Critical-care nurses

After hearing about body lice in health class, a ninth-grade boy last year went to see Karen Anderson, the school nurse at Edgewood High School in Edgewood, Md. The boy had been experiencing certain symptoms and a friend suggested that maybe he had contracted a venereal disease.

After talking with the boy for a few minutes, Ms. Anderson asked him a question: "Did you actually have sex?"

"I only did it once," the boy said.

The nurse noted how young the boy was and asked him why he had made that choice. "We had a real good discussion about that," Ms. Anderson, 42, told WORLD. "Before he left, he said he wouldn't make that choice again."

Not every school nurse would choose to steer a high-school student toward abstinence. But that's one way Ms. Anderson, a Christian, lives her faith at work without violating public schools' hands-off approach to religious expression.

As public-school bureaucracies step up efforts to lock their doors against God, Christians serving in those schools-and in some secular, private ones-often face conflicts between their faith and official policy. In the classroom, such clashes often occur over curriculum-evolution versus creation, for example-or questions about a teacher's expression of faith. But for school nurses, who often provide guidance issues ranging from drug use to teen pregnancy, the conflict can have more immediate consequences. And schools' "don't ask, don't tell" policy on religion often prevents them from dispensing what is sometimes the best medicine of all: spiritual guidance.

Ms. Anderson spent 10 years as a public-school nurse in a rural farming community before moving to Edgewood, a rough Baltimore suburb. It was a bit of a culture shock, she said, coming from a district where events included "Bring Your Tractor to School Day" to one where kids came to her office asking for condoms.

But at Edgewood, the kids don't get them. The school promotes abstinence, one of the few in the surrounding metro area that does. Still, Ms. Anderson said, "They come in and ask me for condoms, and in some ways that's good. It opens the door for me to talk to them, to say, 'You really need to think about what you're doing.'"

On that front, Ms. Anderson's belief in the biblical concept of abstinence until marriage meshes well with her work. On another, not so: District policy prevents school nurses from telling a girl's parents that she's pregnant. "We have to encourage the girl to tell."

Sometimes that happens, sometimes not. In one case, a senior asked Ms. Anderson to help her tell her mother. Ms. Anderson did and though the mother was upset at first, she helped her daughter place the baby for adoption. Ms. Anderson said talking about her own positive experience as an adopted child helped the family through their decision-making. And she "always, always" counsels against abortion, encouraging adoption instead.

Her attitude contrasts sharply with that of Lola Charette, a public-school nurse fired from a district in Bangor, Maine. Ms. Charette is suing Fort Kent Community High School for reinstatement and back pay after officials terminated her for taking a girl out of class to an off-campus clinic, where the girl received a pregnancy test and an abortifacient drug.

Maine law prohibited Ms. Charette from telling the girl's parents she was pregnant. Ms. Charette said she tried to convince the student to speak with her parents, but the girl refused and would not give the nurse permission to speak to them for her. The district fired her for violating an "unwritten" rule that allows parents to intervene.

Ms. Charette's decision to take the girl for an abortion may be a product of her profession's liberal stance on sex and sexuality. In its statement on sex education, the National Association of School Nurses (NASN) does not mention either abortion or abstinence. But it does endorse "evidence-based" sex education, a companion phrase for "medically accurate," a political term of art that means "not abstinence only." Meanwhile, NASN's official position statement on homosexuality-which refers to homosexual students using the gay-activist shorthand "LGBTQ" (Q is for "Questioning")-acknowledges homosexual students as a subgroup with special health needs to which nurses should be sensitive.

Michelle Treaster found other reasons to be sensitive. Until this year a school nurse in Columbus, Ga.-she's now a stay-at-home mom-her job included teaching an abstinence-based reproductive health course to fifth-grade boys and girls, the classes separated by gender. "I'd talk about puberty, their bodies changing, personal hygiene, but that was as far as I went."

The kids went further: Ms. Treaster's curriculum didn't address sexuality per se, but students would sometimes bring it up, asking, "When is it OK to have sex? When is it OK to have a baby?"

Most of the students came from low-income urban neighborhoods that included a lot of single-parent households. That presented Ms. Treaster with the delicate problem of holding to biblical morality without condemning lifestyles the children had observed in their own homes-of which some were a product. "I knew that a lot of kids had moms who had never been married, or had siblings from different fathers," Ms. Treaster said. "I didn't want to say, 'Well, your life is wrong.'"

Instead, she said, "You're not ready to have sex until you're ready to take care of a baby. And you're not ready to do that until you're married and have a stable family to bring the baby into."

"My mom's not married," some kids would say. Ms. Treaster's response: "That would be something you'll need to talk with her about."

Like Ms. Treaster, Cathy Hongosh, 48, would like very much to delve deeper than her school's unwritten policy on religious expression will allow her. A school nurse at Lakeridge Academy, a secular private school in North Ridgeville, Ohio, she leads a regular, informal chat session for fourth- and fifth-grade girls. The group "gets them ready for middle school, where it's really important to 'fit in,' to wear the right clothes and all that," Ms. Hongosh said. "We try to get to them before all that and talk to them about what makes them unique."

In some discussions, she said, each girl shares about something she likes to do and is good at. Ms. Hongosh affirms each girl's uniqueness, but it frustrates her that she must stop short of indelible affirmation, of telling the girls that God has created and gifted each of them and has a sovereign purpose for their uniqueness.

"I have to keep it on a real generic level," she said. "It's just scraping the surface. I can't get at the truth."

Ms. Hongosh emphasizes that she's never seen a written policy on the topic, or been told by Lakeridge officials that she can't go further. But the school celebrates diversity and she has noticed a hands-off approach to discussing religion. "I'm just being careful," she said.

She is also careful when kids come into her office with somatic complaints: the headache, the stomachache, the all-purpose "I don't feel good."

"Most of the time the [complaints] are not even real," Ms. Hongosh said. "I need to figure out whether they're trying to get out of something, or whether something else is really bothering them," such as fear of peers, a test, or an issue at home.

That's where more frustration comes in. "If I was working at a Christian school, I could talk to them about how God is with them in their situation, how God is helping them," she said.

Instead, she counsels them that she cares, and that there are other adults, including parents, who also care and will help. She also prays silently for each child who comes into her office. "I feel like that's what I can do right now and that that's important," Ms. Hongosh said.

That and giving each child a heartfelt hug. "It's kind of nice," she said, "that you can still do that."