updated 3/4/2004 2:54:39 PM ET 2004-03-04T19:54:39

The nurse at your child’s school doesn’t really spend most of her time tending to skinned knees or dispensing acetaminophen for headaches. There are big issues to deal with as well.

That nurse is the first line of defense for every kid in school who could be grappling with anxieties or depression, overweight, asthma attacks, thoughts of suicide, alcohol or drug problems, lice, rashes, or any other problem large or small.

Sometimes all a tearful child needs is a bit of reassurance and a hug; sometimes the nurse recognizes the need for more serious intervention.

“They are often the first to see signs of trouble in a student and identify alarming trends among students,” said Dr. Gail Milgram, academic director of the Johnson & Johnson School Nurse Fellowship Program and an expert on drug and alcohol abuse.

The squeeze in school budgets makes it all the harder for a nurse to cover all the fronts — at some schools one nurse is responsible to thousands of students — so the program Milgram oversees is trying to make a dent by assisting some school systems with ideas and specialized training to deal with these problems.

An evolving role
Thirty-three school nurses — mostly from the United States but this year including participants from Colombia and Kenya — traveled to New Brunswick, N.J., in July for a weeklong immersion course at Rutgers University’s Institute of Alcohol and Drug Studies, where they concentrated on strategies to help schools deal with drug, alcohol, physical, emotional and behavioral issues.

And the nurses didn’t come alone; the program requires that the principals of their schools attend at least the first two days of the sessions. The 33 school pairs were the largest class since the program was started on 1988.

After completion, the nurse-fellows and their principals were eligible to apply for an implementation grant of up to $1,500 to turn their ideas into realities.

“While the grant money was critical to having activities in our school district, we also had the chance to develop the program with our school principal,” said Karen Tremblay, a school nurse from East Taunton, Mass., who was a fellow in 2002 and subsequently set up a “Fun & Fit Club” for first- and second-graders to learn healthy eating habits. “She was completely on board from the beginning, which was absolutely essential to the program’s viability.”

Some other projects that grew from the fellowship program have included a “You’re In Charge” opera staged by fourth-graders in a Pennsylvania school, showing how kids can say “no” to drugs; a crash course for seventh-graders at an Albuquerque, N.M., school, demonstrating how violence can grow from poverty, substance abuse and teenage pregnancies; and a parenting skills course for pregnant high-schoolers in Pennsylvania.

Johnson & Johnson has sponsored the program since its inception, and more than 300 school nurses have participated. “We wanted to reach out to a population that has a direct and critical impact on children,” Milgram said. “We saw that the role of the school nurse had evolved from a person to go to for a Band-Aid and a sympathetic ear into one of the most important and influential adults in the school community.”

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