GREAT BARRINGTON --- The first task for school nurse Rebecca Donovan, which isn't always easy, is assessing what's wrong with the elementary school children who walk into her office.

Donovan, or Nurse Becky as she's known at Muddy Brook Regional Elementary School here, can easily identify a broken bone. But as any school nurse knows, children's problems won't always be based on physical ailments.

"It's difficult trying to find a real problem because it might not be a health issue at all," Donovan said.

School nurses play important roles, such as administering daily medications students may need, like insulin shots for diabetes or albuterol for asthma.

It's also not uncommon for cash-strapped parents to suggest their child visit the school nurse to save money on a doctor's appointment, Donovan said.

For these growing children, Donovan said providing emotional support shouldn't be understated.

"They sometimes come from difficult living situations, they need extra TLC," she said.

Donovan said as a nurse she can't diagnose medical ailments, but can, instead, assessa patient's condition with serious problems meriting a call to the parent.

"Sometimes their stomach ache isn't a stomach ache," she said.

In Massachusetts, school nurses are required to have at least a bachelor's degree in nursing, a valid license to practice as a registered nurse in the Commonwealth and a minimum of two full years of employment in a clinical-health setting, among several other requirements.

As with classroom teachers, they also need to pass the Massachusetts Tests for Educator Licensure communication and literacy test and complete a maintenance of certification by showing they are up-to-date in their field.

According to Massachusetts School Nurse Organization Region 4 Chairwoman Cathy Draghetti, becoming a school nurse can be a competitive process because the hours are family-friendly

The salary range widely varies depending on whether nurses are on the teacher's salary scale, Draghetti said.

Responsibilities include recording data for state-mandated testing. For example, students are required to take hearing, vision, height, body mass index depending on their grade level.

The age of their students can dictate what nourses are most likely to see. Adolescents in middle school could be dealing with physical and emotional changes, along with a need to exert independence. They also need to learn about alcohol and substance abuse and the dangers of smoking.

"You will troubleshoot the trigger," said school nurse Pat Harper, of Monument Valley Regional Middle School.

There's also a different philosophical approach than in a hospital.

"The focus is on education, it's not on health," Harper said. "We are keeping them healthy so they can be onboard learning."

Still, Harper said she provides health tips when she can on healthy living.

At of Mounument Mountain Regional High School, nurse Nancy Graham said it's not unusual to see relationship troubles lead a student to the school nurse's office.

For these three school nurses, timing played a big role in their landing their current jobs. Graham was a nurse at Albany Medical Center Hospital and Berkshire Medical Center, but then assumed a substitute role before before getting her school post.

Harper, at Monument Valley, worked in emergency care, and Donovan, at Muddy Brook, worked at Berkshire Medical Center for 11 years before becoming a visiting nurse.

The Massachusetts Department of Health and Human Services recommends a school nurse to student ratio of one for every 250 to 500 students.

But there is no state requirement that schools have a nurse on staff. In Massachusetts, Draghetti said the state average is one nurse for every 700 students.

Through two decades of service, Graham said she's learned -- whether it's elementary or high school students -- that it's important to show compassion.

"You are the mother in both," said Graham, 59. "I remember that in grade school it was about being compassionate and caring. It's not much different here. They're just bigger kids."

To reach John Sakata:
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(413) 496-6241.
On Twitter @jsakata.