January 1, 2012

Nurses on a Mission

How three Vanderbilt nurses are changing the world, one child at a time

Vanderbilt School of Nursing’s Marie Phillips poses with 7-year-old A’Darius Parrish at Park Avenue Elementary School in Nashville, where Phillips serves as school nurse. (Anne Rayner/Vanderbilt)

Marie Phillips, Kathy Warren and Theresa Hook are Vanderbilt nurses, but they don’t clock in at Vanderbilt University Medical Center. They wear School of Nursing identification badges, but you won’t see them in the halls of Vanderbilt’s hospitals or clinics. Through a 17-year partnership between Metro Nashville Public Schools and the Vanderbilt School of Nursing, these women serve as on-site nurses at elementary schools in low-income neighborhoods – where families struggle to provide for the basic needs of their children.

“This partnership, which grew out of a small grant 17 years ago, has made such a positive difference in the lives of so many children and families,” said Bonnie Pilon, senior associate dean of Clinical and Community Partnerships at the Vanderbilt School of Nursing. “Theresa, Kathy and Marie are my heroes for the work they do.”

Marie Phillips, known as “Nurse Marie” to the 640 students at Park Avenue Elementary, has been a Vanderbilt nurse for more than 30 years. She served as one of the six original Vanderbilt LifeFlight nurses, and worked in the Emergency Department after that. About a decade ago, Phillips applied through the School of Nursing for the position of school nurse at Park Avenue, where the work has been no less challenging.

“After being on helicopters and working in the emergency room, I thought I had seen it all,” she said. “But I wasn’t prepared for this – children who don’t have enough clothes or food to eat. It’s heartbreaking. How can a child go through this?”

A big part of Phillips’ day is caring for the 100-plus students diagnosed with asthma, an especially serious problem for children in pollen-prone Middle Tennessee, where allergies and asthma symptoms are common and sometimes deadly.

“I often have several students waiting to use the nebulizer. When they start wheezing, my job is to keep them out of the emergency room,” she said.

Diabetes is also a serious issue. “It is necessary to check a child’s blood sugar at breakfast, at lunch and before leaving for the day and give insulin shots when they need them,” she explained.

Often Phillips’ job requires that she dole out more than medical care.

“[rquote]It’s really like being a case manager in addition to being a nurse,” she said. “Sometimes they just need someone to listen, and they know my office is a safe place.”[/rquote]

Phillips said that after all she has experienced in her nursing career, her current work is the most rewarding.

“A child needs to be healthy to learn, and learn to be healthy,” she said. “I’ve been so blessed to be a part of this.”

Terri Crutcher, assistant dean of Clinical and Community Partnerships at the Vanderbilt School of Nursing and clinical director of the West End Women’s Health Center, believes the School of Nursing is providing a much-needed service by contracting the nurses to these elementary schools.

“Children with chronic conditions have complex health care needs that are best managed by having a registered nurse on site at the school,” Crutcher said. “Our nurses work with the children, parents, teachers and staff to keep the students healthy and in school. These nurses are making a difference in the community, and this partnership with Metro Schools is one we are all very proud to be a part of.”

Most public school nurses in Nashville are contracted through the Metro Health Department, and many are responsible for more than one school. Through partnerships and grants, Vanderbilt’s Phillips has been able to focus on just one school – Park Avenue – for the past decade.

“I love it when the children come up to me and hug me in the hallway,” she said. “It’s so rewarding for me to see that child’s smile and know I’m making an impact – to see that I can make a difference, one child at a time.”

Theresa Hook serves as school nurse at Fall-Hamilton Elementary School. (Photo by Jesse Koska)

Theresa Hook, who has served as the school nurse at Fall-Hamilton Elementary School for more than a decade, said that hunger is also an ongoing issue with her students. Fall-Hamilton has 325 students in grades pre-K through four, and like Park Avenue, a great majority of the students live below the poverty line.

