Dr. Sharon Guthrie is the Director of Graduate Nursing Programs and Associate Professor at Mount Mercy University in Cedar Rapids. She worked as a school nurse for 8 years at Xavier High School and has led the Iowa School Nurse Organization since 2008, working to pass state legislation that supports student health. But some of those gains are now in jeopardy as SF438—a bill that would fundamentally change how student health screenings are reported to the state—gains traction at the capitol. The Center's Stephen Dykstra spoke with Dr. Guthrie earlier this week to get her take on the bill and its potential harm to Iowa students.
Do you see the role by schools and school nurses to report health data as an administrative burden?
This whole part of processing and reporting screening results is just a small part of what a school nurse does every day. I think people are blowing this out of proportion a little bit in terms of what the administration has to do—the school nurses are currently the people who do the majority of work around data reporting. Here's the other concern—I don't think anyone has actually talked to a school nurse in order to get that perspective. And public hearings on this issue are scheduled during the day when nurses are unable to leave school and attend. So, I think an important voice is missing from the conversation.
How do schools currently collect and report data? What would this change if SF438 is implemented?
Families are informed through pre-registration materials handed out by school districts, including what's required and so on. Typically, parents will return completed health forms to the school nurse who then creates a file for each kid. For those who fail to turn in the forms, the school nurse can easily and quickly identify them and follow up. In this scenario a parent might inform the nurse they are unable to afford screening services. And even though this is purely hypothetical, consider that nobody wants to be honest about that with a school administrator. Instead, they are much more likely to communicate that to the nurse, who then becomes a key resource for that family. On the flipside, this current bill would require providers—not the school—to submit data. But here's the problem: there are multiple data systems used to report health (i.e. dental, vision) data, and they don't often 'talk' to each other very well. Likewise, providers don't always screen for the same thing in students and many risk submitting insufficient data. All of this creates a gap between what should be and what actually is reported.
Are there benefits to leaving the reporting responsibility with school nurses?
Keeping the data collection and reporting local in the school district is important because that is where assistance is going to come from. And as a school nurse, if I don't have that data easily accessible it's only going to prolong the process of getting students the help they need. Gathering and accessing the data locally is very important to providing timely and helpful resources to parents and students.
This bill has elevated the conversation around the important role school nurses play in our schools. What are ways we can help nurses better serve students?
First, implement the recommendations regarding student health screenings we outlined in the SF475 work group I was a part of last year. The legislature requested those recommendations, and I think there are a lot of great ideas for improvement that can be done without this harmful bill. Also, I hope people will take the time to learn about the role school nurses play in student health. This is not about putting on Band-Aids and handing out ice packs—school nurses do so much more. We help kids find enough food to get them through the weekend; we organize food drives, make sure students have warm clothing during the winter months and provide an immense amount of mental health support. I think if people start to recognize the actual role school nurses play in their communities, they'll realize it makes no sense to remove them from data reporting process.
What's the link between child health and learning? Why is student health so imperative?
We all know as adults if we don't feel well, we certainly don't perform as well at work—we're not as productive. The same is true for students. If a kid comes to school not feeling well or didn't get enough sleep, they're not going to learn as well. If I'm a student who's worried because my parents got in a fight last night, my mind is going to be focused on that instead of what the teacher is presenting in class. This is the harsh reality for many of our kids in Iowa. Here's another thought—if I'm a parent with a sick student but if the school nurse is busy running around between multiple buildings and can't see my kid that day, I'm forced to keep my kid home from school. And we know student learning is hurt when kids miss days of school. Attendance improves drastically when there's a health care provider present at the school building.
Any parting thoughts for fellow advocates and concerned Iowans?
I'd encourage Iowans to avoid making assumptions about how health care works in schools. Reach out and make a connection with a school nurse—ask them about their day. What are their challenges? Another point is that policy should be based on evidence and facts. As a health care provider, I need to practice with evidence-based methods. We should expect the same from our policymakers—they should provide evidence that serves as a basis for their policies. Finally, I'd stress the importance of not making assumptions about students and the circumstances they face. In an ideal world all students would be healthy, but that's simply not a fact of life. So just because my kid doesn't have specific problems doesn't mean others aren't facing challenges of their own. Until you put yourself in their shoes, you don't realize how challenging it can be.