by Michelle Lau
July 23, 1998

Almost every school-aged child has seen the horrible images of children shot at school on the evening news. And children wonder, in the back of their minds, whether that could happen to them—whether they could end up on the news because one troubled peer turned their peaceful school into an unforgettable nightmare.

It could happen anywhere, experts on school violence say. But across the country, people who work with children—including school nurses—are stepping up their efforts to prevent tragic incidents and ease students’ fears.

Becoming confidantes

"What we are seeing is an increasing number of violent, remorseless, and thoughtless youngsters. It’s a tougher crowd than ever before," said Ronald Stephens, EdD, executive director of the National School Safety Center in Westlake Village, California, which is affiliated with Pepperdine University in Malibu. The school nurse can play a critical role in spotting angry youngsters and preventing them from acting out violently, Stephens said.

Gunilla Napier, RN, a school nurse for the San Francisco Unified School District in California, says both kids who threaten others and those who feel threatened come to talk to her about their problems. The conversations are confidential unless students plan to hurt themselves or someone else, or have been sexually or physically abused. Students call her "Nurse G" and spread the word that she is a good person to talk to, she said.

Often when students feel threatened, they head straight to the nurse’s office and use it as a refuge, added Beverly Bradley, PhD, RN, a school administrator and former school nurse who is the incoming president of the American School Health Association.

Detecting at-risk kids

While there is no set formula to identify a child who is about to commit a violent act, experts say nurses and other school employees should always keep their ears open and their eyes peeled for noteworthy signs. One way nurses can search for clues is to review their nursing log for patterns of injury and violent behavior, said Jan Marie Ozias, PhD, RN, who works in the Austin (Texas) School District and is co-chief editor of School Health Alert, a national newsletter for school nurses. School nurses should report a troubled or potentially dangerous child to school officials, who will contact the child’s parents and sometimes police.

"It’s a judgment call, and nurses really need to be aware of what is normal and abnormal behavior," said Virginia Hayes, MS, NP, RN, director of district nursing services for the Los Angeles Unified School District.

Physical health problems such as poor hearing, poor vision, body odor, or obesity can trigger emotional problems, said Pamela Riley, EdD, executive director of the Center for the Prevention of School Violence at North Carolina State University in Raleigh. For example, children could be acting out in class because they are frustrated by not being able to see the board well enough, she explained. Or, a sensitive child may have problems controlling anger when ridiculed for his or her weight.

Experts agree nurses must work with teachers, administrators, parents, psychologists, social workers, and the outside community—including churches and law enforcement—to help youngsters learn how to positively communicate their angry feelings.

"We have to understand that violence is not a school problem. It’s a community and culture problem," said Pamela Eakes, founder and president of Mothers Against Violence in America, a national violence prevention organization. "It’s just that kids spend most of their time in school. But until the community responds, schools can’t do what they need to do to solve the situation." Generally, schools are not equipped to provide professional counseling, but school nurses can refer students to outside mental health services, such as grief counseling for those who have lost a loved one, Ozias said.

Stretched thin

Though some experts suggest that each school should have a nurse on duty every day, budgets preclude this, especially since many nurses must cover multiple schools. In fact, only about 30,000 school nurses are employed by the 16,000 school districts in the United States, according to an American Nurses Association survey. And school nurses who split their time between several schools may not know many of their students personally.

School nurses’ responsibilities are broad. Besides dealing with day-to-day illnesses and detecting at-risk kids, they must know what to do in a health crisis. Trained in first aid and CPR, nurses are the first response in an emergency, Stephens said. It’s up to school nurses to share that knowledge by training teachers in first aid and by helping students and staff find ways to remain calm.

Can happen anywhere

The whole educational mission is being disrupted because of the recent violent incidents, Riley said. "Teachers are leaving, parents are losing faith, and kids are afraid. It’s imperative that schools be established as safe and secure places."

Napier added, "There is a lack of hope, and hope is what fuels kids." To have hope, students need to feel that someone is responsible and cares about their security and well-being, she said.

People who think violence can happen only in gang-infested or urban areas need to get their "heads out of the sand," said Sabrina Steger, RN, the mother of 15-year-old Kayce, who died after being shot by another student at Heath High School in West Paducah, Kentucky, in December 1997. "People need to get over their fear. These are not isolated incidents," said Steger, who is one of the founders of the KNJ Foundation, an organization to stop violence. "If you see a change of behavior, report it. Don’t sweep it under the rug—you could be saving your own life."

XXXXX

Previous Stories

Editor's Note
What's different about differentiated practice?

Rural Technology
Cows, computers and continuing education.

Crime and Punishment?
Could you go to jail for a medication error?

To be, or not to be, in the ER
Should families be present during resuscitation attempts and invasive procedures?

XXXXX

STATS

An alarmingly high number of high school students carry weapons and fight, according to a 1995 survey of youth risk behaviors by the national Centers for Disease Control and Prevention.

The survey asked students to report on their behaviors in the previous 30 days:

20 percent had carried a gun, knife, club, or other weapon.

4.5 percent had missed at least one day of school because they had felt unsafe at school or when traveling to or from school.

In the previous 12 months:

8.4 percent had been threatened or injured with a weapon on school property.

38.7 percent had been in a physical fight.

4.2 percent had been treated by a physician or nurse for injuries sustained in a fight.

24.1 percent had seriously considered attempting suicide.

SOURCE: Morbidity and Mortality Weekly Report, Sept. 27, 1996.

XXXXX