Laura Bryant, like all school nurses in the Cabarrus County School District, keeps a small blue box in her office. Inside, the standing order of Benadryl and epinephrine waits in the case of a student's undiagnosed severe allergic reaction.
In her nine years as a school nurse, she has never had to use it, but knows a few colleagues who have rushed for their boxes after a bee sting or food reaction unexpectedly tightened a student's airway. "If it weren't for that little blue box with that epi and Benadryl in it, those children might not have made it," she said.
Readiness for severe allergic reactions, whether previously diagnosed or undiagnosed, has become standard protocol for school nurses nowadays. So has readiness to treat asthma, diabetes and other chronic conditions students bring to school on a daily basis.
It's a factor that has changed the traditional roles of school nurses. No longer are they simply sticking a bandage on a scraped knee from recess or calling a parent to pick up a feverish child. School nurses today are in charge of more and more doctor-prescribed individualized student plans, caring for everything from ADHD to migraines to seizures.
"The complexity of the role has certainly changed," said Jan Odell, School Health Director for Cabarrus Health Alliance. "Years ago many children who had some of the more profound medical needs wouldn't necessarily have even been in the school."
Last year, the Cabarrus County School District reported 7,200 students diagnosed with chronic conditions. Of those, 2,092 were asthmatics, 105 diabetics, and 670 suffered from severe, life-threatening allergies. Other conditions, such as migraines, leukemia, seizures and ADHD were also included in those numbers.
Bryant, a nurse at Mt. Pleasant Elementary School, is unsure whether children today are diagnosed more proficiently than past generations, or if a rise in the number of illnesses can be attributed to growing up in modern American society. "Children just seem to be sicker," she said. "Children with asthma, diabetes."
In her small cinderblock nurse's office, hand-painted with cheerful flowering pots and leafy trees, Bryant keeps 16 other epinephrine doses, all belonging to students previously diagnosed with reactions severe enough to close their throats or send hives erupting all over their bodies.
She is aware of the 45 students diagnosed with asthma at the school, and the one diabetic student whose fluctuating blood sugar she must watch daily. Other children stop in throughout the day for medications prescribed by doctors.
Each student with a chronic condition has a specialized plan. "There may be a child who needs his inhaler everyday before he goes out to play, and there's another child who has an inhaler, but they only need it if they have symptoms of shortness of breath, or feel tight in their chest," said Odell. "Whatever their doctor says."
Caring for students with individualized plans hasn't erased the other tasks that fall upon school nurses. Organizing mass vision, hearing and lice screenings; educating students on healthy habits; and taking care of those with the contagious coughs, sore throats and stomach bugs that travel through the classrooms still remain as duties.
The roles of nurses may have changed over the years, said Odell, but the mission remains the same.
"Our true objective is really to help keep the child healthy, in their desks, in their classroom, and able to learn."