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Cyldine Fey is the school nurse at Agassiz Middle School in Fargo, North Dakota. Fey sits at her desk and reviews the previous day's caseload.
"I saw about 18 students with headaches and stomachaches," says Fey. "Three of them came in specifically with complaints of their throat hurting. Three had ear problems."
Typically Fey sees about 45 students a day. She treats a wide range of cases -- everything from the flu to pink eye. She's excited that Agassiz is part of the Model School Nurse Program. Three school districts in eastern North Dakota will use a $1 million grant from the Dakota Medical Foundation to pay for nurses.
"A healthy child learns better," says Fey. "In today's society when we talk about healthy, there's physical health, there's mental health, spiritual health -- all those types of things."
Agassiz principal Brad Larson heads to the hallway as students change classes. Larson says having a school nurse in the building is great.
It allows teachers to teach, instead of having to be health care providers. Larson says for many of the 1,100 students, nurse Fey is the only access to health care they have.
"Some of the families that we have ... are coming from a home that doesn't have the health coverage that others might have," says Larson. "Mrs. Fey has the opportunity to work with these kids, and also to make referrals on where they might get better help."
That kind of help is optional in North Dakota, because most schools don't have a nurse on staff. School officials have made that decision in tight budget times. At Agassiz Middle School they've found the money for a school nurse. And now that will be the case in Fargo's public and Catholic schools.
Both districts will work with Fargo Cass Public Health to pay for 15 nurses to serve 26 schools. The Grand Forks school district will use its share of the grant to pay for five nurses. Three of those will be new hires.
Nancy Leith, nursing manager for Fargo Cass Public Health, says part of the money will be used for equipment and training. Leith says getting nurses into the schools means teachers won't have to be nurses.
"Their focus is obviously (on) education, so their focus has never been, 'this kid doesn't have a health problem, he has a learning problem,' not always realizing that the learning problem could be because of a health problem," says Leith. "If the kid is in school more he might learn better. So if he doesn't go home supposedly sick, if the nurse assess(es) him and he can stay, he'll do better in school."
One problem is, in North Dakota, there's never been a study evaulating school nurses. Mary Kay Herrmann, director of Fargo Cass Public Health, says that's a critical element of the Model School Nurse Program. Each year an outside consultant will review the effectiveness of school nurses. Herrmann says the evaluation process is critical in developing a data base.
"Do we provide access to health care? Do we get more kids into doctors and help them find a medical home if they don't have one?" says Herrmann. "Then we'll be looking at absenteeism. We tend to see students stay in school when the nurse is there. They aren't sent home as easily."
Herrmann says students do better in schools with a nurse on staff. But the important thing is having the facts on paper, to help convince the public school nurses are a good investment.