Whether it’s because it’s too late to arrange a sick day or because they called a bluff that turned out to be the flu, most parents will eventually wind up fielding a call from the school nurse or medical point person about the health of their child. It’s not unlikely that this call will include the words “pick up.” Though far from perfect – especially given the dearth of American school nurses – the system by which most schools decide which kids need to go home succeeds by taking a personal approach to triage.
So what does it take to get sent home by the school nurse? Well, it depends. A trip to the school nurse doesn’t automatically result in a trip home. Some symptoms are obvious red flags; vomiting or a fever will often require a student get sent home as a matter of policy, but even if that isn’t the case, it’s a pretty strong indicator of an illness severe enough to disrupt the classroom and write off the day.
“I err on the side of if a student can stay, they should stay,” says Cari Hotckiss, RN, who works as a school nurse. “There are a few definite situations – if a student has a fever, they’re out. That’s easy. But if a kid thinks they can make it through, and they aren’t going to make their friends sick, I think they should try.”
One metric nurses look for in borderline cases is, well, “ooze. If a student isn’t sneezing, or dripping, or otherwise spreading pathogens around, they can go back to class to see how they fare for the rest of the day. Part of this is due to the importance of education, but another part is pure practicality: it’s hard to identify a student’s health complaint when the child is only five or six years old.
“I was used to a hospital setting where children don’t arrive at the doctor’s office without their parents by their side. When a pediatrician asks a question, the kid doesn’t answer; the parent does,” explains Hotchkiss. “The kid might answer one out of ten. So they’re on their own when we see them in the health room, and that is really hard. They’re having to tell us what is going on, in their own words. It’s a really difficult thing to not have that parent filling in the blanks. It’s a totally different set of circumstances than your normal visit to the doctor.”
Parents aren’t always in a better position to answer questions, though. “I’m always surprised at how many times kids will come and they’ll tell me it’s been going on for so long and I’ll ask ‘Well, did you tell your mom and dad about it?’ and they’ll say ‘no’,” says Hotchkiss.
Not every student who visits the school nurse requires such intense scrutiny. In fact, many of them aren’t even sick. The health room is a great temptation to a lot of students, for a variety of reasons. Kindergartners are fascinated with the health room. It is the source of ice packs and adhesive bandages. It has a cot in it. Hell, it’s just a mysterious room kindergartners have no business in half the time, and kindergartners are like cats in that regard. So if having a cough earns the kid next to them a trip to the health room, maybe kids start faking a cough themselves. It’s not particularly devious beyond wanting to see what’s going on in there.
High schoolers are a different matter entirely. They are obviously shrewder than a kindergartner, but also recognize that academic performance matters more. But no matter why teenagers want to be released from school, cell phones allow them to accomplish it with less input than some school nurses like.
“You know, high schoolers just want to get out of school sometimes. And faking an illness to the nurse is one way to do it,” says Hotchkiss. “Technology is helping them get away with it. They’ll text their parents, and say that they’re going to the nurse and they’d like to come home. And so by the time I see them – and I might think they’re full of it – I find out their parents are already in the drive and waiting to pick them up. But the older they get the less I worry about them. They’ll come in and sometimes they just want to complain, and after they rest they go back. Sometimes I will ask them if they think they can return to class, or do they want me to make a phone call, and I get a whole bunch of them who say they don’t think they can stay but they want to take their math test. They are being honest and they are nervous about their class work.”
Anxiety over schooling can certainly go the other way, too. When kids are upset about other school dynamics they aren’t comfortable talking about, they will often try a ruse to be excused for the day.
“Sometimes they are faking a specific illness, but you also see that they are just upset over something else, and they are using that as their way home,” explains Hotchkiss. “That’s a constant negotiation with the parents – there are plenty of times where I’ve spoken very frankly and said they aren’t necessarily ill, but I can also say that nothing good is going to come out of today. If they have gotten themselves into such a point of distress, and maybe the point it they just need to chill, and something else is going on in their world, and they need be somewhere else, with someone else.”
Mental health is still an important part of health and development, even for – or perhaps especially for – school age kids. Not every level of the educational system knows how to effectively advocate for that, so it’s a good thing school nurses can recognize its importance and account for it.