challenges. They are the future. They need a partner who will respect them and help them navigate the path to adulthood. They are not a vessel that needs to be filled, but a candle to be lit.
I believe that school nurses can be the best partners in the world. We are the “tender heart in the school” (Jean Norman, personal communication, August 19, 1999). We know, like Betty Bender, that “when people go to work, they shouldn’t have to leave their hearts at home” (Center for Digital Government, 2001). Yet we struggle with articulating our value to others. We allow ourselves to become so submerged in the field of education that we lose our identity as nurses. Then, because of our humility, not our inadequacy, we allow our jobs to be lost when our communities balance budgets by cutting nurses.
It is time for school nurses to partner with children and attempt to achieve impossible things. NASN’s position is that school nurses should be available at a ratio of 1 for every 750 children, but I believe it’s time to say that Every Child in Every School Deserves a School Nurse. This is a basic right for all children. Why should a child with asthma be denied gym class because there is no school nurse on campus to monitor her? Why should a child whose grandmother is ill with cancer withdraw emotionally from school activities because there is no school nurse to talk with him? Why should a young person with an eating disorder not be detected because a school nurse is not available for height and weight screening? These scenarios are just plain wrong.
I keep this saying on my desk: “Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference” (Anonymous). Well, I know the difference, and I know we cannot continue to accept school practices that are unhealthy for children. As their partners, we can do better. Every Child Deserves a School Nurse.
I’ll tell you why. Do you really know how important you are in the life of a child? I’ll be honest. I didn’t really get it until I moved into an administrative position a couple of years ago. During my first year, I visited a school nurse in a high school. It quickly became obvious that we weren’t going to get much time to talk, even though she had scheduled me for her planning period. In came the flood of students. You know the scene—a child who needs to go home, and you’re calling every phone number in the directory; a child who needs an excuse from gym, and you’re trying to get a case history, and so forth, and so on. In came a young man of about 17. The nurse said with concern, “John, are you late again? You know the principal is going to have to contact the truant officer pretty soon.” “Yeah, I know,” he said. “Look, can you help me with these splinters in my hand? They’re not bad, but they’re really bothering me.” All across the lateral aspect of his hand were tiny splinters. Since I was interested in speeding up the process of emptying out the office, I offered to help. So he washed his hands while I reviewed the nurse’s protocols. Then I sat down and took his hand in mine. It’s a painstaking job to remove tiny splinters. It is also a task that school nurses perform every day. Have you ever considered how intimate a task it is? I sat beside, not over, John and held his hand. Our faces were no more than two feet apart. Then he told me, “This was really a stupid thing to do this morning. I was hurrying out of the house, and I stupidly ran my hand down the wooden railing. It was really stupid. See, my mom has been real sick, but she’s getting better. She goes over to Johns Hopkins for chemotherapy, and she’s doing real good. I try to help her out, but my brother’s been sick, too.” Slowly, one by one, I pulled the splinters out. Slowly, word by word, he told me his story—without the prompt of my voice, but with the support of his hand in mine.
PARTNERS—THE PRIVILEGE OF TOUCH
We are some of the only adults left in children’s lives who are allowed to touch them. I mean physically touch them. We all know the healing power, the connecting power of touch. It is our gift, and every child deserves it. Health and education go hand in hand. School nurses and children need to go hand in hand. Together we can accomplish great things, because hidden inside of you, inside of me, and inside of every child there is a hero.
School nurses and NASN have a long history of growing and changing in order to meet the needs of children. As school nurses, we have the opportunity now to go back to our communities to build partnerships with children. At NASN, we continue to change, and that is good. But we must never lose sight of what is really important, the reason we come together—the children. We must take any opportunity to open doors for children to be heard. This is my dream. This is my promise to you and our children. As Sitting Bull once said, “Let us put our heads together and see what life we can make for our children” (Stories and Language, 2001).
Like the legendary Phoenix of this beautiful city we are visiting, it is time to rise up in compassion, in dedication, in caring. What about the children? I know they are in the best, the most wise, and the most caring hands in the world—the hands of heroes, the hands of school nurses.