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Each June, as the familiar commencement processional plays at the John A. Coleman School graduation ceremony, school nurse Lynn Nazzaro is reminded why her job is so important.

The graduates, mostly 5- and 6-year-olds, line up, dressed in suits and ties or frilly dresses topped off with mortarboards. They march, often on crutches, walkers, or splints, or riding in wheelchairs, each accompanied by a staff member, to get their diplomas.

“It really touches your heart,” Nazzaro says. “They have done everything that they can do to get to this point.”

Nazzaro, RN, knows well what is involved in that journey. She is one of two nurses at the White Plains, N.Y., campus of the John A. Coleman School, which serves more than 300 students from 25 school districts in the New York areas of Westchester, Putnam, Bronx, and Manhattan who have complex diagnoses. After leaving Coleman, some of the children will go on to other special education programs.

Others will enter traditional public schools. Unlike its sister campus in Manhattan, where the students are in-house residents of the Elizabeth Seton Pediatric Center, most of the children on the White Plains campus, who range in age from 18 months to 8 years old, are bused in from their homes and return there after their half-day or full day of classes.

Nurses at the school work closely with teachers and parents to make sure each child is getting the most from the classroom experience. If a teacher sees that a child looks or acts differently, the nurse will assess the child and might need to consult the parent to see what the morning was like at home.

The difference in the child could be as simple as a missed breakfast or a shortened sleep cycle, says Grace Schiavone, RN, nurse supervisor at Coleman. The nurses meet with the parents when they start the program to collaborate on needs and priorities and get family histories. They keep in regular contact on the child’s progress. Sometimes it’s an anxious parent who needs the nurturing.

“Especially at the beginning of the program, it’s difficult for parents. It’s not like these kids are kindergarteners going off to school. These are babies,” says Schiavone, who has worked with the school for 16 years helping parents establish goals. “You have to realize each child is unique. For instance, it could take a child five years to learn to walk.”

Despite the large number of students who come and go, bonds between staff and children are strong and enduring.

Blythedale Children’s Hospital

The nurses who work with the school inside Blythedale Children’s Hospital in Valhalla, N.Y., know that bond well. Four nurses might treat as many as 50 children at the school each day and assess many more.

Blythedale is the only hospital in New York with a public school on site designated to serve more than 120 special-needs students each day. Mount Pleasant — Blythedale School educates children who have had burns or transplants, severe injuries or traumas, seizure disorders, need cardiac or respiratory care, or have feeding tubes or catheters.

Some of the students come from the inpatient unit at Blythedale, an acute care rehab hospital that cares for children who are medically fragile and complex or in need of intensive rehab. But most are bused in from their home school districts.

The curriculum includes traditional core subjects as well as language arts, technology, music, art, and library studies. The nurses work with teachers to make sure each child is comfortable and ready to learn that day.

The goal is to get the children ready to participate in their communities, says school nurse Kathleen Hodge, RN. The school offers socialization opportunities that other children with severe disabilities might not get. Nurses might not see every child every day, but they get to know them well and know when they need attention.

“You have to be prepared for things you’re going to see,” says Hodge, who has been with the school for more than seven years. “Some of it can be difficult to watch because you form such a bond and the child may be in pain, but it’s very rewarding in the end.”

Blythedale nursing director Kathleen Henry, RN, MSN, remembers one boy who particularly touched staff members.

The boy, nicknamed Sali, started life with multiple congenital defects, including webbed fingers, a cleft palate, and legs that would be amputated by age 3. He started using a trach when he was five days old, and it was removed eight years later.

He came to Blythedale in 2000 when he was about 1 month old and became a preschool student there almost three years later. In preschool, he began occupational, speech, and physical therapy. His parents were unable to care for him, and a staff member in the early childhood center provided a foster home for him, eventually adopting him in 2006.

After 10 surgeries, Sali, now 9, walks with prostheses, attends the public school in his home school district, and “is doing just great — the bravest little boy you’ve ever seen,” Henry says. He visits the school periodically.

Watching that progression is one of the best parts of the job, she says. “We get to see kids go from comas to walking to talking and going home, then riding a school bus back to continue in school here. There’s a great deal of satisfaction in getting to see all the different phases of recovery.”

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Marcia Frellick is a freelance writer. To comment, e-mail editorNJ@nursingspectrum.com.