Lisa Marlow is worried about her students. Marlow is a school nurse and educator with the Murphysboro Community Unit School District 186.
The district serves primarily low-income students in a rural part of southern Illinois.
When school is in session, Marlow says having eyes on students, especially those with chronic conditions like Type 1 diabetes or asthma, is crucial.
“The biggest reason why it's a huge part of our job is because people don't get to access health care anywhere else, or won't or don't have the means to. I have high school students who don't have insurance,” Marlow says.
Schools in Illinois are closed through the end of the current school year due to the COVID-19 pandemic, and students may be missing out on more than just face-to-face time with teachers. They also might be missing an important link in their access to health care: school nurses. Without daily access to students, school nurses like Marlow fear that warning signs of illness or abuse may go unnoticed.
Juanita Gryfinski, presidents of the Illinois Association of School Nurses, says she typically sees about 80 students on an average school day. Gryfinski works as a school nurse in St. Charles Community Unit School District 303 in Chicago’s western suburbs.
“So those are 80 children walking in and out of our offices. And, for most of them, we are the eyes on between physician visits, which may or may not occur every year even,” Gryfinski says. “When a child comes to your office, you’re not just looking at what maybe they’re saying is going on, but you’re also looking at all the subtle signs that tell us what else is going on. So that part has obviously gone away right now.”
Gryfinski says most school nurses aren’t legally able to conduct telehealth visits, the go-to workaround for most health care providers during the pandemic. Illinois law dictates that unless a school nurse is working under the license of a physician, they’re unable to conduct telehealth services. Gryfinski says some states are looking at how policies can be changed to ensure school-based health care providers can also use telehealth services to provide physical and mental health services to students.
In the meantime, Gryfinski says school nurses across the state are still checking in with students using a variety of mediums.
Marlow, the school nurse from Murphysboro, says she’s calling families to check on her students.
Marlow works the lunch route now, driving around Murphysboro to provide meals to students and their families who need them. She says she’s used this opportunity as a way to get eyes on her students. Recently, Marlow spotted a middle school student she knows who struggles to keep his diabetes in check.
“I said, ‘Hey, how are you doing?’ And he had this kind of cast to his skin. It was kind of a grayish cast to the skin that I've seen before when he was not well controlled, when he was sick,” she says.
Marlow says he didn’t want to talk to her, so she called his mom. She says his mom told her he was fine. But Marlow says she worries parents might miss something that she’d pick up on.
‘Important and essential’
That’s something parent Rebekah Strate agrees with. Strate, who lives outside Jacksonville in a rural part of central Illinois, has three children — all with complex medical needs.
She says school nurses “are important and are essential in my kids’ lives.”
Strate adopted her children from the foster care system. She says two of her children have tracheostomies and feeding tubes because they suffer from severe lung disease. Typically, she says, those children go to school accompanied by nurses that stay with them throughout the school day.
“They do classroom activities with them under the teacher’s guidance, but they also check their vitals and feed them because they don't eat like regular kids,” Strate says. Now that schools are closed, she says her children aren’t seeing their one-on-one nurses. Those duties have fallen on Strate.
Her third child, JaRyiah, 11, has a severe form of asthma. She doesn’t need a one-on-one nurse at school like her siblings, but she does interact with her school nurse on a daily basis.
“She will check her vitals. She'll listen to her heart and stuff like that, which is very important for a child with asthma. And so with us being home, she doesn't get that,” Strate says.
Strate says she takes notes from all the nurses her children see at school and gives them to their multitude of doctors — none of whom they’re seeing right now because of the COVID-19 pandemic.
Dr. Sanjay Bansal values that kind of insight from school nurses. Dr. Bansal treats children with diabetes at the Loyola University Medical Center near Chicago.
“The school nurses are a huge part of giving us information that we just don't see in the clinic. They're telling us what's happening in the child's daily life. And sometimes some of our patients who really struggle with their diabetes control, the school nurse often is the one who's kind of alerting us that there's something happening that needs to be attended to and sometimes even the parents don't get in touch with us in time.”
Now that schools are closed and that interaction between school nurses and students has stopped, Dr. Bansal says he’s particularly concerned about children with poor parental supervision.
“That's where I think it matters the most,” he says.
Strate also worries about that population of children. Before she adopted her daughter, JaRyiah, a school nurse was the one who alerted authorities that she wasn’t being properly cared for. At the time, JaRyiah attended school in Murphysboro, and Marlow, the nurse there remembers her. She says her colleague, another nurse, called the Illinois Department of Children and Family Services because she believed JaRyiah was being neglected.
Later, Strate says her daughter was found unresponsive in her home.
“She was a latchkey kid, you know, she came home from school, there were no parents at home and she had an asthma attack,” she says. “And she was found by a friend that came over to her house to visit her while she was home by herself at eight years old.”
Strate says JaRyiah was in a coma for two months and in a hospital for four months.
“That (school) nurse is very important to these kids. So I worry about that population myself.”
Strate says her daughter fears that something like that could happen to her again. She says she finds comfort in the daily checkups provided by her school nurse.
“So for our daughter, it’s scary for her to think that she’s not being checked on medically,” Strate says. “It causes anxiety and everything going on is causing more anxiety.”
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