Nurse Megan Szalay's office inside Bristol High School in Bristolville can get busy between stomach aches and bumps and bruises. On one day in November, she had to tend to one student accidentally hit in the head with a racket in gym class.
Nurse Megan, as the students call her, is the sole health care professional for the 550 students at Bristol Local School District's only building which also includes an attached elementary school.
When Ideastream Public Media visited in early November, most students who came by Szalay's office just needed to lie down for a moment or something as simple as Tylenol. But there are more serious issues she tends to.
Kindergartner Isaiah stopped in complaining of a hurt knee after he fell off his bike. While it seems like a minor issue, Szalay explained Isaiah has hemophilia, a rare disorder where a person's blood doesn't clot properly. Even something simple like a cut can lead to a trip to the emergency room for Isaiah.
"The dog jumped up and bumped him, and he ended up in the ICU for, how long were you in the hospital that time?" Szalay asked him.
"That was two days," he responded.
Szalay keeps an eye on dozens of students with more serious conditions like Isaiah’s.
"We have one, two, three seizure disorders," she said, counting medications in her cabinets. "We have quite a few EpiPens. We have inhalers."
According to the National Association of School Nurses, only about 66 percent of all schools have access to a full-time nurse; that number is 11 percent lower when it comes to rural schools like Bristol. Schools across Northeast Ohio engage in a balancing act when it comes to staffing their buildings with health professionals, weighing things like the cost and the number of students with chronic illnesses they serve.
Megan Szalay, the school nurse for the Bristol Local School District in Trumbull County, was placed at the district through a program at Akron Children’s Hospital.
Different school nursing models; what works?
Szalay said Bristol did not have a nurse before she arrived several years ago. Before that, students were getting aid from the front office assistants. Christine Rogen, with the Ohio Association of School Nurses, said the way schools approach nurse staffing runs the gamut.
"We are seeing one registered nurse per building," she said. "We're seeing one registered nurse covering multiple buildings. And then there might be that registered nurse supervising the LPN (licensed practical nurse) or an aide, an educational aide or a medical aid or health aide."
Szalay - who's been a nurse for 23 years, 13 of which was spent as a trauma nurse - was placed at Bristol schools through a school health program at Akron Children’s Hospital.
Michele Wilmoth, director of school health services for Akron Children’s Hospital, said they partner with 43 school districts in Northeast Ohio to provide school nurses and other health services. Schools pay the nurses per hour, while the hospital system covers their ongoing training.
"There has been a gap in school nursing services in our area of the state," Wilmoth said.
Having this healthcare access in school buildings, Wilmoth said, is a way to catch problems early and to connect students with resources in the broader hospital system more quickly.
"This is an intervention in health equity, making sure that our patient population, who live, learn and play in schools are cared for and receive quality care where they spend the most time," she said. "And so it really translates to better health in our communities."
It can be expensive for schools to pay for a full-time, licensed nurse in every building, however some of the region’s urban districts like Akron, Canton and Cleveland all do. But there are other ways to approach school health needs.
Katy Corrigan, the district nurse for Lakewood City School District, oversees health aides – who are not licensed or registered nurses - at Lakewood’s 12 schools. There's one aide per school buildings for the full school day, and she trains them to administer medicine, do basic aid and CPR. She thinks districts only need one licensed nurse.
"You're way overqualified, way over-educated to be in a position all day long sitting in an elementary school or middle school or high school," she said.
Christine Rogen, with the Ohio Association of School Nurses, said she disagrees with that notion. She said the National Association of School Nurses is calling for a grant program, called the One School, One Nurse Act, to be approved federally to ensure there is a registered nurse at every school. She said her additional training and education as a registered nurse, and as a licensed school nurse through the state of Ohio, has been key in her job as a nurse at Orange City School District.
"Being a school nurse is actually a specialty practice of nursing," she said. "So it does take some additional knowledge and and skill."
Rogen said there's not much research in the area of what the best model is for nurse staffing in buildings. She said the need depends on what students' needs are.
"Some districts need more than one RN in a building, just in one building alone," she said.
Why are nurses important?
Rogen said school nurses in general help reduce student absence rates. The vast majority of students seen by a nurse - about 87% - are sent back to the classroom instead of home, Rogen said, citing National Association of School Nurses data. That means nurses contribute significantly to making sure students don't lose learning time, she said. Nurses also manage vaccinations and vision screening.
"It's just such a nice full circle because you see them get their glasses and boy, their whole learning experience opens up," she said.
Bernetta Wiggins, executive director of Cleveland Metropolitan School District's integrated health system, said her school district sees a major benefit to having a full-time LPN or RN in each building. She said it gives parents peace of mind that their children are well taken-care of by professionals at school.
"This helps parents also with transportation and not having to leave work (for medical consultation)," Wiggins said.
But there’s another important aspect that some might miss. At Bristol Local School District, sixth grader Kali visits Nurse Megan Szalay often. She has Type 1 diabetes, so she checks in with Szalay frequently, who even helps her monitor things like the amount of carbs she can eat at lunch. It’s not easy for Kali, but she said having Szalay to talk to helps. Szalay's daughter has diabetes, too.
Megan Szalay, the school nurse for the Bristol Local School District in Trumbull County, stands for a photo on Thursday, Nov. 2, 2023.
"We don't always talk diabetes. Actually, that's probably the least that we talk about," Szalay said.
So what do they talk about?
"Basically anything and everything," Kali said, including her two horses, Cici and Cricket.
Sometimes being a school nurse is about more than just physical health, Szalay said. It’s about providing a reassuring presence to students, to know they always have someone in their corner.