VIENNA — Maries R-1 nurse Lindsay Otto came to the Oct. 24 school board meeting to update board members about some of the challenges her office has faced this year.

One of Otto’s points was discussing the district’s increase in high-acuity students, which are the students who need closer monitoring or quick intervention for their conditions. More than 110 students in the district have some type of medical plan in place.

“That is a lot higher than we have ever had before,” Otto said. “I have had to, in one split-second, decide whether I’m going to give a student an inhaler or run upstairs for a seizure. What do I do?”

The nurse’s office does have part-time help, but Otto said the office still gets overwhelmed, especially in times outside the 17 hours each week when she has extra help. In the last couple of years, a grant helped fund visits from a licensed practical nurse from Four Rivers Community Health Center, but that grant is no longer available. The nurse’s office went from two staff members almost every day to two staff members about two days each week.

“Coming here tonight and asking for help is something that I have not wanted to do, but I’m here on behalf of all my students,” Otto said. “Everything I do here is with their health and wellness and safety in mind. I have been overwhelmed for a long, long time in the office and things have gone undone. It’s time to think about our students and put their health and safety first.”

Otto brought data about how many visits her office handles during the school year. During the last school year, the nurse’s office had 5,649 visits, which was 800 more than the previous year and 1,600 more than seven years ago when Otto started with the district. She told the board to remember that no two tally marks are equal.

A trend that Otto noted is an increase in students visiting the nurse’s office for mental wellness. She said because some students have known her for seven years, they trust her to share their struggles.

Board member Matt Novak asked why students do not visit the counseling office for those issues.

Otto said she refers students struggling with mental health issues to the counselors, but sometimes those students visit her office first because their emotional health is affecting their physical health. Younger students especially do not realize the connection between mental health and physical symptoms.

In cases where a student needs to talk with a counselor, Otto often walks the student to that office or calls for the counselor to come to her office. The nurse and the counselors have monthly meetings where they discuss their concerns about students.

Board member Dave Garro said he had concerns that if the nurse’s office is taking care of students’ mental health concerns, then the district is not realizing the full extent to which students need mental health care. The district could try to bring in more school-based therapists to meet some of those needs, but it first has to know there is a need.

Novak said he understands there is overlap between students’ mental and physical health, but the nurse’s office should work with the counselors as much as possible to make sure students get the attention they need and avoid staff burnout.

“It’s all about the kids,” board member Mike Kleffner said. “If we can do anything for any kid, I don’t care who does it. If we can help a kid out, that’s what this school is about. A lot of these kids have nowhere else to turn to.”

Another responsibility Otto has as the school nurse is completing paperwork. One of the reasons it has gotten more difficult to keep up is because of a state law added a few years ago that requires school nurses to notify a student’s parents every time the student visits the nurse’s office. She estimated that she sees about 20 to 40 students per day. The district’s use of the Class Dojo digital program has made it easier to send messages to parents.

Otto shared a recap of everything she did during one day earlier this semester. Before 11 a.m., she had 17 visitors in her office. She met with parents to update a student’s health plan. She caught up on charting visits from the previous day. She worked on programming a preventative service program. She followed up with the school-based therapist about a referral. She coordinated compliance reports. She provided students with their prescribed medications. She updated a coach about health plans. She made a list of parents to call about missing eighth-grade and 12th-grade vaccines. A call to a classroom interrupted her lunch. She answered calls from the doctor’s office about vaccine records. She sanitized the office. She stayed late to work on charting and continued the task over the weekend.

Other occurrences during the day included a student having an allergic reaction on the bus, a student with a burn wound, a parent dropping off medication, two students hitting their heads and a staff member who came to the office experiencing symptoms of an illness.

Board Vice President Dave Long asked what the nurse’s office needs for help.

Otto said the office needs another person.

Kleffner asked what kind of person the office needs.

Otto said it would be nice to have someone with medical training.

“When I tell parents that we’re going to take good care of their kids, we need to back that up,” she said.

“We appreciate everything you do,” Long said. “We have to figure out something to try to help you a little better.”

Superintendent Teresa Messersmith said the board will discuss help in the nurse’s office more at a later date.

Also during the discussion, Otto said she had finished state reporting, which includes immunization compliance reports and data on how many students have certain types of medical conditions. Teachers and bus drivers had received student medical plans. The nurse’s office would like to do a back-to-school registration before the open house next year to get medical plans out earlier so district staff can be aware of students’ situations earlier. The process would include verification of vaccine compliance and updating medical plans and contact information.

During an oral health program in October, 91 students in the districts received screenings and fluoride applications.

Otto said she learned a lot about trauma response at a state training about medical response. She plans to do Stop the Bleed training next year and get certification. Bleed kits were part of the district’s proposal for a school safety grant it received earlier this year.