The Relentless School Nurse: In Conversation with The White House

 

I had to read the title and content of the email several times before the request sank in. It said, “White House: Invite New Jersey Clinician Leaders Listening Session.”  

The White House Office of Public Engagement creates opportunities for practicing clinicians to engage with the White House and have a role in influencing the policy process by sharing their experiences as clinicians and advocates. Each of you was recommended by a colleague because of the work you have done for your communities as clinicians, as well as the work you put in to advocate for policies that promote health equity and access.

My response to the email swung wildly between “this must be a mistake” to “wow, what an opportunity.” Of course, I enthusiastically agreed to participate. It was a Zoom, so that made the logistics really easy. The agenda was very tight, 1 minute to introduce yourself, your affiliations, and advocacy work, and each participant was given 2-3 min to share their remarks based on the following prompt:

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Based on your experiences caring for patients and/or your work in the area of health equity, what is the most important message you would convey to the White House on equity-related issues impacting patients?

Here is how I introduced myself:

My name is Robin Cogan, I am a practicing school nurse in Camden, New Jersey where I have spent the past 21 years of my 37 career as a nurse. I represent the NJ State School Nurses Association as Director to the National Association of School Nurses. For the past decade, I have also been on faculty at Rutgers-University Camden Nursing in the school nurse specialty program that leads to an MSN in school nursing. My advocacy is school safety in all forms including preventing exposure to gun violence, teaching about Adverse Childhood Experiences, and supporting systems of care that are healing centered. I write a weekly blog called The Relentless School Nurse in an effort to amplify the voice of school nurses so that the community understands the scope of our role in efforts to advocate for safe staffing in schools to meet the increasingly complex needs of our students.

Here are my remarks to the prompt:

The presence of a school nurse in every building, every day democratizes healthcare for our most vulnerable and underserved students. Equity is dependent on eliminating barriers to care because health happens in the community. If a community is rooted in systems that create adverse community environments like exposure to violence, housing insecurities, food insecurities, and poverty, the ability of a child to learn and even to connect to a trusted individual is deeply impacted. 

Maslow before you Bloom is an educational tenent. Meaning unless we address basic health and safety needs, learning will be thwarted. Health and learning are inextricably linked and one does not happen without the other.

We want our children to flourish. And yes, children are resilient, but they need to be in caring environments where connections are nurtured and built over time. The presence of a school nurse is a protective factor. School nurses stand at the intersection of health and learning, home and school.  

But what happens to our 56 million students across the country when 25% of schools have no school nurse or 35% only have a part-time nurse. The 40% where there is a full-time school nurse, like my state of NJ, may have very high ratios, with one school nurse to hundreds and hundreds if not thousands of students. Remember we also care for staff and as an extension, family members and the community. 

For far too long school nurses have been a hidden healthcare system. COVID made it clear that school nurses are frontline healthcare workers tasked with keeping students and staff safe in school.

Let me finish by telling the story of one little girl, who left her home country of Guatemala, trekked miles and miles for more than a year with her mother, and siblings through treacherous terrain, and ended their journey in Camden, NJ. She entered preschool at 4 years old, having never been in school. She spoke an ancient Mayan dialect from her country of origin and was learning Spanish as a second language.

This little girl, at age 4, came to preschool every day, but she refused to eat both breakfast and lunch which were available to her. Instead, we found out that she was putting the food directly into her little pants pockets, filling her pockets with food to bring home to her mother and siblings. She felt so responsible for the health and well-being of her family at the tender age of 4. This is school nursing in the year 2022. This story repeats itself in health offices across the country. 

The good news is that we were able to identify the issue, support the family by creating a food pantry that was delivered to their house, and link them to community services immediately. Care Coordination is one of the pillars of school nursing practice. School nurses are well positioned to work with students and families in their neighborhoods and homes because health happens in the community and school is at the heart of the community, but we have to be present to make a difference. 

The response to my remarks by the moderator of the panel was “Wow, you really gave us something to think about in terms of the need for school nurses in every building.” I think the story that I shared about the little girl who stuffed her school breakfast and lunch in her pockets to bring home to her family was an important reminder of the work we do. We should take the opportunity at any chance to give “one-the-ground” examples of school nursing practice to those who function at 20,000 feet above ground level. It was a memorable experience and I hope that there will be more and that my contribution to the discussion opens eyes and minds about the urgency for school nurses in every school.