GREEN COVE SPRINGS | The morning rush was busy but otherwise uneventful for Beverly Burstell and Angela Fish.

A steady stream of children complaining of coughs, sore throats, headaches or tummy troubles last month filed into the clinic at Shadowlawn Elementary School to be examined by the two registered nurses. Burstell and Fish deftly assessed each students symptoms, checked their temperature, then treated them a salt water gargle for the sore throat, a baggie of ice for the headache and a peppermint candy to soothe the throat, calm the tummy and spark a smile before contacting the youngsters parents to let them know their child was sick.

Burstell, recently reassigned to Clay High School, and Fish have 42 years of combined nursing experience. Both are well-versed at handling medical emergencies and complicated health issues involving students. On a typical day, about 40 to 70 students are seen at the clinic at Shadowlawn, which has an enrollment of about 700, Fish estimated.

Its not just putting bandages on skinned knees, Fish said.

Fish, Burstell and their fellow Clay County school nurses routinely handle myriad student health issues ranging from routine bumps and bruises to complex medical needs related to physical or mental disabilities as well as chronic illnesses such as seizure disorders, cardiac issues, asthma and severe diabetes. They administer daily medication to students needing it. Clays school nurses also help coordinate services for students with complicated health issues.

The Shadowlawn nurses cared for two medically complex students at the beginning of the school year. Both youngsters had feeding tubes so they could eat, as well as tracheostomy tubes to help them breathe. They needed nursing care several times a day. The students have since left the school.

We do put bandages on. We do take care of skinned knees and sore throats but you have to be ready for whatever walks in the door, said Fish, who added that they see a lot of students with severe asthma, allergies and diabetes, all of which can be life-threatening.

Clay school nurses keep tabs on, and if necessary, coordinate state-mandated student health screenings. Theyll also train teachers and other school staff how to recognize symptoms of the onset of a seizure or other medical incident and how to respond appropriately to medical emergencies. The nurses have reams of paperwork, albeit much is on computer, such as documenting student health conditions and medical services provided. They also help parents better understand their childs illness or injury.

School nursing is a specialized practice utilizing all realms of our nursing education, said Shelley Bumm, a registered nurse and president of the Florida Association of School Nurses Board of Directors. The association, which has about 350 members statewide, is an affiliate of the National Association of School Nurses.

Yet, in Clay as well as nationwide, school nurses typically are among the lowest paid in their profession compared to their counterparts working in hospitals, home health care and doctors offices, according to national studies and anecdotal reports.

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Clay County school nurses contend with complex medical issues, low annual salaries