She doesn’t wear white. And she doesn’t back off if she thinks a student’s health is at risk.
Meet school nurse Colette McGeough, who wears sandals instead of sturdy white shoes as she strides briskly through Montgomery High School in Santa Rosa. “Am I going too fast for you?” she asks in a lilting Irish accent. “I walk quickly when I’m putting out fires.”
There are many fires to put out when you are responsible for the well-being of 6,500 students. That is McGeough’s caseload — the Santa Rosa City School District has 30 schools, 16,500 students and 2.8 school nurse positions. It is sometimes overwhelming, she confides.
The recommended school nurse to student ratio is 1 nurse to 750 students — and 1 nurse to 125-225 students with health problems, according to the National Association of School Nurses.
In her jurisdiction are 2,700 students with asthma, 40 students with Type 1 diabetes requiring insulin at school, 102 students with seizures, 100 students with heart conditions, 50 students with life-threatening allergies, and a large special education student population with many requiring daily medical procedures, emergency care plans and staff training.
She performs vision, hearing and scoliosis screening, attends Individualized Education Program (IEP) meetings for students with special needs, case-manages and evaluates health treatment plans, links families and students to community resources, and assists with medical insurance applications. She is often the first line of defense for students lacking medical insurance.
She saves students’ lives by connecting them to health care providers and requesting that certain diagnostic tests be performed. One student whose recurrent fainting spells were blamed on heatstroke was diagnosed with a heart condition after McGeough wrote to the girl’s doctor requesting certain cardiac tests. Another student with severe stomach pains was found to have a rare and sometimes fatal disease after McGeough asked the girl’s parents and doctor to re-evaluate. While school nurses save lives, they are an endangered species. California is 45th in the nation for student-to-nurse ratio, with just 3,000 school nurses serving 6.3 million public school children.
McGeough has worked in hospital emergency rooms and intensive care units, but she loves being a school nurse best of all. She drives 90 minutes each way to work, but says it’s worth it.
“It’s amazing what you can see and achieve in a day,” says the Santa Rosa Teachers Association member. “It’s a wonderful job where you can make such a difference in a student’s life.”
Indeed, a typical day in the life of a school nurse is hectic, unpredictable and rewarding.
Montgomery High School
A student has been burned on her arm by a chemical in science lab. She is holding back tears. “Let’s call your mom,” says McGeough reassuringly, after making sure the arm has been rinsed in water. She calls the parent to explain the injury and asks the parent to call the doctor for follow-up. The parent agrees to make the call immediately; the student returns to class until her parent arrives.
A boy comes in with a bleeding hand. He and his friend were horsing around and the friend punched him with his ring. McGeough demonstrates to her health technician how to treat and bandage the small wound. “Should we bandage the other hand so you’ll have a matching set?” she asks the student, who laughs and momentarily forgets his discomfort.
A student with Type 1 diabetes checks in to determine whether she has a handle on controlling her blood sugar and insulin. The girl says she checks her blood sugar before lunch and before a snack; then she shows McGeough her fruit snacks and carbohydrates, needles for checking blood sugar, and insulin pump. McGeough tells the girl she is “astute” at managing her disease and asks if she can use her as a role model with other diabetic students. McGeough promises to generate a care plan to follow at school. She then reviews doctor’s orders and emergency glucagon use with the health technician should the student lose consciousness and be unable to inject herself.
She visits special education teacher Margaret Buhn, whom she recently trained to administer Diastat rectally for students with a seizure disorder. The Board of Registered Nursing maintains that only school nurses should administer the drug. However, last year the governor signed SB 161, a bill that allows school employee volunteers to administer the drug with training from a registered nurse. “We administered Diastat last Thursday behind a curtain and it went smoothly,” reports Buhn, an SRTA member. “We’re going to need to do it often, because another student with seizures joined the class.”
McGeough confers with special education teachers and classified employees about a student who has become aggressive with ADHD medication. The teacher says the student used to sleep during class time and is angry that he is not allowed to sleep anymore. McGeough asks the teacher to document the change in behavior so it can be presented for medication evaluation. She promises to contact the parents and doctor with the information so they will be aware of the effects the medication has on the student.
A student with special needs runs after McGeough and gives her a hug. “She is a wonderful nurse,” the girl says. “The first time I ever hurt my kneecap, she was there for me. There was a lot of pain. Nurse Colette is the best. I want her to be in my wedding.” “They love me here,” McGeough says after the girl returns to class. “They know I support them and that when I get a case, I never let go of it until it is resolved. I will talk to their parents. I will talk to their doctor. I will do follow-up. I will call an interpreter. I will link them to resources if they don’t have a primary care provider. Students know that they can count on me.”
An undisclosed school site
A teacher requests a child’s skin condition be evaluated. There are numerous abrasions covering the student’s arms and legs. McGeough privately assesses the student's condition and finds multiple lesions, most of them scabbed over. She is worried there is a staph infection, which could be dangerous and contagious. She informs the teacher that the child must be sent home until the wounds are evaluated by a doctor and possibly cultured. A few of the wounds are “suspicious,” she says, so the doctor will perform an overall assessment for skin infection and safety issues.
A student’s TB test is positive. The student says she had a chest X-ray and spoke with her doctor, who promised to send the school a note stating she does not have TB. McGeough checks to see if documentation was received. It was not, so the nurse writes an “exclusion notice” stating that the student can only return to school with a doctor’s note. The girl is dismayed, but agrees to go home and return to the clinic for the clearance note.
Nueva Vista High School
McGeough visits the infant toddler program because staff asked her to check on a 2-year-old with a seizure disorder. The school has day care for babies while moms attend class. The baby’s mother would like to go on a field trip with her classmates, but McGeough instructs the staff that only the parent may administer Diastat, according to doctor’s orders, so options will need to be explored for the baby if “Mum” goes on the field trip.
McGeough meets with teen moms to ensure all baby immunizations are on schedule. “What about you?” she asks one of the mothers. “Do you have health insurance?” “No,” says the girl. “Just my baby.” “I’ll link you up to some insurance so that you can be healthy, too,” says the school nurse. “It’s important for you to stay healthy so that you can take care of your baby.”
Montgomery High School
It’s time for an IEP meeting. Afterward, she will schedule staff trainings, make numerous calls to parents, doctors and the Public Health Department. Before she leaves, McGeough will find health insurance and dental insurance for students and their families, as needed. “I am passionate about my students’ health and safety. I will do everything I can. I hope it is enough.”