Education Funding

School Nurse Positions Among The First Cuts as Districts Feel Pinch

By Darcia Harris Bowman — April 02, 2003 5 min read

School nurses are feeling the pinch of a weakened economy as districts across the country are forced to tighten their budgetary belts.

In Massachusetts, hundreds of school nurses have been laid off because of cuts to the state’s public-health budget, according to the statewide association for school nurses. In Virginia, Gov. Mark Warner cut a grant program this year that helped pay for school health-care programs, forcing some districts to weigh nursing positions against other needs.

And in Indiana, nurses throughout the state are watching the 22,000-student Evansville-Vanderburgh schools, where the fate of half the rural district’s $1.5 million health-services program will be decided by voters in a referendum this month.

For Evansville-Vanderburgh’s superintendent, Bard McCandless, the decision to offer up the schools’ health program for such deep cuts was painful. But the district, with a $139 million budget, is facing a crippling deficit of $11 million next year. The nursing positions that may be lost are among more than 100 jobs the school board voted to sacrifice in an effort to balance spending.

“If this referendum doesn’t pass, our quality of life in this community won’t be as we know it today,” Mr. McCandless said. “Nearly half our kids are living in poverty-stricken situations, and many of their families can’t afford to go to a doctor. Our nurses provide a lot of preventive care ... but this means we would have to adjust our entire delivery system.

“We would no longer have a nurse in every school,” he said.

Stretched Thin

In that respect, Evansville- Vanderburgh wouldn’t be unusual. The National Association of School Nurses recommends providing one school nurse for every 750 children, but many districts fall far short of that standard.

Yet the demands on school health professionals are growing.

More students are coming to school with chronic health problems such as asthma and diabetes, nurses say, and more children with serious medical conditions and disabilities are joining the mainstream student population.

At the same time, federal and state officials are urging schools to prepare emergency-response plans for bioterrorism that would enable them to care for sick children, employees, and the broader community in an event such as an anthrax attack. And, of course, someone in a school still has to respond to the day-to-day bumps, bruises, fevers, and colds.

“I think there’s probably a misconception all over the country that the school nurse is someone who sits at a desk all day, and maybe takes a few temperatures, but [the job] is much more than that now,” said Brenda C. Isaac, the head nurse for the 28,000-student Kanawha County schools in Charleston, W. Va.

In the Montgomery County, Va., public schools, located in southwest Virginia, nurses have seen one new diabetic case diagnosed every month this academic year. As of November, the district had 765 asthmatic students, 540 with attention deficit hyperactivity disorder, three with seizure disorder, and 56 with diabetes or severe hypoglycemia, said the school health coordinator, Erin G. Cruise.

When three of the district’s six nurses retired last year, the school boarded hired only one replacement. Now, Ms. Cruise and four part-time registered nurses are responsible for the district’s 9,000 students in 22 schools.

The state of Virginia recommends—but doesn’t require—districts to maintain a ratio of one nurse for 1,000 students. One nurse on Ms. Cruise’s staff is responsible for 1,900 students across six schools; another juggles care for 2,800 in three schools.

In districts with nursing shortages, clerical and administrative employees are often called upon to administer certain types of medications, nurses say.

In the case of Virginia’s Montgomery County schools, administrators and support staff must dispense at least oral medication. But giving shots to diabetics or nebulizer treatments to asthmatics can be risky enough procedures that they are typically handled by the licensed health professionals in the district, Ms. Cruise said.

“Most of our employees are willing to learn because they understand there’s a need,” said the nurse, who is anxiously watching district efforts to secure financing for two more part- time nurses. “Just five years ago, we had only one nurse covering all the schools in the county, so we are making progress.”

Some districts are finding creative ways to bridge the health-care gap. In the 37,000-student Sarasota County, Fla., schools, fiscal constraints have left the district with one nurse for every 4,600 students. That’s three times the state’s recommended ratio.

In a bid to bulk up its nursing staff in tight budget times, the district has formed a partnership with the county health department, a public hospital, and a private hospital to add five school nurses.

In other states and districts, nurses are simply trying to figure out how to get their jobs done—and meet the extra demands of safeguarding schools against potential terrorism.

First Responders

In Massachusetts, where schools are reeling from a $5.8 million reduction in state grants that had helped localities pay for hundreds of nursing positions, school nurses are among the community health-care providers who would serve as “first responders” in the event of a terrorist attack.

Marcia A. Buckminster, the immediate past president of the state school nurses’ association, spent two days last week in an emergency bunker with school administrators learning how to help her 8,600- student Framingham district respond to disasters and emergencies, including biological and chemical attacks.

In an interview, she wondered aloud how well the district’s 21 nurses would be able to aid schools in such situations when they are already struggling to cover basic health needs that arise in 15 schools.

At that staffing level, would the Framingham nurses be able to handle the aftermath of a biological attack, administering to potentially hundreds of sick children and teachers?

“No, probably not,” Ms. Buckminster said. “It’s pretty scary.”

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