For school nurses these days, it's not all scraped knees and stuffy noses.
“People have seen the role of school nurse over time as someone who puts on Band Aids,” said Kathy Boutilier, a registered nurse in Helena Public Schools. “But really what we are doing is working with the student and their family, the teacher, and administrator to help manage these chronic illnesses.”
A lot of students, 1,300 at Capital High School and another 250 at Hawthorne School, depend on Boutilier every day.
They come in for diabetes shots, sprained ankles, asthma attacks and queasy stomachs.
“We have students we see daily because of chronic health needs. We see students daily because they might need medication," said Boutilier, who holds a bachelor's degree in nursing. "And then a lot of students we see are situational, they might come up with an acute illness."
Type 1 diabetes now plays a huge roll in her medical treatments. New cases have almost doubled in the past 10 years, according to the National Association of Nurses.
"It used to be one or two (diabetic students) per school district,” Boutilier said. Now it's 41.
And she sees some of those students three times a day.
One of her diabetic students is first-grader Adam Grasmick. He was diagnosed roughly a year ago, when he was 5.
“Sometimes she calls my mom,” Grasmick said.
Boutilier explains that his mom wants to know what his blood sugar numbers are, especially at the beginning of a new school year.
“My stomach hurts when I’m high,” he said. “My leg is shaky when I’m low.”
It’s a balancing act to keep his blood sugar at a normal level. He works with his teachers, nurse and parents to help count his carbohydrates intake.
In a perfect world, all of those diabetic students would be spread out across the entire school district.
Between Capital High School and Hawthorne School, Boutilier has 10 diabetic students under her watch.
The rest are spread across the watch of seven other school nurses.
Most of the nurses are full-time, managing two schools, sometimes three.
School assignment is based on, in order of priority, the needs of students, the size of the schools and the travel time between schools.
School nurses work with public health officials as well, especially because they are somewhat “in the trenches,” Boutilier said.
“We started out this school year with some cases of whooping cough that had morphed over from the spring, so the school nurses worked together with public health nurses to manage and control the outbreak,” she said.
“We had some cases, not very many, but when there is one, that means you want to find out who the contacts were. So there’s a lot of working with that, communicating with parents or public health.”
Boutilier says she commonly sees asthma and allergy attacks.
“And dental issues,” she said. “That is a surprise to many people.”
School nurses do routine screenings, including dental, vision, and hearing. They also check for osteoporosis.
She’s not afraid to admit that she gives out plenty of Band Aids. But she emphasizes the importance of following up.
“You might go back and find out what led up to this (accident),” she said. “What we need to do to prevent this from happening in the future.”
She also says part of the role of the school nurse involves health education and screening.
“It helps kids stay in school,” she said, “because teachers can teach and other staff can do their job.”