School Nurses Head Back to Class at UTEP

By Laura L. Acosta

UTEP News Service

The role of the school nurse has changed dramatically in the 15 years since Rebecca Madrid, a 1988 graduate of The University of Texas at El Paso’s nursing program, started her career as a school nurse.

Today, the medical attention her students receive often requires more than a Band-Aid or sending them home when they’re sick. Instead, caring for students with ventilators, catheters or feeding tubes has become an integral part of a school nurse’s job.

Oralia Acosta, a school nurse with the Canutillo Independent School District, flushes a feeding tube on a child mannequin in UTEP’s Center for Simulation. Photo by Laura Trejo / UTEP News ServiceOralia Acosta, a school nurse with the Canutillo Independent School District, flushes a feeding tube on a child mannequin in UTEP’s Center for Simulation. Photo by Laura Trejo / UTEP News Service    

“We’re seeing a lot of students in our offices with tracheostomy (trach) or gastrostomy tubes; serious conditions that we didn’t used to see in the schools,” said Madrid, the nurse manager with the Socorro Independent School District. “It’s like your own little clinic. It’s non-stop. Now you’re seeing kids coming in with medications for attention deficit hyperactivity disorder or different treatments like for asthma. Diabetes is a big one. They’re on insulin so you need to see what’s going on, what they’re eating.”

To keep up with their expanding roles, 135 school nurses from the El Paso, Socorro, Canutillo and Anthony independent school districts attended a one-day training workshop Jan. 6 at the UTEP Center for Simulation in the Health Sciences and Nursing Building where they received hands-on training to provide health care services to students with medical conditions or a disabilities in their schools.

Hosted by the UTEP School of Nursing (SON), participants used simulation technology to get a refresher course on pediatric gastrostomy tube management, tracheostomy and ventilator care, and heart and lung assessments. SON uses state-of-the-art programmable mannequins capable of simulating many life-threatening scenarios.

“We’re teaching school nurses basically (what to do) when they have a student that comes in that’s on a trach (tube) or a ventilator in a school setting by teaching them some basic trouble-shooting tips or guidelines,” said Ronnie Stout, simulation center director. “Whatever issues are at the school, we want to help them train and simulate it. The beauty of this is that it really is hands on.”

Mike Vicar, an elementary school nurse with the Socorro Independent School District, used a stethoscope to listen to the heart, lung and bowel sounds on one of the mannequins.   

“We’re listening to the different lung sounds in case something happens to the students,” said Vicar, who sees about 70 students a day in his office. “There’s different lung sounds such as asthmatic. I asked (the sim lab technician) if he could change it to a stridor – a high-pitched, musical breathing sound caused by a blockage in the throat or larynx – and he changed it and it was like, ‘Oh, wow that’s what a stridor sounds like.’”

Respiratory therapists Vince Duran, Edward Pacheco and Monique Melendrez from the El Paso Children’s Hospital conducted exercises on a ventilator to show the school nurses how to troubleshoot in case there is a problem with a ventilator.  

“We made a Quick Tips (sheet),” Duran said. “We’re showing them how to suction, how to check the vent and what to look for in the event that the ventilator malfunctions or is (sounding) an alarm.”

Duran and Pacheco also recorded a 15-minute video of their presentation, which will be available online for nurses to refer to if they ever need to refresh their memory, Madrid said.

According to federal law, public schools must comply with the Individuals with Disabilities Education Act (IDEA), which ensures children with disabilities receive Free Appropriate Public Education (FAPE).

Madrid believes the law is one of the reasons the role of school nurses has expanded to meet the needs of the growing number of students with disabilities who now attend public schools.

The training at UTEP is especially helpful for nurses who haven’t cared for patients with these types of medical conditions since they worked in a hospital.

“I can understand the insecurity sometimes if you haven’t worked with (ventilators, catheters or feeding tubes) in such a long time,” Madrid said.

Grace Carbajal has been a registered nurse for 21 years. Though she has experience with feeding tubes, practicing how to connect the feeding bag tubing on a mannequin was a helpful way for her to review her technique.

Since she started working in the Canutillo Independent School District six years ago, Carbajal has seen an increase in these types of procedures.   

“School nursing has changed a lot,” Carbajal said. “School nurses are doing a lot of things that we never used to do before. That’s because a lot of students with disabilities are being (integrated) into the schools.”

Carbajal is also amazed by the simulation training available at the School of Nursing.

“When we went to school we practiced on each other,” said Carbajal, a UTEP graduate. “We did sponge baths on each other. We practiced giving medications. Now you have an ideal hospital setting. You walk in (to the Center for Simulation) and this is what you’re going to see in the hospital. When we went to school, none of this existed.”

Madrid said the relationship formed between UTEP, the El Paso Children’s Hospital and the school districts has helped enhance the skills of school nurses and also improve the quality of care students receive.