Northfield Middle School nurse John Costello was at the beach one day, enjoying the last vestiges of summer, when he spotted the parent of one of his students.

“‘Oh!’” she said, as Costello paraphrased it. “‘I have my child’s medication!’”

Into the nurse’s room cabinet it went, one more individual precaution to keep track of during the coming school year.

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Today, the nearly 74,000 school nurses in almost 100,000 public elementary and secondary schools across the country do so much more than the cliche of handing out a few aspirin and sending kids back to class.

They perform bloodwork, are consulted on mental health and influenza outbreaks, and keep track of specific students’ needs.

“There’s an idea of what school nurses used to do,” said Somers Point Superintendent Bob Previti. “What they have to do every day is very different.”

One change, said Northfield Superintendent Janice Fipp, is the increasing number of reports due to the state Department of Education from everyone from superintendents to principals to business administrators.

“In the past five years, it’s like we’ve never seen it before,” Fipp said of the demands of paperwork. And this mandate has also found its way to the school nurse’s office. “My nurses have to be well-versed in law, medical issues, requirements and mandates of the Department of Education. ... And they’re asked to be consultants to administration, the maintenance department and parents.”

Costello and the Northfield Elementary School nurse, Virginia Wolf, were getting their shared office ready Monday for the influx of kids next week — which, thanks to advances in medicine and state regulations, will include a number of children who may not have been able to go to school in the past.

“We have children with unique maladies who used to be homebound,” Costello said. “Now they’re in public school, taking part as fully as they can. ... (It) makes it possible for children to succeed in a new environment.”

One of the issues that has grown “exponentially” in Somers Point and elsewhere, Previti said, is allergies — food and otherwise.

“In every grade level, there’s children with food allergies,” he said. “And almost every section of every grade level, there’s children with asthma.”

In Northfield, issues come to Wolf’s attention beginning in preschool, which allows her to add to a child’s Individual Healthcare Plan, or IHC.

“Some have sensitive food allergies, some have sensitive environmental allergies, and some kids have very severe allergies,” Wolf said. “All require an individual chart. ... (But with) little tiny kids, it’s difficult. They can’t speak up, and a lot of them don’t know.”

Once they get to middle school, “they’re more independent, and they’re going to be advocating for themselves,” Costello said.

In Wildwood, where Thursday was the first day of school, Glenwood Avenue Principal John Kummings said nurse Cindy Fritz has been instumental in helping students (and parents) find access to care ranging from dental work to mental health.

“One of the things she’s done is reach out and get mobile dental clinics to come to the school,” Kummings said. “She’s been very involved in finding resources for students. Many have very specific needs, and a great deal falls on the nurse.”

Then there’s times when the nurses have to diagnose.

“A lot of stuff is a judgment call,” Wolf said. “There’s no X-rays, there’s no doctors here.”

Recalling her 27 years as a nurse, one occasion stands out in her mind.

“A little girl walked in off the playground,” Wolf said. “I think she fell off the jungle gym? Did we still have that? There were a lot of kids in here, and she sat in the very last chair. She was just a little thing. I saw her sitting there, and I told the other kids to just chill. I put her on a cot and told her to sit still. And we needed to call an ambulance, because she pulled all the muscles in her back. She ended up in a brace. I just knew something was wrong. (Sometimes) you don’t know except from the facial expression or the way they’re sitting.”

In Northfield this week, Costello and Wolf changed the pads on the defibrillator stationed outside their office, one of three placed around the complex, part of a requirement implemented in 2002. Another recent requirement is the focus on concussion awareness, which includes a detailed poster just inside the office.

“That’s been going on now for three years, but it took full effect last year,” Costello said of the concussion program. “It’s about making kids and parents aware of it. Nobody wants to pull their kid out. In eighth grade, (they think) everybody’s going to get a scholarship to Duke. ... It’s tough. But I don’t pay people’s bills.”

Nurses have also been consultants on some of the flu outbreaks of the past few years, including swine flu.

“In my experience, not to cause panic is the best course of action,” Wolf said. “And sometimes things get a little overblown, no offense, in the media.”

“You get a lot of, ‘Johnny went to my daughter’s class and went through a whole box of tissues yesterday; Johnny doesn’t need to be in school today,’” Costello said. “We have to educate people on flulike symptoms, whether something’s a virus or it’s allergies.”

Like other districts, Northfield partners with Atlantic County in keeping track of the number of student absences and their reasons, part of the voluntary Influenza Survey Program. The county also provides information on respiratory and gastrointestinal illness prevention, regular sources of referrals and resource guides for families, said Pat Diamond, director of the Atlantic County Division of Public Health.

AtlantiCare runs a continuing education program for school nurses called the “School and Pediatric Nurse Lecture Series” and offers workshops four times a year, said AtlantiCare spokeswoman Betsy Woerner. Past lecture topics have included childhood depression, immunizations, pediatric emergencies and cardiovascular diseases.

The staff at Northfield, Costello said, is very amenable to adapting to new ideas and models — which, he added, is not often the case.

“I’ve worked for principals where I’ve had to (keep saying), ‘I know it used to be done that way, but it’s done this way now.’”

Kummings, for his part, knows how important nurses can be.

“I don’t know how I could ever live without a school nurse,” he said. “Especially the school nurse here, who goes above and beyond.”

The Associated Press contributed to this report.

Contact Steven Lemongello:


@SteveLemongello on Twitter

Press copy editor since 2006, copy desk chief since 2014. Masters in journalism from Temple University, 2006. My weekly comics blog, Wednesday Morning Quarterback, appears Wednesday mornings at

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