A 21st century school nurse

Five minutes into the first period at Northeast Middle School in Minneapolis, the school nurse, Nathan Grumdahl, is contemplating calling 911. A teenage girl is in his office wheezing and complaining that she is dizzy. She tells Grumdahl that she was in the emergency room at 3 a.m. this morning with an asthma attack and she doesn’t have her rescue inhaler. He coaches her through breathing exercises, listens to her lungs and takes her vitals, jotting notes on his hand — an old habit from his days as an emergency room nurse. On his mind is another student’s death from unmanaged asthma at her home only days ago.

Grumdahl calls the student’s mom, who is 45 minutes away and without a way to get to the school. Without other better options, he calls the paramedics. When the first responders and paramedics arrive — cramming into the nurse’s office, which still has a stovetop from its days as the teacher’s lounge – they give the girl a nebulizer treatment and take her back to the hospital she was at only hours ago.

Most days don’t start this way, but it’s not uncommon either. “There are days where I don’t stop, I’m eating, charting, running, responding to calls, getting meds,” said Grumdahl. “It can be pretty intense.”

A team of health professionals

Grumdahl is just one of a team of health professionals working at the school. A dentist comes in once or twice a week and there are social workers, mental health therapists, medical assistants and paraprofessionals on hand daily. Given the number of American Indian students, about 10 percent, there is a mental health professional from the Indian Health Board and a social worker from the district’s Indian Education Program.

Of the students attending Northeast, nearly half are African American students and about a fourth are white. The vast majority — 80 percent — qualify for free or reduced lunches and 20 percent of the students receive special education services. Grumdahl adds that many of the students are homeless or in transitional housing, including the teenager with the asthma attack.

The school is equipped to address some of the challenges that can get in the way of learning. There is a room full of toiletries and clothes for students to take who need them, a washer and dryer, and a punching bag and yoga mat for de-escalation.

Punk rock days

Prior to becoming a school nurse, this isn’t what Grumdahl envisioned the work would look like and he didn’t see himself as one either. In fact, he spent a few years touring as a musician with the punk rock band Selby Tigers, which eventually led to opening for The Hives. He was selling vintage musical instruments when his son had to be delivered via an emergency C-section. That health scare reminded Grumdahl of an earlier interest in becoming a nurse. “I remember thinking if I’m ever going to do it, I’ve got to do it now,” said Grumdahl. So in his early 30s, he enrolled in the Bachelor of Science in Nursing program at the University of Minnesota. Juggling the responsibilities of work, being a dad and full-time student was hard, but he thinks he got more out of the experience than he would have when he was younger.

Although he doesn’t fit the typical profile, he said serving as a school nurse was an immediate fit. “You don’t see a ton of men working in any kind of pediatric field, especially as a school nurse, it’s pretty rare,” said Grumdahl. “But after the first pediatric rotation I did as a student nurse, I was like ‘This is it.’” He credits his initial interest in nursing to having a younger sister who is developmentally disabled, and he is also a child sexual assault survivor. “There is a piece of it for me that wants to be there for kids,” said Grumdahl. “That, for me, informs how I showed up to nursing.”

Not a one-size-fits-all environment

Grumdahl learned early on that as the school nurse at Northeast, there would be no one-size-fits-all answers. “It’s not as simple as recommending a parent take a kid to the doctor,” he said. “It’s the public health piece that can be difficult.”
While difficult, he also finds the work meaningful. “The stuff that these kids are dealing with is profound,” he said. “I’m providing another layer of support in their lives, so when they’re at school there is someone who is knowledgeable and who they know cares about them when they’re in a bad place.”

Not long after the girl with the asthma attack was wheeled away on a stretcher, another student comes in complaining of a sore tooth. Grumdahl is quick to ask him when his last cleaning was and to remind him that he can see a dentist at the school. He also asks if he had breakfast and when the student said he hadn’t, Grumdahl reminds him he can have breakfast for free at the school and encourages him to have lunch. Later, when a student with Spina Bifida comes in, the banter is easy and light hearted.

“Being a school nurse here means supporting a community of kids that are not getting a lot of support in this world and that’s pretty meaningful. You can throw yourself at it 150 percent and it will be like ‘give me some more,’” said Grumdahl. “So yeah, this is the kind of nursing I want to do.”