By Kim McCarten, contributor
March 3, 2011 - In Texas, the school nurses who are registered nurses (RNs) are looking at the possibility of being replaced across the board by licensed practical nurses (LPNs) in order to “save money.”
In Missouri, Governor Nixon cut $5 million for state school nurse salaries, which forced communities—which were already stretched to the limit by the ongoing recession—to scrape together funds on their own in order to keep school nurses on staff; they were able to save most of the 455 nurses who had faced layoffs.
And in Wisconsin the fight is being played out night after night in the news, as public employees—school nurses included—fight to keep collective bargaining and to protect funding for education and public insurance coverage that impacts tens of thousands of children. The besieged governor's “budget repair” proposal is being released this week.
As they wait to get the details, people at "every single public school in the state are holding their breath," said Ann Riojas, head of the Wisconsin School Nurses Association and nurse supervisor for Milwaukee Public Schools.
School nurses in Vermont are faring a little better, in terms of more stable state finances and the best student-to-nurse ratio in the country: 311 students for every nurse. But the situation does not look good in other states.
“Last fall, in Georgia, when [the state legislature] cut school nurses out of the budget, parents and RNs stood together, and many of their [positions] were restored,” reported Amy Garcia, RN, MSN, executive director for the National Association of School Nurses (NASN). “But they don't know what will happen next year.”
With little change in the federal and state economic trends, these battles are beginning to look like they could become annual events.
In California, state budget cuts include "reducing or eliminating school nurse positions," reported Linda Davis-Alldritt, RN, MA, PHN, FNASN, FASHA, president-elect of NASN, adding that, without these nurses, "children with asthma, diabetes, epilepsy...or poorly managed chronic diseases are more likely to miss school, and as a consequence, [ironically] schools will lose educational dollars."
Not to mention the price kids will have to pay in terms of their compromised health.
Davis-Alldritt and her team are talking with elected officials at all levels, including local school board members, to educate them "about the critical health needs of many students and the impact school nurses have on keeping children in school and learning." They are also reaching out to parents to let them know that their children may soon not have any access to a healthcare professional at school.
"What qualifications and training do non-licensed personnel who are assigned to the school health office in the absence of a school nurse have?" she asked.
Garcia concurs that advocacy with policymakers at all levels—including federal, state and local—is essential. "School boards really make a big difference," she said, adding, "84 percent of school nurses are funded by the local educational association."
"The problem is that we have 52 million children in school every day [in the U.S.], but children don't vote," said Garcia.
However, their parents do.
Back in Wisconsin, as more people join the protest against the budget cuts, school nurses are feeling like they're fighting a war. Said Riojas: "School districts have cut and cut and cut, and are down to bare bones.”
"I had an email from a nurse," Riojas continued, "who is [handling] a district of 9,000 students by herself, who wrote that if they reduced her hours to where she doesn't get benefits, then she can't stay at her job because her husband just got laid off." Cutting benefits is another tactic being used in many of these budget battles.
School nurses say they are too often overlooked in terms of the critical role they play in public health, particularly the health of children who come to school with complex—and often multiple—disabilities and conditions. "School nurses may be the only healthcare professional that some children see if their families have no insurance or other access to care," said Garcia.
Riojas agreed, saying, "We have so many children who survive cancer, who survive low birth weight, and in Wisconsin, we have one of the highest rates of Type I diabetes... [these cuts] will have a huge impact on our students."
“They’re going to run out of people to lay off," she continued.
And what if these cuts go through?
"As far as contingency plans ... I'm not sure there is one."
NASN's Student-to-School Nurse Ratios by State