School nurse describes her expanding role

After Central High School teacher Lenny Fiorentino noticed a bruise on junior Willie Gray’s head last year, Gray reported that he’d hit his head on a concrete floor over the weekend while he was horsing around with his cousin. Fiorentino noticed that Gray was answering questions slowly, and recognized the possible signs of a concussion.

Fiorentino notified the school nurse, Lesley Rothschild, who went to the classroom and escorted Gray to her office. He told her that the headache wasn’t going away, but that his mother was aware of the injury and that he was going to see a doctor soon. Rothschild examined the bruise, noted that Gray’s left pupil was constricted and called his mother. She said she had not been told about his injury and spoke to her son briefly. She told Rothschild she would take Willie to a private physician after school.

Gray was hospitalized overnight and sent back to school the next day, with instructions to refrain from physical education or contact sports for two weeks. That was the last day before spring recess. Over the break, his symptoms returned, and he was hospitalized again. He underwent emergency surgery to relieve pressure on his brain, but his condition declined after the operation. He was put on a ventilator and transferred to the Intensive Care Unit for another surgery, in which a shunt was implanted to relieve the swelling, which it did. It took Gray three days to start breathing on his own again, and he was discharged the following week.

“She has really been a source of inspiration to me,” Gray’s mother, Orlette Sancho, said of Rothschild, adding that she lost “all sense of reality” as her son lay hooked up to machines. “She was a companion to me through a very difficult ordeal.”

She said Rothschild called her daily to check on her son’s status, Sancho said, and Rothschild explained things to her that the doctors didn’t.

The surgery saved Gray from permanent damage or death, but it was a frighteningly close call. Those can be the stakes in any student’s case, Rothschild said, and being prepared to recognize vital warning signs and to treat a wide variety of symptoms and conditions is important for someone in her position.

Rothschild, who has been at the school for five years, is studying at the Advanced Practice Nursing Program in Psychiatric/Mental Health at Stony Brook University, from which she expects to graduate in 2018. Most of her classmates are family practitioners in private practice, but she believes that having a registered nurse practitioner in the school who is trained in cognitive medicine would be an important asset to the student population. Her job, she said, goes far beyond what most people imagine when they think of a school nurse.

“We have a psychologist, but that’s a different model than a psychiatrist or a mental health nurse practitioner, who looks at the whole picture,” Rothschild said.

A psychologist can’t address, for instance, the effects of blood sugar levels on a diabetic student’s cognitive abilities. Rothschild said she sees a wide variety of conditions in the student population that include many potential threats to their ability to learn — from vision problems to uncharacteristic anger due to a concussion, or increasing rates of epilepsy, ADHD and autism, or other cognitive and emotional conditions. As the mother of a child with autism, Rothschild said she is aware of the lack of services for such children. Add to that the ever-increasing rates of myriad health problems and psychological needs, including common teen issues like depression and anxiety — and health issues that appear in children who arrive from other countries, where things like malnutrition and certain other conditions are more prevalent — and the scope of Rothschild’s role increases.

“If kids aren’t healthy, they’re not ready to learn,” she said.

The issues she describes are continually evolving, and awareness is increasing in certain areas. The Centers for Disease Control has made a big push to educate the public about concussions and the dangers they pose, as have some youth sports groups. Some local medical and mental health service providers, like New Horizon Counseling Center in Valley Stream, make efforts to reach out to schools and the rest of the community to address needs, but Rothschild said that many students experience barriers to care. Lack of transportation or money often make seeking treatment difficult.

There are also the stigmas of certain illnesses. Students might not realize they are dealing with a treatable condition, or, as Rothschild said is often the case with students from different cultures, there can be a reluctance to seek mental health services.

“Sometimes my role is educating kids about their own condition. Sometimes nurses are the first to see an issue with a student,” she said, mentioning signs of self-harm that could indicate depression or anxiety.

Each of Valley Stream’s schools has an on-site nurse, but that’s not true of schools everywhere. The National Association of School Nurses recommends one nurse per 750 healthy students — and that doesn’t include those who require special care or monitoring. At Central High School, Rothschild is responsible for 1,100 students. There is no legally mandated ratio.

A school nurse is on his or her own, said Rothschild, who celebrated National School Nurse Day on May 6, but progress is being made in some areas. She introduced the Sight for Students program to Central, which obtains free glasses from local providers for students with impaired vision. And a push is being made in the State Senate for the opioid overdose drug Narcan to be made available to school nurses in response to the heroin and painkiller epidemic among young people.

“Not to have access to a lifesaving drug — that’s crazy,” Rothschild said.

As students’ needs evolve, she said she hopes people will understand and support services that would help them be better prepared to succeed, and that would help all those in her role serve the students in their charge.

“We do the best we can,” she said, encouraged by public campaigns like concussion awareness that could make the difference in a case like that of Willie Gray, who gives Rothschild a big hug whenever he sees her.