Many people think of school nurses as the people in a school building responsible for patching up a scraped knee, confirming a fever and checking students for lice.
It’s not that they don’t do those things. It’s that those tasks are only a very small part of what Eva Stone views as a significant role within a school.
Stone, manager of district health at Jefferson County Public Schools, a large district in Louisville, Kentucky, with about 100,000 students, has served as a school nurse for more than two decades, after working in a hospital setting and in public health.
School nurses, she notes, have more access to children — seven or eight hours a day — and their families than really any other health care professional. It’s unique, and it’s also full of opportunity.
In a large, diverse district, she works with children and families who face significant barriers to health care — be it because of language, education, time or money. The school often can step in and help. “We have the opportunity to take them out of poverty, to change the course of what the rest of their lives will look like,” she says.
Stone knows that health is not only critical to a person’s well-being, it’s essential to their learning and academic success too. That’s why school nurses, she says, are key to helping students get — and stay — “classroom-ready.”
For our Role Call series, we feature individuals in traditional school roles that are often misunderstood or overlooked, pulling back the curtain on what their work looks like and how they help shape the day for kids. In this installment, we talk with Eva Stone about school nursing.
The following interview has been lightly edited and condensed for clarity.
Name: Eva Stone
Age: 56
Location: Louisville, Kentucky
Role: Manage health services for the district
Current age group: All ages, including staff
Years in the field: 24
EdSurge: How did you get here? What brought you to your role?
Eva Stone: When I first got out of college, I worked in an ICU for a while, and I decided I wanted to be doing something that was more on the proactive side. I wanted to help prevent people from ending up in ICU and with the chronic conditions that they had. That's what led me to public health.
Way back when my children were small, I was supervising health services for a health department, and a school nursing job came open in the neighboring county. I wanted some more time in the summer with my kids, and so I moved into that role. That’s what started it, and then I just fell in love with it.
My mom is a retired nurse and my dad is a retired principal, so it was kind of the best of both professions. I used to spend summers helping my dad deliver things to classrooms when all the orders came in, and so I guess that's where I developed a love.
[After I became a school nurse], I went back to school and became a nurse practitioner. I didn't know that I would stay working in school health, but the role, it just kind of worked. So I started doing more. I worked in a fairly small district at the time. We had 10 schools, and I was able to do more with staff, do bus driver physicals and those things, and be part of the administrative team for the district. I just fell in love with school health and the opportunities that we have to impact students.
I worked in that district for a number of years, then worked in a neighboring county, worked between both of the counties and got my doctorate degree, and then landed this position in Louisville. We didn't live in the Louisville area, but two people reached out to me about applying for that position. And so I thought, ‘Maybe that is a sign that I need to check it out,’ and ended up coming to Jefferson County Public Schools.
Of course that was before the pandemic, so it's been an interesting ride. But there's just such incredible opportunity in schools that no other entity in the health field gets to see. And that is, you're in an environment where you see the family — or you don't see the family, which is telling — and you see the child throughout the whole day. You just have access to things that health care providers in clinical settings outside of schools really don't have.
There's just such an incredible opportunity, first and foremost, to help children succeed educationally, which is the most important thing we can do for their long-term health. But then to help teach them self-management of chronic illnesses, to help identify mental health conditions early, so many ways that we can touch children's lives and their families’ lives. Again, in our field, it's all boiling down to helping a child get through school successfully.
So you feel like part of the allure and the reward of being in the school setting, for nursing, is just being more proactive than reactive?
Yes, but it's also helping families to navigate health care. Our health care system is very complex, and the more technologically advanced we've become, the more we've left a lot of families behind. If I have to call a clinician, I'm calling a central number and they ask me 10 questions to get me to the right person. If I have a language barrier, if I have an education barrier, if I have a poverty barrier, meaning I only have so many minutes on my phone, all of those things make it challenging to access the health care system as it's become in the United States. School nursing is an opportunity to meet families where they are and help them get the care that they need.
When people outside of school ask you what you do, how do you describe your work?
