School nurse marathon

Sarah Griffith just returned home from running the Portland Marathon.

But, as only one of nine lead nurses in the 29,000-student Spokane Public Schools, every day is a marathon of sorts.

Griffith oversees the health care of students at five Spokane schools and at all of the district’s alternative programs, such as Crosswalk and MAP.

She shuttles back and forth between Holmes Elementary, where she has an office, and Bryant Center, Moran Prairie and Jefferson elementaries, as well as Ferris High School.

If she happens to be at a school when someone skins a knee on the playground, she’ll be the one to dry the tears and put on a bandage. Most often, though, that task falls to school office staff.

For most of her day, Griffith has more serious health concerns to deal with.

Does the child with severe asthma know how to use his inhaler? How is the student who had a grand mal seizure on a field trip doing? Does the girl who’s allergic to bee stings have an epinephrine shot at school, and does the staff know how to use it?

“Our job has evolved into a safety net for kids with chronic and severe conditions,” she says.

Long gone are the school days many adults remember, when there was always a smiling nurse waiting in the sick room with a cool compress and a soft pillow.

Currently the Spokane School District has about one full-time nurse for every 2,000 students (that includes the lead nurses and staff of 11 part-time nurses), according to health services coordinator Kathe Reed-McKay. All of the nurses travel to at least six schools.

In Coeur d’Alene, there are two full-time school nurses and four part-time ones for the district of about 9,800 students, says Cindy Perry, health-services director, who was recently named Idaho’s School Nurse of the Year.

Neither Washington nor Idaho has a law regulating nurse-student ratios. But the National Association of School Nurses recommends one nurse for every 750 students, almost three times less than the ratios in Spokane or Coeur d’Alene.

“If you have six buildings, you’re delegating too much,” says Wanda Miller, executive director of the nurses’ association. “The children in those buildings are not safe. That’s way too much to cover for any nurse.”

Much of the day-to-day health care for students has fallen to the office staff. They make sure kids take their medicine. They keep track of immunization records and are there when a sick child comes in to lie down.

“A nurse in every school could stay very busy,” Reed-McKay says. “We’re in a position of having to delegate.”

Follow Griffith for a day, and it becomes clear what a juggling act her job is.

Griffith is 45, a mom of two school-age boys who grew up in Elk. She’s fast-moving, smart and the kind of person with whom people want to stop and talk. (“This job is all about relationships,” she says.) She’s been a nurse more than 20 years, in cardiac rehabilitation, pediatric intensive care, even in the Peace Corps in West Africa.

For the past five years, she’s been a school nurse.

“You’re supposed to go by ‘Mrs. Griffith,’” she says. “But they always call me ‘Sarah.’ It feels much better when they call me ‘Sarah.’ “

She starts her day at Holmes, on Spokane’s near North Side, answering e-mails and phone calls. She is often interrupted by the ringing of her cell phone, a lilting cha-cha ditty.

She takes a first-grader out of class for a minute to teach him how to properly use his inhaler. It’s this one-on-one contact with kids that Griffith says she most enjoys, but her days of paperwork, phone calls and e-mails often leave little time for that.

Griffith spends about 90 minutes at Holmes before driving to Bryant. She needs to check on a student with autism who had a seizure at the end of last week.

She’ll also meet up with part-time nurse Jill Hunter to do a medication check, a task that must be completed three times a year at each of Griffith’s schools.

She and Hunter remove all of the student medications that are kept in a locked closet. They cross-check each drug – from Benadryl to Lithium to EpiPens – against a form filled out by each student’s family. They count every pill in every bottle to make sure all doses are accounted for.

They call the parents when they find an expired dose of asthma medication.

“It’s boring,” she says. “But it’s my job.”

Today’s check took less than an hour; sometimes it can eat up a couple of hours, Griffith says.

Around noon, Griffith heads back to Holmes to eat her sack lunch and answer more e-mail and phone calls. She’ll also do a quick blood-pressure check on one of the school aides who stops by.

By 12:45 p.m., she’s driving up the South Hill to Moran Prairie to visit a classroom where she spends much of her time. The half-dozen kids in the room suffer from multiple physical and mental disabilities. They are in wheelchairs, use feeding tubes and are not toilet-trained.

As Griffith walks into the office, she sees a little blonde-haired girl with blood on her shirt and a golf-ball-size goose egg on her temple, the result of a playground accident.

By the time Griffith arrived, the office staff had cleaned her up and calmed her down. She was reading quietly with a teacher on her prep period while waiting for her mom to show up.

“With that they didn’t really need me, even though it was a huge bump,” Griffith said.

The office staff would say later, though, that the bump looked so bad at first, they weren’t sure if they shouldn’t have called 911 and that they didn’t feel comfortable making the decision without a nurse present.

But Griffith is quick to point out that she can always be reached on her cell phone and that school staff should never hesitate to call 911.

“We’ve really taught our schools to use the EMS system,” she says. “If they think they need 911, call 911. Most school staff didn’t want to call in the cavalry at first.”

She had planned to head to Ferris to lead a medication-training session, but high school staff decided to reschedule.

Instead, she returns to Holmes to get back to e-mails and phone calls. She doesn’t have any parent meetings after school, so she’ll be able to make it to her son’s cross country meet.

Early on, she’d get frustrated at not having time to solve all of the problems kids bring to school with them. But now she has learned to focus on the school day and how she can help students be prepared to succeed while they’re in the building.

“We’re just looking at six hours,” she says. “I can’t cure their asthma. I can’t fix their family.”