School nurse – A one-person clinic that cares for kids

We are IU Health

September 19, 2019

On any given day, Tiffany Lindsay never knows who will walk through her door – an eight-year-old with asthma, or a seven-year-old who lost a tooth. It keeps her on her toes.

By T.J. Banes, IU Health Senior Journalist, tjbanes@iuhealth.org.

She’s a mom, she studied child development in college, and she later became a nurse working in adult trauma care.

Those qualifiers alone could put Tiffany Linsday at the head of the class as a school nurse. But she’s learned over time there are no two patients alike – especially in a school that represents 17 different countries, 12 different languages, and a large population of students who receive free and reduced lunches.

On any given day she can see as many as 150 students. Their needs include diabetic blood checks, asthma treatments, and first aid for scrapes and cuts.

Lindsay began working for IU Health in 2006 as a unit secretary. After high school she attended Purdue University studying child development but eventually felt it wasn’t her calling. At IU Health her co-workers encouraged her to go back to school for her nursing degree. She completed her degree in 2017 and began working at IU Health Methodist Hospital with adult trauma critical care patients.

A back injury lead to on-the-job restrictions and when she could no longer lift patients, she began searching for alternate paths to pursue a career she loves. Married to Nathan Lindsay for 20 years, the couple has three children attending Washington Township Schools – Adeline, a junior and Gavin a freshman at North Central High School and Garrett a first-grader at Allisonville Elementary.

IU Health provides 12 nurses throughout Washington Township Schools – including eight elementary schools, a developmental preschool and three middle schools.

Lindsay works at Fox Hill Elementary in an office that displays a poster of a hand-drawn roll of Lifesavers and several colorful candies. The sign reads: “Mrs. Lindsay, thank you for taking such good care of us. You’re a lifesaver.” The rest of her office is decorated in bright colors – encouraging students to eat a rainbow of colors. She changes the theme throughout the year to drive home other messages: Heart health, appropriate sleep and summer safety.

On any given day, her office is a flurry of activity. She answers the phone “Good Morning, Fox Hill clinic,” and proceeds to answer parent questions. One student comes in with a tooth that has just fallen out. Lindsay helps her wash up and then places the tooth in a necklace, puts the necklace around the little girl’s neck and sends her on her way. There are other students who come in regularly for blood sugar checks and asthma treatments. A teacher comes in to have a burn bandaged.

To keep track of the youngsters in her care, Lindsay keeps a notebook and also records activity electronically. At the end of last year, the notebook was so full she couldn’t close it.

“It’s just like nursing at a hospital – you triage with ABC – airway, breathing and circulation,” said Lindsay, who also spends a lot of time talking with parents and helping educate them when a child has a chronic condition such as asthma or diabetes. With 100 fewer students in the school this year, she’s not as busy as the previous year but there is limited downtime.

“We want the kids to be successful. When you get medicine from the drugstore they don’t give it to you in Burmese or Swahili. We have a very diverse student population here so I spend a lot of time working with parents and helping them understand their child’s ongoing cough is not just a cough, it’s symptoms of asthma,” said Lindsay. All the school nurses work closely with IU Health’s Rebecca West, the district manager to help connect families with additional resources. “If I have ten kids I’m worried about, she knows all ten kids,” said Lindsay. If the family needs to see a specialist such a pulmonologist, the nurses help connect them and refer them to IU Health physicians.

The nurses meet twice yearly to talk about primary concerns such as allergies. Many students have never been exposed to certain foods and parents aren’t familiar with allergies. The nurses often become the first line of contact.

“I’ve had parents bring younger siblings in. We joke that it’s like urgent care. Parents have me look at something on them because they have nowhere else to go. As a nurse you get asked a lot of questions,” said Lindsay. She takes it all in stride and manages her day with a cadence filled with smiles and words of encouragement.

Fox Hill Elementary serves children in Kindergarten through Fifth Grade. Lindsay’s goal is to help the older students – with chronic conditions - learn to manage their treatments. Last year she had 60 scheduled medicines and treatments a day – every one of them organized in a secure file cabinet. The same cabinet houses a red medic bag that she grabs every time there is a fire drill or emergency. She is ready for whatever comes her way.

Each Friday she gives out prizes to the students who have ongoing medications. They are rewarded for their compliance at a time in their lives that they’d rather be playing with friends and ignoring treatments.

“It’s not always fun being called out of class for meds. I have students with diabetes who have to miss gym if their sugar levels are too high and I have students with asthma who can’t go outside if the temperature is above 80 or below 40. That’s a lot of time they spend in my office,” said Lindsay. To help them pass the time she provides books and drawing materials and sometimes employs their help making ice packs. Her prize box is filled with stuffed animals, pencils, books and bracelets.

When a little girl fell and broke her arm last year, it was one of those stuffed animals that helped soothe her until her parent arrived at school.

Lindsay has also used the prizes to motivate students with difficult health issues. Last year she helped nurse a young student who was born prematurely and was underweight. He just wasn’t eating and his mom often called or sent text messages to Lindsay seeking advice.

“My goal was to encourage him to eat and by the end of the year he was eating chicken nuggets and pizza. He’d gained eight pounds,” said Lindsay. She works closely with teachers and the school social worker in situations where student conditions are more than just a scrape from a playground fall. She even keeps a box of clothes for when a child needs a quick change.

“That mom instinct comes out a lot. When I have a student coming in frequently with an upset stomach, I start asking questions about a break up with a boyfriend or what’s going on at home,” said Lindsay. When a student complains of heartburn she asks what he ate on his way to school. All students receive free breakfasts at Fox Hill but there are always backpack snacks that they grab from home.

“A big one is those hot Cheetos and corn chips. When they eat those we might Google heartburn and then have a full conversation about healthy snack choices,” said Lindsay. “We look at the lunch menu together and I help guide them to make the best choices.”

In addition to the daily care of the students, Lindsay arranges vision screenings with the Lions Club for third- and fifth-graders and any other student recommended by staff members. She also coordinates a visit by a mobile dentist, Big Smiles.

“We have so many who need these services. Last year we had them once, this year my goal is every six months,” said Lindsay. The dental care includes cleanings and she is working to also get fillings for the students. “Last year we had kids referred for root canals. Can you imagine sitting in class and trying to learn and being in so much pain and then trying to eat a healthy lunch of carrot sticks and still feeling the pain,” said Lindsay.

She sees her role as not only a caregiver, but also a nurturer. Like the teachers in her building, Lindsay doesn’t clock out when the buses leave for the day.

“I absolutely love this job and connecting to the kids. I am here to help them learn by managing their physical health – that impacts so many areas of their lives,” said Lindsay. “Last year we had 800 students and I could call 700 of them by their name. Either I had seen them in the clinic or I knew their face. They all mean the world to me.”

Photos by Mike Dickbernd, IU Health visual journalist, mdickbernd@iuhealth.org

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