I tell them that I work in school nursing, and if it's in the summer, they always say, ‘Oh, well you have the summers off then,’ or, ‘What do you do in the summers?’ I chuckle when I say that because a lot of people think school nurses just have an easy job. School nursing is a unique type of nursing. It's very specialized, and people just don't realize that.
So I tell people what I do is I get to make a difference in the lives of children and families and help work toward setting a trajectory of their lives, that we have the opportunity to take them out of poverty, to change the course of what the rest of their lives will look like. And that school nursing is very important work.
What do you wish you could say to them?
What I would like to say is, ‘Does your child have a nurse at their school? And do those nurses get to practice to the full scope of their practice? And does your district have children that aren't succeeding academically?’ Because if that's the case, then there's an underlying reason, and there need to be people involved in that work. School nursing is so much more than just the Band-Aids and boo-boos and head lice that people, for a long time, have perceived school nursing to be.
Do you feel like the role has evolved to be more expansive now? Or has there always been that misconception?
I think there's always been that misconception.
When school nursing was developed — which was in New York, by Lillian Wald, who was a public health nurse that made a big difference in schools — it was not designed to be Band-Aids and boo-boos. It was communicable disease. It was preventive care. It was making sure that children were in school. It was doing something about attendance when kids weren't in school.
That is what school nursing has always been designed to be, but school nursing is often led by educators in districts. And I have the utmost respect for educators, but they're not nurses. So there are times when a school nurse’s role has been defined as Band-Aids, booboos and head lice. But if they're limiting the work of their school nurses to those things, they are greatly underutilizing an incredible resource in their schools.
You've mentioned, a few times, the opportunity to take families out of poverty and change the course of their lives. Could you maybe say a little bit more about how, through nursing, you might be able to do that for a child or their family?
Say you have a child who is missing a lot of school. I'll use chronic absenteeism because that's such a significant issue at this point in time. So the child comes to school every day and is coughing, coughing, coughing, coughing. I've actually had teachers tell me, ‘Oh yeah, he's been doing that for a while now.’ Well, the nurse assesses the student and says, ‘This child's not breathing real well.’ So that leads to a phone call with the parent. And in talking to the parent, there's all sorts of things that you find out. You find out they don't have health insurance, which in this day and age should never be a barrier, but it's an incredible barrier for families. It might be that this family has grown up with everybody coughing like that, so they don't recognize that as abnormal.
And so when the nurse gets involved and starts working with the family and developing those trusting relationships, what you end up discovering is the child has asthma. He's missing school all the time because he's ‘sick,’ but really he has asthma. If I'm a child living in poverty and I'm living in poor housing conditions where there's cockroaches, for example, that's a significant trigger for asthma.
Then you start this whole cascade of resources and working with the family and educating the parents on management of a chronic disease that has significantly been impacting their learning. Now you have the chance to change that child's school attendance, and then you have the chance to ensure that the child's at school and classroom-ready, which at the end of the day is what every child needs to be successful.
Another example: During a recent year, we had over 9,000 elementary students who failed their vision screenings at school, who had nowhere to go. We have no referral sources in the city for kids who don't have insurance, or don't have means to have a vision screening or a vision exam or can't navigate that system. So we partnered with a local foundation, some eye doctors, and we brought vision clinics to the schools.
In the very first clinic that we had in a school, the doctors were completely blown away because these children's prescriptions were so severe, and they'd never had glasses. Well, if you aren't reading by third grade — there are states that predict the number of prison cells they will need based on third grade reading levels. They're at a disadvantage from there on out. So is it significant that kids can see when they start school and they start to learn to read? It's incredibly significant, and it can make a difference in their education for the rest of their school years.
Lots of states have laws that require these things. They require families, for example, in Kentucky, to have a vision exam before they start school for the first time. But if I don't have the resources to have a vision exam, then I can't go. The intent of the laws are great, but until you have the mechanisms in place to ensure that every child has equal opportunity to access the services that we all know are necessary, then every child living in poverty is at a disadvantage.
