Making the Ow-ies Go Away

Fifteen fresh-faced second-graders file into the school nurse’s office at Napa Street School in Northridge and stand at attention.

“Today we are going to do head checks,” Clara E. Banda tells her charges. “Does anyone know why?”

One little boy pipes up: “To see if we’re smart?”

His response draws giggles from classmates and a warm smile from Banda, a 19-year veteran of school nursing who says she can’t imagine doing anything else.

Banda explains that today is the day for pediculosis checks.

Head lice.

“Piojos,” she adds for some of the school’s 750 students whose first language is Spanish.

One by one, the children stand like statues under an examination light as Banda gently strokes through each head with a fresh wooden applicator. Then she pats each child on the shoulder and whispers, “OK, sweetie.”

And when a few children don’t pass muster, Banda is discreet so as not to embarrass them.

While head lice checks may seem routine, even disgusting, they underscore some of the most important skills and qualities crucial for school nurses: attention to detail, charisma, patience, diplomacy, and an ability to deal with subjects and situations some find repulsive.

Banda, 44, has those qualities--and a passion for her work.

*

On this particular day, Banda, as usual, arrives early, settling in a good half-hour before the 8:15 bell to prepare for the morning onslaught. By 8:30, she has already seen five children or has talked to their parents.

Among them:

A child who is wearing a cast.

A child with a fever who needs to be sent home.

A child with problems adjusting to class, who may also have a throat infection.

The stream of students is so steady that Banda doesn’t stop for lunch.

Two boys come in from the schoolyard, one pointing to a minuscule cut on his knee, the other offering moral support. Banda pays attention, mindful that his need for TLC may be greater than his need for a bandage.

Most troubling, though, is the fourth-grader who complains of a stomachache and tells Banda that the last time he ate was at school the previous day. Now, she must solve the mystery: Is there no food at home? Or is there an emotional problem? Or is this simply high drama?

She gently questions, phones his mother to arrange a meeting, and sends him to lunch with instructions to report back to her. He’s probably the student she’ll fret about later, when she’s home.

The daily total eventually swells to 125 students--94 for head checks, 31 with other health-related problems or questions. But the numbers are only part of the story. “Some days, I only see 20 students,” Banda says. “That’s a light day. But sometimes one case will take up the whole day.”

To minimize anxiety, Banda never wears a uniform, opting for more casual attire. Today, it’s tan pants, a matching top, stylish white athletic shoes and an apron given her by school staff that proclaims: “Nurses Help Make Boo-Boos Better.” Students, she says, “need to be comfortable or they won’t tell you anything.”

Between patients, Banda catches up on her daunting paperwork load, completing reports required by the district or state and making sure no student falls between the cracks.

Elementary-school students are her favorite age range: “They’re so spontaneous.”

One frustrating drawback: parents who don’t cooperate. Banda has asked one parent three times for an updated form granting permission to dispense asthma medication to her daughter if needed. So far, the parent has ignored the requests. The student, Banda says, is well-controlled with medicine she takes before school. Still, she worries.

Getting tough when necessary--for the student’s sake--is just part of the job. “For certain things,” Banda says, “I can’t be patient.” There’s no velvet glove treatment, for example, if child abuse is suspected or in other situations where children may be in danger.

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Born in Mexico, Banda was 11 when she came to Southern California with her three brothers and her widowed mother. She met her first school nurse soon after, visiting her when her eyes became watery and she felt suddenly stuffed up. “We didn’t know much about allergies then,” Banda says with a laugh.

She planned to study humanities, but made a last-minute career switch and enrolled at Cal State Los Angeles, earning a bachelor of science degree in nursing and a bachelor of arts degree in Spanish. She says she was following a gut feeling that she’d be more successful in nursing.

Now, her job and its hours fit her lifestyle perfectly. A single parent, she has an 11-year-old son and a 7-year-old daughter.

So, what does she do to de-stress after a day’s sneezes, coughs and runny noses?

“I go home and take a bath and read. I try not to read medical things.”

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All About School Nurses

* Demand for school nurses, first employed in New York City schools in 1902, will rise, predicts Genie L. Wessel, president of the American School Health Assn., a Kent, Ohio-based organization of school nurses and doctors.

A growing number of universities, including the University of Maryland, where Wessel is on faculty, are including special courses in school nursing. Increasing numbers of schools are viewing the job as crucial because of the growing number of children’s issues both directly and indirectly related to health.

* In California, schools are not required to hire a school nurse, says Joe Symkowick, general counsel for the California Department of Education. But about 95% of the 1,100 school districts in the state do have a school nurse, says Charlotte M. Brandt, president of the California School Nurses Organization.

* School nurses must be registered nurses. They may be required to pass other programs and demonstrate other competencies, such as vision screening.

* Nationally, there are 45,000 nurses; in California, 3,200.

* Nationally, the annual salary is $30,000 to $46,000, but can vary from district to district. Los Angeles Unified School District: $29,233 to $50,980.

* For more information:

* California School Nurses Organization, (888) 268-CSNO.

* School Health Resource Services at the Office of School Health, University of Colorado School of Nursing, (800) 669-9954.

* American School Health Assn., 7263 State Route 43, P.O. Box 708, Kent, OH 44240.