SDR nurses manage growing health needs across six buildings

Two registered nurses are responsible for managing health services across all six School District of Rhinelander buildings, serving hundreds of students daily including 11 students with diabetes who require monitoring multiple times per day.
School nurses Valerie Leighton and Gary Leinon outlined the scope of their work during the Feb. 16 school board meeting, detailing how they coordinate care, train staff and partner with community organizations to ensure student health and safety.
Leighton works primarily at the high school and middle school, while Leinon rotates between Crescent, Pelican and Central elementary schools two days per week, adjusting as needed based on personnel changes and student needs.
“Obviously, there’s only two of us. We have six buildings, so we have to depend on a lot of people and a lot of community organizations to assist us in making sure that our students are as safe and healthy as they can be,” Leighton explained.
Data presented to the board showed a significant increase in health office visits this school year compared to last year. Central Elementary has nearly reached or exceeded last year’s total number of visits despite being only partway through the academic year, the nurses reported.

The nurses emphasized that visit numbers don’t tell the whole story, as appointments can range from a few minutes for scheduled medications or temperature checks to several hours for students with complex needs.
“These visits can range anywhere from a few minutes, depending on if they’re, like, a scheduled medication or just a temp check things like that, up to a couple hours,” Leighton said, noting that some students have migraine treatment plans allowing them to remain in the health office for up to two hours.
The district currently serves 11 diabetic students who require scheduled health office visits at least two to three times daily for blood sugar monitoring and management.
Thanks to Dexcom technology, nurses can monitor some students’ blood sugar levels remotely through mobile devices, allowing them to catch trending issues before they become emergencies.
“With the help of that, we’re able to catch a lot of trending low blood sugars before they arise,” Leinon said. “Sometimes those visits take, you know, it’s a minimum of 15 minutes to raise their blood sugar and recheck if they’re at a safe level.”
If blood sugar levels don’t stabilize quickly, nurses must continue monitoring for additional 15-minute intervals, meaning a simple check can easily turn into 45 minutes to an hour depending on how the student’s body responds.
“So there’s a lot of time spent with that,” Leinon said. “Those visits, just because their numbers are down, doesn’t mean that the length of those appointments aren’t greater too.”
To ensure coverage when nurses cannot be present in every building, Leighton and Leinon conduct extensive training at the beginning of each school year. When Leighton started with the district, she trained 62 to 65 staff members in medication administration. That number has grown to just over 100 staff members.
Building-level administrators identify staff for training, typically including at least one teacher and one teaching assistant per grade level, plus all office staff and additional personnel needed for field trips.
Each school also has building responder teams trained to handle emergencies like seizures, and all buildings are equipped with AED devices. Staff members are trained on epinephrine auto-injectors as well.
The nurses delegate certain tasks to trained staff members for situations like field trips and when they cannot be in buildings, though they remain available by phone and email for consultation.
According to Leighton and Leinon’s report, approximately one-third of district students have at least one documented health condition, ranging from diabetes and asthma to gastrointestinal issues and allergies.
The nurses work to identify and address barriers to care for individual students. “We really want to close the gap by addressing what is appropriate for each and every student,” Leighton said. “We know that everyone’s different. We know that their access and their barriers are different.”
The district collaborates with North Lakes Community Clinic for annual dental outreach, addressing the shortage of dental care access in the area. Last year, 296 students received care including 71 sealants and 805 fluoride applications, representing nearly $54,000 in preventative dental care provided to students in grades kindergarten through fifth.
All families have the option to opt into or out of the program. The nurses promote participation by offering electronic opt-in forms and sending reminders as appointment times approach.
“We really tried to promote all of them to do that by having the option to opt in electronically,” Leinon said, emphasizing the importance of preventative measures. “We really want that opportunity to come across the parents as often as possible.”
The district also partners with the Rhinelander Lions Club members for vision screening. Students in kindergarten, first, third and fifth grades are screened annually, with second and fourth graders screened by referral. This year nearly 700 students were screened, with just under 50 requiring referrals for follow-up care.
Families without vision coverage receive vouchers good for one free eye exam, one free set of frames and one free set of lenses through Shopko Optical.
Leighton and Leinon are both members of professional nursing organizations including the Wisconsin Association of School Nurses and the National Association of School Nurses. They participate in ongoing training including managing special education needs, vision screening through Prevent Blindness, and Stop the Bleed certification.
School nursing services are governed by educational code and include developing emergency action plans and providing district employees with guidance on health-related situations.
“A hallmark of our successful school nursing practice is building relationships,” Leighton said, noting their work with athletic training services, the community health department, school resource officers, EMS, police and medical providers to coordinate comprehensive care.
Superintendent Eric Burke acknowledged the nurses’ critical role in supporting students and families. “We’re very fortunate to have Val and Gary in the district,” he said.