MCSD lead nurse retiring, proud of progress but hopes program continues to grow

The quote at the end of Darlene Shirley’s emails, paraphrasing former U.S. Surgeon General Joycelyn Elders, sums up her philosophy as the Muscogee County School District’s lead nurse:

“Children must be healthy to learn and learn to be healthy.”

After directing MCSD’s Department of Health Services for the past 16 years, Shirley is retiring next week. Her last day of work is on Halloween. She joked, “I think I’m going to come dressed up as a nurse.”

When she began her MCSD career January 2001, there had been only one nurse in the school district. MCSD’s Health Services Program now consists of the lead nurse, nine registered nurses, seven licensed practical nurses and 57 part-time clinic workers. Each RN serves a cluster of six to seven schools. The LPNs are scheduled as needed to cover designated schools. The clinic workers are permanently assigned to their school to assist students with daily healthcare needs. They are certified in CPR and First Aid, Shirley said.

“The program has grown to better meet the needs of the students with health issues and continues working to remove health-related barriers to learning for our students,” she said.

Her supervisor, MCSD student services director Marcus DuBose, said the district’s student immunization compliance rate has soared from approximately 75 percent to 99.5 percent during Shirley’s tenure.

“She is a very caring, loving person who would help anybody in need,” DuBose said. “… We are losing another trailblazer in MCSD, but her vision and passion for the job will still affect all of us to be greater.”

‘Need a nurse in very school’

Shirley praises the progress MCSD has made in student health services, boosting quantity and quality while keeping up with the increased student medical needs and required documentation, but she wants the program to continue to grow.

“We need a nurse in every school,” she said.

Then she explained why.

“When you have a nurse in the building, the administrator can administrate, the teacher can teach, the secretary can secretary,” she said. “I mean, they can do their jobs. They’re not having to deal with their job and trying to manage a child. They don’t know the underlying pathophysiology of hypoglycemia or hyperglycemia.”

The “gold standard,” Shirley said, would be to have an RN at every school, “but I think, for where we live, that’s unrealistic.”

So she hopes MCSD will have LPNs at every school. She even would accept an intermediate improvement of having full-time clinic workers at every school.

But sometimes more staffing doesn’t equal better care.

Shirley recalled the time she was discussing with a school nurse from another school district how to accommodate a student who was transferring to MCSD. That school district has a nurse in every school, Shirley said, but she overheard the nurse say to a colleague, “You know, that child was supposed to have an EEG back in April, but that mama never got back to me.”

Shirley declared, “That would just not work for us. When it comes to taking care of a child, we will move Heaven and Earth.”

Health advocates

Indeed, sometimes school nurses seem like a better advocate for students’ health than their parents.

“Sometimes the parents can’t be,” she said. “It’s not because they don’t love their child; it’s because they don’t have the resources they need. We do some of that too.

“We try to help the parents get the resources they need to better supply what their child needs at school, like children’s medical services at the health department. They’re a good resource. When you have a Type 1 diabetic, you have to have snacks and you have to have (glucose test) strips and you have to have a meter, so we get things as best we can. Sometimes we go to the store and buy snacks and things ourselves.”

In addition to helping her fellow nurses, Shirley often dispenses health advice for school staff and parents treating children.

She soothed an upset mother who called and asked about the controversial HPV immunization, which Shirley assured her the student doesn’t need to attend school. “That is something you would want to discuss with your doctor,” Shirley told the mother.

Shirley emphasized that school nurses don’t diagnose. Instead, for example, they tell parents, “Your child has symptoms consistent with conjunctivitis.”

‘It takes everybody’

The part-time clinic worker at each MCSD school is available for a total of 19 hours per week. The time periods vary, depending on the needs of the school. The principal is the supervisor, and the secretary or school counselor usually fills in when the clinic worker isn’t there, although the itinerant nurses also help, Shirley said.

“It takes everybody who touches that child every day,” she said, “and it takes relationships with parents and the care providers in the community.”

A high school diploma is the only educational requirement for a clinic worker to be hired in MCSD, which then trains them before school starts each year, usually with two half-day sessions, Shirley said.

Clinic workers can administer medicine, take care of Type 1 diabetics, manage an asthmatic or an anaphylactic episode, provide tube feedings and empty colostomy bags, Shirley said.

“But we have many clinic workers who are certified nursing assistants,” she said. “We also have a couple of retired nurses.”

Shirley noted, “There are other school districts that are staffed just like we are across the state. There are some that are staffed better, and there are some that are staffed not as well. I think we fall somewhere in the middle. … There are some school districts that have one nurse for 20 schools.”

‘Can’t imagine doing anything else’

As a teenager growing up in Phenix City, Shirley was a candy striper at Cobb Memorial Hospital.

“I just liked being in that environment and being helpful and providing care for people,” she said. “I can’t imagine doing anything else.”

And she hasn’t for 42 years, but her mother wanted her to become a teacher, so Shirley went to Auburn University to achieve that wish.

Following her first year at Auburn, however, Shirley transferred to Columbus College for pre-nursing studies, earned her LPN diploma at Cobb Memorial School of Practical Nursing and her associate’s degree in nursing to become an RN at Chattahoochee Valley Community College.

Shirley worked as a nurse at local hospitals and doctor’s offices until 1997, when she became executive director at the House of TIME (This I Must Earn), a residential addiction treatment program for homeless women. Nearly four years later, she heard about the lead nurse position MCSD was creating. It was a chance to work more directly in the nursing field again, she thought – and sort of fulfill her mother’s wish of being an educator.

“It’s so funny because I didn’t want to be a teacher, but we do so much teaching in the training of our clinic workers,” she said, “and I love doing education with the children.”

Shirley helps educate MCSD staff members who are responsible for students with medical needs, from duties as routine as dispensing daily medication to services as complicated as helping a student who had an organ transplant.

“We do a lot more than just give out band-aids,” she said. “We take care of children who have medically complex problems … and we manage a host of chronic health problems every day in our clinics across the schools, and I’m very proud of the job that our clinic workers, our nurses and the school staff does every day.”

Shirley said she is looking forward to “spending more time with family and not working so hard with the really long hours.”

Then, relieved that she didn’t cry during the interview, she added, “I’m going to miss everybody here. I’m going to miss the kids and the nurses I work with every day.”

This story was originally published October 25, 2017 at 1:51 PM with the headline "MCSD lead nurse retiring, proud of progress but hopes program continues to grow."