School nurses in trenches of flu warfare

He shuffles into the health clinic, a note clutched in his hand.

“Doesn't feel well,” it reads.

Diane Rehak takes the note and the student's temperature. It's slightly higher than 100 degrees. Time to call Mom or Dad; he's going home.

“Sometimes you just know when they aren't well. You don't even need to take their temperature,” said Rehak, school nurse for Grant Wood, Harrison and Viola Gibson elementary schools.

From playground accidents to upset stomachs, Rehak's goal is to keep students healthy - something that has been difficult this year for school nurses across Eastern Iowa because of the H1N1 flu virus.

Schools have reported higher numbers of student absences because of H1N1, commonly called swine flu.

“Usually, the school year starts slow, kids trickle in (to the clinic),” said Christine Baxter, Viola Gibson's health secretary.

When flu season hits, anywhere from 40 to 50 students will visit Viola Gibson's health clinic on a given day.

There wasn't a gradual increase this year, though.

“It was at 40 to 50 kids right away,” Baxter said.

The Cedar Rapids district had 14 schools each report more than 10 percent of the student body absent during the week of Oct. 19 - the district's peak time for illnesses related to H1N1. The numbers have since declined.

“It's been a week since we had a school with 10 percent of its students out,” Sally Immerfall, the district's health services facilitator, said Monday.

While the first wave has passed, school nurses and health secretaries - full-time employees who work in the school health clinics - won't ease their focus on prevention.

“Just because we've gotten through one wave doesn't mean it's going to go away,” Immerfall said.

Flu seasons are unpredictable, the timing uncertain. H1N1 concerns aside, schools also need to gear up for the regular flu season. Seasonal flu activity typically does not reach its peak in the United States until January or February.

The district launched an H1N1 informational task force last month to share information with district staff, students and parents. Posters throughout schools emphasize healthy habits. Sick students sent home from school leave with an informational brochure.

A list of frequently asked questions is maintained and updated, as needed, by the task force on the district's Web site. School nurses also promote communication with students and parents.

“Parents need to know that they can call if they have any questions,” Rehak said. “We rely on the parents to help us by providing good hygiene, prompt response if their child is ill and keeping sick students as home until they can return.”

The district employs 17 school nurses, but not all are full-time. Each nurse oversees several schools throughout the district. There is a health secretary for every school in the Cedar Rapids district.

The Iowa City school district employs a director of health services and six full-time school nurses who provide nursing coverage to all buildings and off-site programs. Building secretaries and health paraeducators administer medications and provide first-aid to students when nurses aren't in the building.

The paraeducators provide direct care to students with more severe health conditions and physical limitations, but the district doesn't have a health paraeducator for every school building.

Like Cedar Rapids, Iowa City schools stress prevention regarding H1N1 and seasonal flu.