By Megan M. Krischke, Contributor
Oct. 16, 2009 - School nurses have a myriad of responsibilities: providing direct health care and emergency services, administering vision, hearing and scoliosis screenings, keeping the school free of allergens, teaching health education, encouraging families to enroll children in their state’s insurance program, providing leadership for health policies and programs within the district, serving as a bridge between the health and education communities, and the list goes on.
Not only are the roles of a school nurse many and varied, the number of students and their health needs are increasing.
Linda Davis-Alldritt, RN, MA, PHN, FNASN, serves as the NASN president elect, 2011 and works as a school nurse consultant in California.
“Over the past ten years or so one of the biggest changes I’ve seen in school nursing is children coming to school with increasingly complex health needs that require managing during the school year,” explained Linda Davis -Alldritt, RN, MA, PHN, FNASN, who serves as president-elect for the National Association of School Nurses (NASN).
“In the past, we didn’t see children who needed insulin during the day. The treatment of diabetes, however, has become very tightly controlled which is good for long-term health, but the upshot is that now students need medicine during the school day,” she explained.
“That same type of advancement in technology has happened across the board,” Davis-Adritt continued. “Children who wouldn’t have survived infancy or would not have made it to school age are surviving longer because of medical technology, and all of that comes with the need for those children’s health to be well managed so they can get and stay healthy and stay in school.”
Sandi Delack, RN, MEd, NCSN President, NASN, volunteers as a health services coordinator for Johnston Public Schools in Rhode Island.
Sandi Delack , M.Ed., RN, NCSN, president of NASN and health services coordinator for Johnston Public Schools in Rhode Island, agrees that caring for children with chronic illnesses and disabilities is a significant change in school nursing.
“The number of kids we have with chronic health conditions is amazing. We are seeing an increase in Type I diabetes, food allergies, and mental health concerns that are significant— a lot of kids are struggling with social and emotional issues,” Delack said. “Over the last 10 to 20 years, kids with more extensive handicaps have been moved out of special schools and into public schools, so now many schools have students with tracheostomies and feeding tubes. “
In addition to caring for students’ individual needs, school nurses also play a role in public health.
“H1N1 has occupied a whole lot of our fall. School nurses are charged with monitoring students for flu symptoms, educating teachers, students and parents about symptoms and how to stay healthy,” remarked Delack. “During this school year nurses will be ensuring consent forms are in place and administering vaccines. You really have to stay on top of the latest information because recommendations can change frequently.”
Some school districts are considering using more temporary nurses to shore up their resources, depending on how the flu season unfolds.
School Health nurses and other school health professionals are hired direct by school districts and agencies like AMN Healthcare. In times of shortage, agencies provide schools with cost-effective and dependable school nurse staffing, as well as physical, occupational and speech therapists.
The NASN recommends that schools employ one nurse for every 750 well students and a lower ratio of 1:250 in student populations that require professional nursing services on a daily basis. Yet only 13 states meet the 1:750 recommendation. Vermont has the most school nurses per student at 1:275 and Utah has the fewest with 1:4,893.
The issue is not a lack of school nurses, but a lack of funded school nurse positions.
“Some states do have favorable laws that say every building needs a nurse. Some don’t. Finances are a challenge across the country. Often decisions are made that exclude support services and school nurses are often the first to be cut,” Davis-Alldritt stated. “If one nurse is responsible for 15 schools and thousands of students—we have to ask if that is a safe situation for the children.”
Delack, who says that testing and administering insulin to just five diabetic students in her charge occupies much of her day, concurs that too few nurses compromises the health and safety of students.
“Ratio is a huge challenge,“ Delack acknowledged. “Where ratios are thousands of kids per nurse, essentially students don’t have access to a nurse. What they have is an unlicensed person being trained to do medical tasks by a nurse. To care well for kids in schools, safe ratios are critical.”
“The expectation,” she continued, “is that we are able to do an assessment, develop a plan and communicate that plan to teachers so they know when to send kids to the nurse for testing and how to treat a student if they become suddenly ill. That expectation is difficult to meet with most current ratios.”
Currently, there is a bill in Congress that aims to improve nurse-to-student ratios. According to the NASN website: “The Act would provide competitive demonstration grants through the Centers for Disease Control and Prevention (CDC) to eligible states so that they may reduce the student-to-school nurse ratios. CDC would then report to the Congress on the efficacy of the piloted grant program regarding the relationship between the provision of student health services and educational outcomes.”
“We haven’t done a good job of letting policymakers know what our needs are,” Delack concluded. “There is still a perception that the school nurse is in the office waiting for someone with a bellyache to show up. School nursing is the silent health care system. For kids whose parents are out of work and have lost insurance, the school nurse may be the only health care provider they see.”
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