School Nurse Has Many Different Roles At Sandy Hook

By Jeff White

It is Monday afternoon and Sandy Hook School Registered Nurse Sally Cox says her office was surprisingly quiet for much of the day. The office, adjacent to the school’s main office, is usually teeming with students – as many as 70 in a given day. As the last bus pulls away for the day and sloshes out to Riverside Road, she muses about only having seen 32 children today.

Mrs Cox, 47, is sad this afternoon. Amid Winnie the Pooh and Mickey curtains, and walls adorned with animal pictures, she sits behind her desk and speaks generally about one of her special-needs students who passed away over the weekend. It is a difficult thing for anyone to deal with, especially for someone who comes in contact with children, both healthy and sick, every day. Mrs Cox is charged with caring for a school population of 700 students. “You get attached to them,” she explains. “You really get to know their emotions and needs.”

Sally Cox has been a registered nurse for 26 years, getting her start in hospital wards and doctors’ offices. During some of the time she was at Danbury Hospital specializing in orthopedic nursing. She has worked with an oncologist, administering chemotherapy doses, and allergists.

She has been a nurse at Newtown High School and St Rose Parochial School, and for the past 12 years she has traveled down Dickinson Drive to go to work at Sandy Hook School.

Being a school nurse, especially at the elementary level, has its attendant challenges that differ from clinical and emergency nursing. Young students often are not as cognizant of the nuances of their bodies, Mrs Cox explains. “Just because kids are younger it is more difficult for them to communicate [exactly] how they feel,” she says.

It is this reality that often thrusts her into the role of something akin to a sleuth, where various pieces of a student’s puzzle need to be assembled in order to get an overall picture of what potentially is behind a persistent ailment.

A Detective

“I really am like a detective sometimes,” Sally Cox confides. “You have to have a lot of knowledge about how kids act.”

For one thing, she keeps constant tabs on each student and the number of visits he or she makes to the nurse’s office in a given week. Each one of Sandy Hook’s students accounts for a 5 x 8-index card in Mrs Cox’s filing cabinet. “Because every person is different, there is a challenge to get to know [each student] individually,” she admits.

Frequent, even daily, trips could indicate something more than an upset stomach. “I keep an eye out for trends,” she says.

A student can come to her a couple of days in a row with a stomachache. Mrs Cox will take note of the symptoms, the approximate time of each visit. The student’s ailment could be indicative of an impending virus. But she will also check in with the teacher, see what the student is studying at the time he or she has been making the trip to the nurse’s office. She will even call home, talk with a parent. The stomach discomfort might indicate a problem with school, a student struggling with a particular subject perhaps. It does not hurt to check all bases, Mrs Cox insists.

Often, setting up unfettered communication channels between parents and teachers will help get at more of the big picture. A student could be battling stomach irritation at night and make a passing comment to a parent. A teacher might also be able to corroborate with daytime evidence that a student has looked ill for a few days in class.

By covering her bases, Mrs Cox says she is able to get to the bottom of what exactly is troubling a particular student and to take action when warranted.

She knows that understanding how young students behave can aid her in determining if certain ailments are indicative of social or learning deficiencies that often mask themselves in common health complaints. Mrs Cox also uses experience dealing with special needs students — those students who have profound medical conditions that call for special feedings and medications — to look for warning signs in all her young patients.

But normally Mrs Cox is seen by students simply as the friendly woman in the colorful nurse’s gown — today, a white gown dotted with various Betty Boop nursing scenes — and a warm smile. She will be there to comfort an under-the-weather student.

Her detective work aside, on any given day Mrs Cox has to worry about recess.

Out there, amongst swings, slides and seesaws, the drama of an elementary school student’s life unfolds in dodgeball games and raucous tag sessions. Alas, in recess’ maelstrom, students can and do get hurt.

And that is what makes up most of Mrs Cox’s visits with students, tending to bumped heads and bruised elbows.

Or course, a playground injury can turn serious, as a fall off a jungle gym can land a student in an ambulance on his or her way to the emergency room with a broken bone or a concussion. Mrs Cox recalls one such scary incident, when a student suffering from a bad fall went into seizure.

But those are rare, yet serious, cases. More often than not, a student found sitting in her office at lunchtime is there for a scheduled reason, to receive a daily antibiotic or allergy pill, to have their hearing and vision tested, or to lie down temporarily to abate nausea or a headache.

“I’ll ask them if anything hurts, do they feel sick,” she explains of her basic procedure with a student. “I’ll look at their throat, [take their] temperatures. Sometimes it’s a simple case of not enough sleep. Other times it’s indicative of impending illness.”

Diagnosing a health problem, and subsequently bringing relief to an ailing student, is reward enough for Mrs Cox. “I get a lot of satisfaction in following through and problem solving.”

Sandy Hook’s booming population, the highest of any Newtown elementary school, requires Mrs Cox to utilize help, in the form of Jill Schmidt, who works with Mrs Cox two hours a day “to help alleviate the stress of the [increasing] student population.”

In addition to students, Mrs Cox is also charged with looking after Sandy Hook’s 80-plus faculty and staff, who often come through her door looking for medical advice. Although she does not necessarily treat them, Mrs Cox explains, she does give her coworkers insights and advice on how to proceed treating various health problems.

In recalling her years tending to the needs of Newtown High School students, Mrs Cox agrees that the older the students get, the less they need the teaching facilities of a school nurse. But for elementary school students, who do not have the independence (and often knowledge) to make health decisions on their own, Mrs Cox finds that her duties as school nurse ultimately boil down to teaching children about their bodies.

An Educator

“I’m very verbal,” confides Mrs Cox. “I like to explain things. You try to give [students] simple explanations and that’s how they learn about themselves.”

She might shed light on a stomachache by telling a student why they happen, what they often mean. A exceedingly hot day might land a student, red-faced and sweating, into the nurse’s office after recess. Mrs Cox will explain to that student that because of the heat he or she is simply overheated and drinking water on such a day is the best way to cool down.

“I try to teach them about cause and effect,” she says. “I think the more knowledge they have about their bodies, the less anxiety they have.”

Not surprisingly, Mrs Cox is hesitant to dole out pills and aspirin for apparent aches and pains. Rather, she opts to explain to her students why they feel how they feel, and encourages them to relax. Often times, 30 minutes on one of the two beds in her office will bring beneficial results, she says.

According to Mrs Cox, it is important to emphasize to students that “a pill isn’t what they should reach for first.”

Perhaps what makes Mrs Cox effective in balancing her investigation, diagnoses and teaching among Sandy Hook students is that she has ample chance to hone her craft outside of school. One night a week, she is down at Ashlar tending to residents. And then there is perhaps her toughest job: she is a mother of two college-age girls.

Although she might often change her nurse’s gown between Snoopy and “Super Nurse,” she remains constant in forging a maternal-like relationship with her students. “Working in a school is a happy environment,” she laughs, not least of all because each day brings with it the chance to get closer to another student. “You think of them as your own children.”