VA Nursing Matters
February, 1992
by Nell Perry

Caring for Kids
As far as anyone can tell, this RN-run child-care center is the first comprehensive child-care center in the country.

Gail W. Johnson, RN, MS, didn't set out to be a pioneer, but she may have stumbled onto one of the newest specialties in nursing.

Child care.

Her business, Rainbow Station Inc. of Richmond, which offers child care for children from birth to age 12, opened in December 1989 and has been so successful that last Nov. 26 she opened a second center.

What makes her center so different from the others -- the difference that is attracting attention from all over -- is that it even cares for children who are sick. Rainbow Station provides child care for healthy children and for children with long-term health problems, children who are recuperating from hospital stays and children who just plain don't feel good that day.

Sick-child care started in California about 10 years ago, and today there are about 100 such centers nationwide, about half in pediatric units in hospitals. But as far as anyone can tell, Rainbow Station is the first comprehensive child-care center in the United States.

"There are centers that care for children with special needs," Johnson said, "and there are centers that just happen to have an infirmary nearby in case a child gets sick. But nothing else like this is out there."

The key to the whole program is the addition of an RN to the child-care setting.

Johnson has 24 years of nursing experience, including a master's degree in maternal child nursing from Virginia Commonwealth University. The director of the first Rainbow Station, Pam Carlsen, is a former head nurse of pediatrics at St. Mary's Hospital, who also has degrees in child development and therapeutic recreation. Jennie Trovinger, who has joined the company as director of the second Rainbow Station, is a curriculum specialist who has nearly completed her master's in early childhood education.

Working with both directors as assistant directors in charge of nursing are pediatric nurses.

"It's a perfect blend of professions."

In fact, adding a nurse to the preschool setting -- just as nurses have been included in the public school setting -- is a logical step for child care to take.

"It is my opinion that young children present the most challenging setting requiring nursing support," she said. Their immune systems are still immature, making them more susceptible to illness; they are more prone to accidents and a number of chronic illnesses; plus their ever-changing developmental status affects their health and safety.

"Rainbow Station has been able to address these and other issues with access to a professional nurse."

HEARD OF PROBLEMS
Johnson no longer had child-care problems of her own -- her three were teens -- when she became aware of how many of her students in the nursing program at the Medical College of Virginia were seeing patients with child-care problems.

The mother of an 8-week-old on an apnea monitor, for example, was frantic to find a provider who would care for her child. The parents of a 2-year-old diabetic couldn't find care for her child.

"I thought, 'Gee, if you understand what you're doing, caring for a diabetic child does not have to be a big deal.' But very few child-care providers were willing to take on these children with long-term needs.

And then I thought, 'Well, nursing can do something here.'

I began thinking of a wellness center where we could care for children who had special needs for a day or for a lifetime."

The center was still a long way off. Johnson had to learn the field of child care, for starters.

"I didn't ever intend to get into child care. I just saw the need, so I took a class in child-care management, attended every conference I could find and toured centers to find out what is this thing called child care."

What she learned was that nurses fit into the field beautifully. "They can provide for the health and safety of the children, for the nutritional needs, and they can offer on-site parental support."

Her idea hit stumbling blocks. Here was a nurse who wanted to set up a child-care center for sick children -- when there weren't any regulations written for such care. But she persevered through the licensing process, and Rainbow Station was born.

At Rainbow Station, children with long-term health needs are mainstreamed in regular child-care activities, and the nurses take care of any medical needs in that setting, as much as possible. A child with spina bifida, for example, plays alongside children who run and jump with ease. A child with an apnea monitor fits right in.

In fact, one child at the new center doesn't speak and is fed by gastrostomy tube, and the children treat him as if he is no different.

"The kids don't tolerate him not speaking," Johnson said. "They are continually talking to him. Given time, that stimulation will make a difference in that child."

Rainbow Station also can provide care for children with short-term health needs --those recuperating from accidents or burns, those who need medicines monitored or oxygen therapy for a while.

When a child is too sick, or infectious, to join the others, there's the Get Well Place in a separate wing of the building, an infirmary of four rooms designated as the Sniffle Stop, for children with respiratory illnesses; the Whoozy Station, for children with tummy problems; the Spot Stop, for those with chicken pox (it has a separate entrance); and R&R crossing, for recuperating children.

CORPORATE INTEREST
The Get Well Place is licensed for 20 children, and it is not limited to children from the Rainbow Station. In fact, the existence of a place for employees to take sick children has attracted the attention of eight major employers in Richmond, including Philip Morris USA and Signet Bank.

Signet pays the registration and $20 of the daily fee for the children of its employees who use the Get Well Place; Philip Morris pays a fee that equals the cost of one employee using the Get Well Place each day. It is a benefit offered to its employees at no charge.

Employee absenteeism when children get sick is a real problem for companies. Johnson pointed out the statistics: A study by the Westinghouse Corporation found that mothers with children under 6 miss an average of 13 to 14 working days per yea because their children are mildly ill. Almost all of them could be cared for in a center for mildl ill children.

Rockwell International looked into the problem and determined that it was costing the company $500,000 a year in the Los Angeles area.

Get Well Place was used by 823 children during its first year, Johnson said. "Parents are reluctant to leave children usually the first time," she said. "They think, 'What kind of parent am I to leave a sick child? But it doesn't seem to matter to the child, and they feel more confident the second time."

Part of the success of the first Rainbow Station center was its proximity to both residential and business districts. Its second center was built in an office park, on land donated by the developer of the park as an enticement for companies to locate there.

The new center already has 60 children. The first Rainbow Station serves 136. "Our society has changed," Johnson said. "Children are no longer being cared for in the home by their mother while daddy goes to work. This change makes one concerned for the welfare of our next generation if child care is not provided with the same love and attention that a parent might deliver."

Johnson is quick to challenge other pediatric nurses to get involved in the child-care profession. "The field is ripe for picking. Anyone who likes community health nursing, who really enjoys patient teaching and nurturing families -- this is ideal. Of course we are providing a service to families who need child care, but we have such opportunity to work with those families. They are almost a captive audience, and many of them, particularly new parents, lack many parenting skills and confidence about their ability to handle the particulars of child care. We are a personal consultant, their own expert, someone they can ask all the questions they have about diaper rash and feeding, about raising their children.

"We are real positive role models to those parents, and we make a difference in the growth and development of children. You can make this job what you want it to be."

"Child care isn't going away, and health and safety issues are paramount. Nursing has a lot to contribute to this whole area."