By Carol Chmelynski
08/02/05–The school nurse plays a pivotal role in helping schools maintain a safe, healthy climate, particularly at a time when schools are enrolling growing numbers of students with allergies, asthma, diabetes, and severe disabilities. Nurses even contribute to higher student achievement by minimizing student absences.
However, at many schools across the country, the school nurse is becoming an endangered species. Strained budgets, combined with a national shortage of nurses, have forced many districts to cut these positions. Often, several schools now must share a single nurse.
For example, the Palm Springs (Calif.) Unified School District, with an enrollment of 23,000 students, has just six nurses, two of whom work part time. That breaks down to about one nurse for every 4,440 students.
In California, which doesn’t require schools to have nurses, there are less than 3,000 across the state, serving more than 6.3 million children, says Nancy Spralding, executive director of the California School Nurses Organization.
Half of California’s 1,000 school districts don’t have any nurses at all, including many large, urban districts, and many districts have just one or two, she says.
Spralding attributes the problem in part to California’s budget crisis and the general shortage of nurses nationwide. But she says there’s another factor: “School board members and administrators just don’t realize how widespread the ‘chronic and acute illness’ situation is in schools. It’s frightening.”
“Many parents assume that there is a school nurse on the premises, but secretaries and health clerks, who basically have no medical training at all, administer medications to students,” she says.
Budget troubles
The Buffalo, N.Y., school district is breathing a sigh of relief after the state legislature came through with a last-minute vote June 24 to provide state funding to ease the district’s nursing shortage and to require the district to provide nursing services. Buffalo was one of a few districts in New York without such a mandate.
For the last 50 years, Erie County had been financing school nurses in Buffalo schools, but the county terminated this service in March. As a result, the district, which serves 37,000 students, had to make do with just 15 nurses providing part-time coverage at 60 schools.
Buffalo does have school-based health centers in 12 schools, says Assunta Ventresca, the district’s director of health-related services. These centers, funded by the New York Department of Health, provide primary care for students.
But other schools had a nurse on duty only 30 to 45 minutes a day, says Ventresca. “Some nurses were going to four schools a day.”
The shortage of nurses meant Buffalo administrators, teachers, school clerks, and other school staff had to fill in -- and even had to administer medications illegally. “We know this is a great big no-no, but we were desperate,” Ventresca says.
Fortunately, the district was able to make it through the year “without any major student injuries or severe health issues,” she says
A task force had suggested that the district allocate $5 million in next year’s budget for a full-time nurse in every school, but officials in the financially struggling district could pledge only $3.2 million for nursing services.
State lawmakers also allocated a $1.4 million advance in state aid payments, which were due later in the year, to allow the Buffalo school system to have more nurses on board by September.
So, now instead of facing further cuts in nursing services, Ventresca says, “we might be able to have one nurse for every 500 students or so, instead of one for every 2,467.” And it’s far more likely that the district could have a school nurse in every school someday.
The National Association of School Nurses recommends that school districts have one nurse for 750 students. But that ratio refers to “a basically healthy population in a single building, and even this is not the most ideal,” says Executive Director Wanda Miller.
More responsibilities
Today’s schools often have students with serious health problems. “There is an ever increasing number of medically fragile children in school,” Miller says, including children with asthma, diabetes, cystic fibrosis, sickle cell anemia, seizures, and severe allergies. “When these conditions exist, the more manageable ratio would be two school nurses for every 100 children.”
The nature of the job demands a highly qualified professional. Unlike nurses working in hospitals where plenty of back-up help is available, nurses working in schools often must make split-second decisions on their own.
“Once our nurses are hired, they stay with us for years,” says Karen Watson, director of special services for the Lyon County school district, in Yerington, Nev. But two of its nurses are retiring, and she is scrambling to find replacements. The 8,000-student district has about seven nurses for its 15 schools.
“I really try to play up all the perks and benefits of the school schedule,” Watson says. These include a 7:30 a.m. to 3 p.m. workday, no work on weekends, no shift work, no call ups, winter and spring breaks, and the summer off.
Nevertheless, the sticking points are the district’s isolated location -- a rural area about 80 miles from Reno -- and salary. The district pays registered nurses on the teacher schedule, $33,403 to $56,189, while licensed practical nurses are paid hourly wages, ranging from $12.66 to $17.82.
Cindy Helitzer, a part-time school nurse in Pittsfield, Mass., explains in a letter in the Berkshire Eagle why so many school nurses are leaving their jobs for higher-paying jobs in the private sector: “School nursing is a challenging job that I find very rewarding but the frustrations are wearing me down.”
Job frustrations
“Our job is complex, requiring a high degree of skill and knowledge of children’s needs,” Helitzer says. New nurses “are overwhelmed at the amount of responsibility we have.”
She says school nurses must help children with diabetic pumps or EPI pens for treating severe allergic reactions or asthma, children needing tube feedings and catheterizations, as well as injuries, illnesses, emotional and behavioral problems, along with mounting paperwork.
William Cameron, Pittsfield’s assistant superintendent for personnel, would like to see higher pay for school nurses, but they are employed by the city’s board of health, not the school district.
“There is a considerable shortage of school nurses” in Pittsfield, he says, and the low compensation of school nurses makes it “very difficult for the city to compete as an employer for nursing services.”
A 20 percent pay increase for school nurses recently approved by the city council will help, Cameron says, but that’s “still not going to get them competitive salaries.”
There are just nine full-time and one part-time nurse covering Pittsfield’s 13 public schools, which enroll a total of 6,700 students.
The biggest problem with having a nurse shortage is the need to administer medications to students with disabilities, Cameron says. “It creates of lot of stress for the nurses to try to be in multiple places during the course of the day.”
It’s also a problem when the district can’t find a nurse to accompany a disabled student on a field trip, he says.
He says the school nurses in Pittsfield “have done an excellent job over the years,” working with school staffs, students, and parents, “but this is becoming a crisis and I don’t know how much longer we’ll be able to count on people putting in this enormous effort for comparatively small wages.”
“There is nothing more important than the safety of students in the school, and you rely on school nurses to provide a key element of ensuring that safety,” he says. “They’ve become almost indispensable.”