CEO Darcy Davis spotlights School Health's Michelle Iavarone in Walk a Mile in Your Shoes
Michelle Iavarone, RN
School Health Supervisor
When I finished this Walk a Mile experience, I realized that this was the most emotionally draining of my interactions with staff thus far. I went to South Grade Elementary School in Lake Worth and Lake Worth High School. I only spent half a day between the two schools, listening and learning from our teams, but felt like I absorbed a lifetime of emotion.
I witnessed children dealing with adult problems and saw our school nurses, Antonio Artero, RN, Liz Condon, RN, and Jenny Saccarelli, RN and School Health Supervisor Michelle Iavarone, RN gracefully managing one heart-wrenching issue after another. These nurses are not just passing out aspirin and Band-Aids as a stereotypical perception might suggest…these caregivers are significantly impacting the lives of over 170,000 children in Palm Beach County every day.
Managing the volume
By the numbers there are 167 public schools in the county with dedicated Health Care District school nurses serving more than 170,000 children. That requires an army of qualified nurses to deal with the number of issues that they may see. Nurse supervisor Michelle has one of ten regions with 17 schools. In those 17 schools there are over 1,000 chronic conditions that are managed with approximately 579 medications. Many of those conditions are life-threatening, including 30 diabetics. But some of the more difficult situations they deal with are not purely medical.
Antonio Artero, RN, - South Grade Elementary School
Antonio is a pillar in this school. All of the children, teachers and most of the parents know who he is, not just because he has worked at the school for 15 years, but because he lives in the heart of this community. Antonio was very modest about his role and gave me a lot of the “facts” about his job, but Michelle gave me some behind the scenes stories about his lasting impact.
One such example, was about a boy from Guatemala with cerebral palsy who came to his school. When the parents brought him in, he was wheeled into the room in an infant umbrella stroller. The boy was obviously too big for it, but it was all they could afford given their modest means. Antonio took it upon himself to find a used wheelchair that was a better fit. But he didn’t stop there. He continued to advocate for this child with local agencies and was ultimately able to get a $7,000 mechanical wheelchair donated to the family so that the boy was more self sufficient.
Hearing and Vision screening, it doesn’t end there
On the day that I was at South Grade, Lauranette Wilson was also at the school conducting hearing and vision screenings as mandated by the state. I watched her act as a technician and a very patient child-advocate as she repeated the directions over and over and firmly got the anxious and rambunctious groups of first graders through the routine.
When one little girl clearly failed the hearing test while we were watching, I asked Antonio what happens next. He said he will check to see if perhaps there is something in her ears. This immediately piqued my interest; I mean what could be in her ears besides wax?
He proceeded to share with me a number of situations that he had encountered, particularly centered on finding roaches in kid’s ears. Some alive, some dead. Whoa! I was floored. We continued our discussions about roaches and I learned that this was not unusual at all.
He had another wheelchair-bound patient whose wheelchair was infested.
“What do you do about this?” I asked.
In the case of the roach in the ears, beyond just removing it right away, he successfully had the landlord fumigate the family’s home after working with the child’s parents. For the boy in the infested wheelchair, Antonio took it apart and cleaned it himself, then followed up with education for the parents about preventing this from happening again.
I was amazed, impressed and truly humbled by his compassion for these children who were facing challenges I had never even imagined. Antonio goes above and beyond and truly lives his calling.
A child’s perspective
I spoke with a few of the children about Antonio as they were waiting for their screenings. I asked them what they liked best about him. Of course as first graders, their vocabulary may be a bit limited; most of them said, “He’s really nice,” one child said he was really tall, and another one shared that he was a good dancer. He’s not only admired by all the adults, but he also has a special place with these kids who will remember him positively for forever impacting their lives.
Going to High School
The children are bigger, the schools are bigger and sometimes the problems are bigger. Even as we were walking into the school, Michelle was educating me about the teen pregnancy issue.
In this school alone, there were 33 teen pregnancies last year, but this year the good news is that they were on a downward trend. But even one may be too many.
From left: Liz Condon, RN, Michelle Iavarone, RN, Jenny Saccarelli, RN, and Darcy Davis
As we walked into the school clinic, there was a teenage girl in tears, talking earnestly with Liz. I soon learned that this girl was pregnant for the second time, and had been kicked out of the home she was living in the night before. She was now homeless and had nowhere to turn, except to the trusting relationship of her school nurses. Liz was connecting her with local resources that perform outreach and allowing her to use the phone to make arrangements for herself and her child.
Because this is an all too-familiar challenge, there is history and precedent on this matter. Our school nurses have been instrumental in establishing teen peer groups. While this may not have had a direct impact on the number of pregnancies, there does appear to be a correlation between the peer group and ultimate graduation rate of these pregnant girls.
In this capacity, I was witnessing our nurses in the role of counselor, shoulder to lean on and emotional supporter. This was not the medical care that is assumed when the word “nurse” is used, but it is the ever-necessary role that our valuable human resources perform when they step into a high school.
Seeing it all
While I was caught up in the emotional turmoil of the pregnant teen in front of me, the medical issues started piling into the school health room. The diabetic patients were coming in for sugar checks, all very familiar with the nurses and the process, because they were “regulars.” A girl with a high fever and a sore throat was being addressed; strep throat was going around. A boy was sick to his stomach and was lying on the cot. The clinic was an array of medical and emotional issues.
Jenny told me that just a few days ago she was also doing some wound care treatment on a boy. He had been involved in a fight off campus and his assailant attacked him with a machete. Again, I was overwhelmed by what these nurses were dealing with. It didn’t feel like the school clinics that I went to when I was in school.
I felt like I was in an emergency room or a counselor’s office, but in this case there was only one, or in the case of Lake Worth High School due to its huge student enrollment, two people to deal with this menagerie of complex issues.
Lifeline
Without ever being prompted by me, Antonio, Liz and Jenny all raved about their boss Michelle. She had been my guide and educator all morning and I could tell from her very calm demeanor that she was well-suited for the role of nurse supervisor. She and the other supervisors are the lifelines for our nurses. They are the tethers between being a guest in someone’s house, i.e., the School District, and being part of the clinical army for the Health Care District.
From left: Antonio Artero, RN, Lauranette Wilson, Health Support Technician, Darcy Davis, Michelle Iavarone, RN, School Health Supervisor
Michelle troubleshoots with nurses and supports them when they feel like they are out on a limb. Imagine the challenge of seeing an abused child and having to call the authorities. Or regularly subjecting yourself to the wrath of the parents or the ire of teachers when making a decision. How about navigating a disease outbreak like norovirus? No one should have to do that alone.
Dr. George L. Lockhart, Principal of Lake Worth High School also knows Michelle and spent a great deal of his personal time telling me stories about how valuable she and the nurses were to him. He’s been in several schools throughout the county and shared with me his perception on the true partnership he had with our caregivers, the only medical professionals in a vast educational operation.
Our nurse supervisors walk hand in hand with the nurses on the front lines. Just talking about how supported she felt by Michelle, Liz broke down in tears.