Supporting Delaware’s school nurses
Photos by Ashley Barnas October 30, 2023
Innovative partnership between UD’s College of Health Sciences and school nurses aims to address pediatric health inequities
As a school nurse in the Indian River School District, Stacy Robinson has applied her fair share of band-aids; she’s handed out ice packs and dealt with lice. But the scope of the school nurse is far greater.
In most Delaware schools, a single school nurse cares for hundreds, even thousands, of children. From medical emergencies to verifying immunization records and conducting state-mandated vision and hearing screenings, the school nurse plays a vital role in pediatric healthcare.
“We have a lot of difficulty accessing resources for our kids, and our population in southern Delaware is growing rapidly,” Robinson said. “Our kids deserve to see and eat comfortably and not have mouth pain and get treated for their illnesses in a timely manner.”
Access to healthcare has always been something Robinson struggled with as a school nurse. In her nine years as a school nurse, no one had ever asked Robinson what she needed.
“Being in Sussex County, we often feel like we have limited resources because we’re so rural and farther away from larger providers,” Robinson said. “Indian River is a huge school district, and we have needs unique to us, so we’re always looking for opportunities to advocate for ourselves.”
That is, until the University of Delaware College of Health Sciences stepped in. Lauren Covington, assistant professor in the School of Nursing, and Freda Patterson, professor and associate dean of research for CHS, were strategizing ways to increase access to healthcare services for pediatric populations, particularly in southern Delaware.
“Contacting school nurses was a great gateway to accessing children and their healthcare needs,” Covington said.
With support from UD’s Center of Biomedical Research Excellence (COBRE) in Cardiovascular Health, Covington and Patterson organized a dinner last March following CHS Research Day that served as an active listening session.
“It was an opportunity for school nurses to come together and talk about health priorities, the barriers they face in helping students, and their goals to improve pediatric health,” Covington said. “It was a really rich and vibrant discussion.”
Seventy-five nurses from up and down the state attended, and from there, an authentic community partnership was born.
“This truly marked the first time someone asked us, ‘What do you need?’ Every nurse in that room had their hand raised,” Robinson said. “And we left there feeling like someone heard what we had to say.”
Sanaz Taherzadeh, who’s pursuing her doctorate in nursing science, facilitated discussions at the dinner and continues to work with the school nurse partnership.
“I had never talked to a school nurse before,” Taherzadeh said. “As a nurse in a hospital, if I have more than 10 patients, I’m overwhelmed. They’re dealing with hundreds or thousands of children, so it was such an eye-opener.”
That’s a common misconception about school nurses.
“When I got into school nursing, people would say, ‘Oh, it’ll be a cakewalk. You get your summers off,’ recalled Heidi Hildick. “You’re constantly spinning. People don’t realize you’re the lone health expert and clinician in the building who must be prepared to manage anything that comes your way.”
Hildick, a UD alumna who graduated from the School of Nursing in 1996, has been a school nurse in the Colonial School District for more than 12 years and currently serves as the district’s lead nurse.
“We manage emergencies, sometimes, daily; we managed a pandemic,” Hildick said. “So it felt really good to have the University reach out, acknowledge us as health professionals, and ask how we could collaborate. It’s been a fantastic start to our partnership.”
From there, a working group of pediatric researchers within CHS and school nurses, including Robinson and Hildick, was created.
The group meets monthly and has worked to identify priorities they’ll work to address together, including access to healthcare, burnout, continued education and advocacy. The group recently published an editorial in the Journal of Advanced Nursing highlighting the impactful and organic community engagement effort.
“As an academic research partner, we have the skills to write and submit grants to try to get school nurses funding for their initiatives; we can help them write grants themselves and coach them on how to better communicate with the community and their administrators about their vital role in pediatric healthcare,” Covington said. “Next, we plan to draft a call to action on what they want to address in pediatric health.”
To increase access to care, UD is working to secure grant funding to expand HEALTH for All services so a mobile clinic can travel to schools to provide much-needed care services. HEALTH for All is a collaboration between UD’s Partnership for Healthy Communities (PHC), the Epidemiology Program and the Delaware Division of Public Health.
“We want to add pediatric-specific based care, including physical therapy, speech-language pathology, health coaching and mental health services,” said Jennifer Horney, interim director of PHC and founding director of the Epidemiology Program. “This would enable us to bring vital services we already offer on our STAR Campus to the community.”
On the continuing education front, UD hosted a professional development day for school nurses on Friday, Oct. 13, made possible through generous support from the Delaware-CTR ACCEL Program's Institutional Development Award from the National Institutes of Health. The professional development day centered around identifying top priorities to address pediatric health inequities and provided listening sessions on policy and politics in school nursing, workshops on grant writing and an opportunity for school nurses to put their skills to the test in state-of-the-art simulations on asthma exacerbations, diabetic emergencies and seizures — all topics school nurses said they wanted to see.
“Some of our nurses see seizures regularly while others may have had few experiences with seizures,” said Ann Covey, lead nurse for the Delaware Department of Education. “So it’s important to sharpen those skills that are so critical in life-or-death scenarios.”
Senior Associate Dean of the School of Nursing Elizabeth Speakman spoke at the event, emphasizing the importance of the school nurse.
“The school nurse is a true public health nurse, serving as the conduit between the school system and the healthcare system, and their work cannot be underestimated,” Speakman said. “The school nurse continues to be the broadest of nursing roles as they provide both primary and preventive care for our children on a daily basis.”
But in addition to fostering learning, School Nurse Professional Development Day also helped build camaraderie and a much-needed support network.
“Adequate staffing levels, access to necessary medical supplies and a collaborative network of healthcare professionals can greatly alleviate the stress on school nurses,” said Covey, who serves on the working group. “This partnership also gives our school nurses a voice, which is so important. We want our school nurses to feel encouraged and supported to become leaders, and UD has helped us do that, and it’s been invaluable.”
Robinson hopes the partnership continues to grow and flourish.
“I hope this is the first step in a long partnership that helps us gain more credibility and backing as school nurse professionals in the state,” Robinson said. “I want to see this evolve into an advocacy and assisted partnership that gets much-needed services to kids in our schools and increases pediatric health equity in the state.”
Hildick is proud to see her alma mater at the front and center of these important conversations.
“I am proud that my alma mater recognized the vital role school nurses play in the health and wellness of students and reached out to develop this collaboration,” Hildick said. “Students come into our office for so many reasons, and we are always ready to provide care and interventions. As a result, school nurses are often the first to know about a student’s physical or behavioral needs. The more we can work together to align and enhance services, the healthier our students will be.”