Like Warren and Phillips, Hook spends time in the classroom educating children on preventive health care, such as hand washing, dental care and personal hygiene. She also has taken a special interest in educating her students on the importance of eating right and has elevated the nutritional offerings in the cafeteria.

“I’m focused on nutrition, because that is an area that children can have some control over,” Hook said. “They can choose to eat the vegetables that are put on their plate; they can learn to ask for veggies and fruits for snacks and not eat so many fast food meals. When they’re eating right, they can learn more effectively.”

A VUSN student dressed as a carrot and handed out bags of produce during a Veggie Fair at Fall-Hamilton Elementary School. (Dana Johnson/Vanderbilt)

But how do you get them to try something leafy and green? Thanks to a Hidden Valley “Love Your Veggies” grant, Hook was able to create a nutrition education program at Fall-Hamilton that not only features healthier fare in the lunch room, but also an on-site mobile fruit and vegetable cart stocked with healthy afternoon snacks three days a week.

“Give them a fruit or vegetable slice and a healthy sauce to dip it in, and you can get a child to eat just about anything,” she said. “The children are often surprised that these healthy foods actually taste good.”

In October, Hook was honored at the White House for promoting nutrition in public schools through the Healthier U.S. School Challenge Program, an initiative of the U.S. Department of Agriculture. Through the program, schools work to achieve bronze, silver and gold levels based on students’ physical activity and the nutritional foods offered at the school. Fall-Hamilton was awarded the silver level, and Hook is currently working toward the gold level for next year.

“Michelle Obama hosted the celebration on the South Lawn of the White House, and she had the chefs prepare healthy snacks for 1,000 guests,” Hook recalled. “The first lady recognized the ‘unsung heroes’ that have worked to make a difference in the movement to help students make healthier eating and active lifestyle choices. It was an exciting trip.”

Hook spends much of her time convincing parents to take advantage of the resources available to them. “One of the most challenging aspects I face is how the families view the importance of good health, especially when the benefits are ‘down the road’ and they have more immediate needs,” she said.

Hook also is contracted to visit two child care centers in Nashville that accept children with medical issues. She instructs the caregivers on different medical conditions and how they affect the children in their care, along with training them in how to do procedures such as tube feedings, nebulizer treatments or seizure management.

“[rquote]Like every nurse, I want to make things better. Whether it is cleaning a scrape or helping a child understand their asthma, there are opportunities to educate on how to be the healthiest they can be,” she said.[/rquote]

Taylor-Stratton Elementary in Madison has an enrollment of 675 students, more than one-third of which speak English as a second language. Many of those students come from low-income homes where one or both parents do not speak English. “We often have to rely on the students themselves to act as translators for us,” said Kathy Warren, a Vanderbilt nurse who has poured her heart into Taylor-Stratton for the past nine years. “That’s a daily obstacle.”

Warren keeps up with various cultural celebrations and religious holidays observed by her diverse student population.

Kathy Warren (Lauren Owens/Vanderbilt)

“When Ramadan is going on, children might be fasting, so we may have a child who seems pale and dizzy and the teacher is concerned. We will monitor that. And we make sure our meals are suitable for the various religions, depending on the food they can and cannot eat.”

Warren estimates she has about 100 or so students who deal with a chronic health issue, including diabetes, asthma, heart conditions, seizures, food allergies and more. She works daily with students with diabetes and those with asthma, and dispenses medications on a daily basis.

“I may not know a child has a condition until he presents and I have no medication – that makes it difficult. And there are probably many more students with conditions that I don’t know about,” she said.

Warren said it’s not uncommon to learn a student comes from a home in which a parent is in jail and the child is living with a distant relative. Some are homeless or in foster care.

“Sometimes a visit to the nurse’s office is about a health issue, but sometimes it’s about getting a hug and a smile,” she said.

Through health fairs and classroom presentations, Warren engages students about health issues, including puberty and the dangers of smoking.

“This is our mission – it’s our calling,” she said. “It’s so rewarding, this job we’ve been given. I can’t imagine doing anything else.”