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Ever wonder what becomes of those desperately ill children
years after they leave pediatric intensive care?
Sherrill Bookey, RN, said she's found nothing more
challenging and rewarding than the continuing care of
one such boy, a second-grader in Anchorage, Alaska,
as she discovers just how far some school districts
will go in the care of their students.
"I start the day up at his house and we get on
the bus together," Bookey, 47, said. "I spend
all day by his side, then I ride the bus home with him."
The boy also is tutored by a full-time teacher's assistant.
Throughout the day, Bookey manages the boy's care on
and off of a ventilator, moving him from a wheelchair
to a mobile exam-type table for classroom work because
he is unable to sit up for long periods of time. He
has a different chair for music and library studies.
Bookey also sees him through lunch and involves him
in recess.
"From my job as a pediatric intensive care nurse,
I'm doing those same things but in a school," Bookey
said.
When her husband transferred from Spokane, Wash., to
manage a country-music radio station in Anchorage, Bookey
signed on with the pediatric intensive care unit at
Providence Hospital. She had worked on call at a Providence
affiliate, Sacred Heart Hospital in Spokane, while her
main nursing career was investigating medical malpractice
and insurance cases for a group of Spokane lawyers.
At Providence, Bookey was able to work weekends, which
solved the child care issue when her now college-age
daughters were young and allowed her to volunteer during
the week at their school. That volunteerism eventually
led to a school district career as a "health treatment
specialist."
Anchorage makes the distinction between RNs with a
bachelor's degree and others, requiring its school nurses
to have a four-year degree. But the Anchorage school
district employs about 10 treatment nurses who hold
associate degrees or, like Bookey, are graduates of
a diploma program.
Treatment nurses give medication and handle all but
the administration of the nurses' offices, Bookey said.
"I would do tube feedings, any type of respiratory
treatment, oxygen, chest percussion, suctioning, trach(eotomy)
care" along with the bumps and bruises, fevers
and flu that most people associate with pupils.
That evolved into full-time care of the second-grader,
whose needs increased in the span of three years as
he progressed from a special-education preschool program
to kindergarten and first grade. Bookey said she anticipates
years more as the boy's caregiver. "I got wonderful
training. I got to work alongside his mom," she
said.
A school nurse and another part-time treatment RN care
for the rest of the pupils at Bowman Willard Elementary,
Bookey said.
When the district's health office is fully staffed,
four of 10 treatment nurses fill in as substitutes and
help with wellness screenings: height, weight, vision,
hearing and tuberculosis tests for nearly 50,000 pupils.
The others are assigned to a specific school and, in
Bookey's case, to a particular student.
"I have a niece who attends school in Spokane
and there's not a nurse there all the time. One nurse
oversees many different schools," Bookey said.
Felix Ortiz, communications specialist for the National
Association of School Nurses, said that's the norm in
almost every state. Association guidelines call for
at least one RN for every 750 students, he said.
"Considering the way budgets are, the days of
one school, one nurse are gone," Ortiz said. "Alaska
is the exception to the rule."
Nursing in Alaska is exceptional in other regards,
too.
"Sacred Heart, in their pediatric intensive care
unit, handled a lot of its patients at that hospital,
where we sent out from Providence," Bookey said.
She found that children requiring heart surgeries or
chemotherapy routinely were flown to Seattle or Portland.
"That was a little bit hard to take when I first
started, not being able to follow those families,"
Bookey said.
To a large extent, though, that is changing as Anchorage
grows and its 280,000 population can sustain increasingly
sophisticated medical procedures and specialties. "We
have excellent physicians here," Bookey said.
She said the jokes are fewer than a decade ago when,
in a nod to Alaska's remoteness, you would hear "The
barge must have sunk" when supplies ran low.
Contact
Phil McPeck at getpjm@aol.com.
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