Nursing Director Ensures Students Are Really 'Ready to Learn'
Focus of Strength: Student Wellness
Position: Director of Nursing
District: Kent School District, Washington
Mary Newell has seen firsthand that students with unmet health needs have a hard time learning.
A student with poor vision is likely to fail his math test if his parents can't afford the eyeglasses needed to see what his teacher is writing on the whiteboard. Another student may fail if repeated bouts of strep throat, which could be easily tackled through antibiotics, keep her out of the classroom.
Ms. Newell, a former nurse educator, started working with the Kent, Wash., district as a volunteer. Her passion for the integration of health and learning grew, and she eventually became director of nursing for the 27,500-student district. In her position, she tackled the needs of its high-poverty student population by establishing an in-school clinic for Kent Phoenix Academy, the district's alternative high school, and she supervises a staff of 25 nurses who help draft health plans for students with chronic illnesses, such as asthma.
The clinic, widely used by the students there, has become a crucial part of its host school's comprehensive plan to help students at risk of academic failure earn diplomas, Principal Merrilee Lyle said.
"I have said more than once, if you close the teen clinic, you might as well shut down our school," Ms. Lyle said.
Ms. Newell, who conceived of the clinic through a fellowship with the Princeton, N.J.-based Robert Wood Johnson Foundation, has raised awareness about the mental- and physical-health needs of students in the Evergreen State through her research and advocacy efforts, colleagues say.
Raised in Wisconsin, Ms. Newell, 54, initially thought she would be a teacher. When it came time to select a path of study in college, however, she chose nursing.
"Going through school, I had always wanted to combine the two, to be a teacher or a nurse," she said.
Volunteer to Career
The combined interests eventually led her into nursing education. She earned a master's degree and doctorate before she taught at a community college and led professional development at a Baptist hospital before she found her way into school nursing.
Ms. Newell took a sabbatical from teaching when her son, Cameron, started kindergarten. Born at 25 weeks, he had kidney problems and had to have his catheter changed regularly. Because the school didn't have a full-time nurse to do the job, Ms. Newell did it herself.
She never returned to teaching. Ms. Newell quickly became the school's nurse and then the district's nursing director, a position that requires her to write health plans for students that mesh with the classroom plans of teachers. For example, she might meet with a mathematics teacher to coordinate a student's insulin injection and testing schedules.
"It is probably the most rewarding career you could ever have," Ms. Newell said of nursing.
More than half the students in the Kent district—located in a city of about 120,000 people 19 miles south of Seattle— qualify for free and reduced-price lunches.
The idea for the in-school clinic grew out of experiences that Ms. Newell had navigating the unique needs of individual students. Some had unusual health conditions that required extra help during the school day, and some had needs that were going unmet because of their parents' circumstances.
For example, Ms. Newell once grew concerned when a boy began failing school because he was chronically absent—missing 60 percent of school days—and he couldn't keep up with his lessons.
During a home visit, she discovered that the boy and his mother both had severe asthma and lived in an apartment that was infested with mold and mildew.
"He stayed home so they could share the asthma inhaler," Ms. Newell said.
District leaders contacted public-housing officials, who helped relocate the family, and Ms. Newell helped the student buy his own inhaler.
Link to Absenteeism
Asthma, which affects about one in five students in the district, is a major contributor to absenteeism, particularly for poorer students, who may live in older dwellings with air problems and may go longer without a diagnosis or treatment, Ms. Newell said.
The district's nurses meet with classroom teachers at the beginning of each year to discuss how to identify and respond to life-threatening conditions—including allergy, asthma, and seizures. Because of Ms. Newell's leadership, the National School Nurse Association gave her an award for asthma management in 2003.
School staff members have a special insight into students' health needs, Ms. Newell said, because they consistently see them at the students' most active point in their day.
The district's nurses work to take advantage of that perspective, she said. At one point, following complaints from school staff members that a student repeatedly visited the nurse's office unnecessarily, a nurse listened to her lungs and discovered undiagnosed asthma, a condition she immediately reported to the girl's parents.
"They're not always coming in just to get out of math class," Ms. Newell said. "There's usually something underlying that's bringing them there."
That same whole-child approach became central to conversations about the design of a new alternative high school that the district planned to launch, said Principal Lyle.
"We looked at the risk factors [for dropping out], and so many of them were really around the social, emotional, and physical health needs of students," Ms. Lyle said.
"If students aren't healthy, if they're having [post-traumatic stress disorder], if one parent has just killed another parent—literally, these are cases that are in our schools—if somebody doesn't work with that student, and talk to that student, and help them keep healthy, they're not going to be able to do high school."
A team of district administrators charged with planning the alternative high school listed 15 risk factors for dropping out and decided what programs to pursue based on how many risk factors those programs addressed. The Teen Health Center, as Ms. Newell's program came to be called, addressed 13 of those factors.
Care on Site
The school, Kent Phoenix Academy, also provides emergency food supplies and hosts credit-recovery and online programs.
The clinic, staffed by a part-time nurse practitioner and a full-time mental-health therapist, is underwritten by a grant from the Washington state health department. It also accepts insurance if students have it.
Ms. Newell devised plans for the clinic as part of her participation in the Robert Wood Johnson Executive Nurse Fellows program, a competitive, three-year leadership program.
The program's leaders selected Ms. Newell, a rare school nurse fellow, because it was clear that she had influence outside her district, said program director Mary Dickow.
"We had that unique case of having a school nurse in what we saw as a very influential position," Ms. Dickow said.
Last year, about 75 percent of the school's 400 students used the Teen Health Center at least once, and about 75 percent of visitors came more than once, Ms. Newell said.
While the clinic is primarily designated for the alternative school's students, it also offers limited appointments to students from a nearby campus.
About seven out of 10 clinic visits are related to chronic or ongoing conditions—such as asthma and diabetes, district data show.
The staff there have helped students with suicidal thoughts come up with safety plans, referred students to optometrists who fit them with their first set of glasses, and diagnosed anxiety disorders—all conditions that threatened to keep them out of the classroom. Clinic staff members also help students make plans to discuss their health situations with their parents, which can be daunting for some, Ms. Newell said.
"I think we're looking at it from the holistic perspective," she said. "Health is not just physical health, it's also mental health. In order to be successful at school, one needs to be successful at home."
The program reduces out-of-class time for students, even offering on-campus prenatal care for pregnant girls, and lessening the need for them to travel to off-site clinics for care, Ms. Lyle said.
"Mary is just a collaborative leader that is insightful to the needs of the community and its students," the principal said. "We talk too much about academics only, especially with the challenges students face."
Vol. 33, Issue 23, Pages s45,s46
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