Budgets' Ill Health Prompts Cuts in School Nurses
Faced with the deteriorating health of their budgets, a number of districts across the country are cutting back on school nursing services.
Since the beginning of the school year, district and public-health officials have made significant cuts in student-health services in New York City and suburban Sacramento, Calif., for example.
In other smaller districts, budget problems have caused school officials to reduce nurses' hours or pay or to reduce already-slim staffs by one or two workers.
The cuts, several school nurses said in interviews last week, could not have come at a worse time.
Nationally, school-health workers are feeling the effects of a health insurance crisis that has left an estimated 12 million children without any coverage, they said.
At the same time, school nurses have had to cope with a growing immigrant population that is spreading new or once-vanquished diseases in the classroom, they said.
Any loss of hours or employees can dramatically increase workloads, health officials said.
"We feel badly for the kids, first and foremost," said Beverly Farquhar, the executive director of the National Association of School Nurses, which recommends that schools have at least one nurse for every 750 regular-education pupils. "Who's going to adjust their medication, talk to their doctor?"
"1 guess it is going to be dumped on the teachers," she said. Adria Thomas, who directs a project on school health for the National School Boards Association, said health services, like all school services, have been hard hit during the current recession.
"It's just a matter of getting down to the barest of essentials," she said, "and health services haven't traditionally been provided."
Despite the cuts, Ms. Thomas said, "I think school-board members are very aware of the links between education and health."
"I think the concern is that the school nurse may be the only source of health services that the student has," she added.
A 'Big Gap'
In the San Juan Unified School District, in suburban Sacramento, no nurses or health assistants are left to provide emergency or ongoing services to regular-education students. Until two years ago, said Lucinda Dodge, the district's program specialist for health services, the system had nearly 40 nurses.
After six nursing positions were eliminated in 1990, the district pared an additional 20 nursing positions and all the health-assistant's positions this spring, she said.
The eight remaining nurses, Ms. Dodge said, must spend all their time on special-education children in order to meet federal and state requirements.
Although school personnel have been encouraged to take first-aid classes, she said there remains a "big gap" in health services for students.
"I think the difference between what a [person with a] minimum first-aid class can do and what a trained nurse can do is enormous," she said. "I don't think the full effects of this will be apparent for a while."
In New York City, meanwhile, only 88 nurses, who are paid for by the city health department, are left to serve more than 1,000 school campuses, said Margery Manly, the director of the city's schoolchildren's health program.
A year ago, she said, the school system had 200 nurses and 23 teams that provided mandatory hearing, vision, and scoliosis screening.
City officials, she said, had originally proposed eliminating all school nurses, but compromised by agreeing to fund half of the positions and 10 of the screening teams. The program's total budget, she said, was reduced by half, to $7.5 million.
Given the large student-to-nurse ratio, she said, the school nurses can only concentrate on reviewing the medical records of newly enrolled students, many of whom have emigrated from a foreign country.
And confronted with the ongoing budget concerns, she said, "the morale has been decimated."
"It makes you feel that your position is not worthwhile," Ms. Manly added. At the same time, she noted, salaries for school nurses run far below the industry average.
"They can go out to any other area and get $10,000 more," she said.
While the cuts in most California districts have not been as dramatic, Andree Wallis, the state director of the California School Nurses Association, said many schools have felt the pinch.
In some districts, full-time positions have been reduced to half-time positions, she said, and other positions are now being funded with grants and other "soft money," instead of with general operating funds.
In the Central Berkshire Regional School District in Massachusetts, the decision not to replace a retired high-school nurse has meant that other nurses must carry a larger load, said Mary Martinelli, a school nurse there.
Ms. Martinelli, who splits her time between a middle school and the district's high school, said she cannot spend as much time as her predecessor did on counseling students.
"I'm giving very little care," she said. "It's Band-Aid services."
Vol. 11, Issue 09, Page 10Published in Print: October 30, 1991, as Budgets' Ill Health Prompts Cuts in School Nurses