Sunday, October 14, 2007

On My Soap Box

Kids' health... in my opinion there is no other more serious domestic issue. I think the face of our country and the next generation will be most impacted by the health of American children. I will admit that I don't follow politics, I rarely watch the news if ever, and I hardly ever weigh in on something that I don't know much about. But I spent one year as a school nurse in a fairly economically sound area of Los Angeles County (as LA goes - that's not saying much) and I am currently an ER nurse in a suburb of Austin, TX, and somehow I feel that qualifies me to speak on the issue of children's health.

I can't tell you how many kids I see any given night (I work nights - so that's what I can speak on) who are uninsured or if they are insured typically by a government run program. Many children are arriving right now with upper respiratory illness, stomach aches, rashes, earaches and other generally simple medical problems. My frustration is that usually these are not reasons to take your child to the emergency room. Most of these kids, if they were properly seeing a pediatrician, would not be so sick if they had earlier care. Frequently we see the same children on a regular basis because their family uses the ER as their primary care doctor and we are in the suburbs.

As a school nurse, I generally knew when kids were ill whether they had been sent to my office because the teacher had noticed they were under the weather or the parents called our office to let us know their child wouldn't be in (our health offices in this district also frequently handled attendance). Many times we required a note from a doctor to come back to school especially after an extended illness. We also managed our chronic illnesses or issues which requred medication such as asthma, diabetes, ADD/ADHD, and seizure disorders. Many times we had kids in my office with an asthma attack and no inhaler, diabetics with no education or follow up plans - seeing the local free clinic, or children who seemed to always be sick but NEVER saw a doctor (usually for lack of parent education, insurance or resources). It became more and more frustrating.

My proposed solution to medical care for children in the United States is to offer a school based clinic run by Nurse Practitioners and over seen by an off site MD. The children are already at school. When they are sick they already come through the health office. When immunizations are due the nurse is already doing more work chasing the parents down than it would be to just immunize the child. If they have a chronic illness such as diabetes we already see them in the health office to check sugars and give insulin (often more than once a day). We are already looking in throats and ears and what we usually tell parents is, "take your kids to the doctor." This is all well and good for the insured child or the kids with parents who actually have a clue, but the reality is there are plenty who don't. It wouldn't solve major catastrophic issues like major broken bones or other accidents, but it could make a huge impact in getting a grip on health care for kids.

I haven't written any formal proposals and haven't conjured up all the details but I think this is a great idea. I also can't take complete credit for this idea - it is a dream of my former boss to have a school based clinic in her school district. She is currently working on her advanced practise nursing degree to do just that. In this country it is a law that every child be offered an education. Great! Terrific! We already have that set up (better in some places than others). Why not use a system that is already in place, already sees our children on a daily basis, and is most apt to know already when kids are sick and healthy? Don't spend money on developing a new system full of administration fees and other such nonsense when you could be hiring a Nurse Practitioner for every school district (at a minimum).

I think the best way to start is small and local to prove that this plan could work. I don't live in CA anymore but LA county seems like a great place to start. Wonder if the governator would extend a grant for a pilot program? I don't even know who my TX governor is - maybe I should start with my school district...

The school nurse motto is, "Healthy kids learn better." Duh... Let's change America for the better - how about producing a whole generation of smarter kids.

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