What does a hard day in your role look like?
When we came back to in-person learning during COVID, the district used ESSER funds to put a nurse in every school. Now that ESSER funds are gone, our administration decided to continue that anyway. They're funding a nurse in every school, and we're actually going to have 15 nurse practitioners out in the schools moving forward, providing physical health services for students because there's such a gap. So a very hard day for me is trying to make sure that the health needs are being met in 155-plus schools. When we have nurses who are out sick and we have all these dynamics going on, that makes for a really hard day.
But the boots-on-the-ground level of that is just hearing and meeting kids, knowing what they're going home to every day — or not going home to every day — and having to recognize that I'm limited in what I can do. I don't like it, but that is the way it is.
To give you an example from last year, we have a lot of international families, children who are new to the United States, in our district. We have about 20,000 kids who are multilingual learners. When you hear the stories — kids just will look at you and tell you in a matter-of-fact voice what they've been through in their life and that they've spent most of their years in a refugee camp — when you see families that have made these very difficult journeys to get their children here so their children have a better chance, and they come and the child has diabetes and they're rationing insulin, meaning the child's not treated appropriately because they don't have enough medicine to treat the child appropriately and trying to figure out how to navigate those things.
I mean, it's just hard. It really can wear on you after a while because we're in the 21st century, and we're a resource-rich country. The fact that we have so many children going without basic needs — and that includes food — is just mind-boggling to me.
What does a really good day look like?
A really good day looks like finally getting somebody in the community to listen and engage when you talk about the issues that students are facing that you just can't get any help with.
Here’s an example. So our medical director, when he first started at the local health department, he wanted to meet. I sat down with him, and he wanted to know: What do you see as issues for children in Louisville, Kentucky, that attend Jefferson County Schools? So the vision exams — kids needing glasses — is what we talked about. He said, ‘I think I can do something about that.’ His background is as an ophthalmologist, so he rallied volunteers, and we worked together and we planned this first clinic.
So they came in, and like I mentioned, the eye doctors were blown away by the level of need. But then we scheduled a day to come back and hand children their glasses — I'm going to get emotional. They put on their glasses, and they could see things they've never seen before. You leave at the end of the day thinking, ‘Yeah, there's a lot more work to do, but we're going to take this win because it's a pretty big one.’
What's an unexpected way that your role shapes the day for kids?
I tell the nurses this all the time: You're going to have students who come into your office because they need your pat [on the back]. You're a nurse, and there is a respect that is associated with nurses — America's most trusted professional for over 20 years. We tell them all the time, ‘Your interaction with children has the ability to shape their day. And so you are the pat that they need.’ They'll just come in and really all they need is just somebody to say ‘Hello,’ and ‘How is your morning going?’ And get them off to class. But maybe they're not getting that need met elsewhere. Maybe they're not getting that hug or that smile elsewhere. Nurses — that’s really what we try and emphasize — make a difference for every child.
What do you wish you could change about your school district or the education system today?
What I would change is really the recognition that nurses are health care professionals and that health care is not separate. Health is not separate from a child's academic success. So what I would change about the education system in general is to make health foundational, not ancillary, for education. Until every child is classroom-ready every day, then that child's not going to reach their full potential.
Your role gives you unique access and insight to today's youth. What's one thing you've learned about young people through your work?
No matter what is happening, I never leave a school after being around children that I don't feel recharged and rejuvenated. They're resilient, they're brilliant, they're passionate, and they give me such hope for the future because I see a wisdom, particularly in our young adults, that maybe they've not always seen in the world around them. We can talk a lot about young people and worry — there are a lot of issues and challenges this generation of kids is facing — but we're the adults. We're supposed to live in a world where we value our children and put all their needs first. And I don't see kids giving up in that hope. I see kids engaging, and I'm just always astounded by their resiliency and their smiles and their hugs. It's why I do what I do. They have a joy that hasn't been snuffed out, and we need to make them a world where they can continue to be happy and healthy.
