School nurses are in short supply

This fall, more school systems have cut back on registered nurses, assigned them to cover more schools or delegated health-care activities to less-qualified health professionals.

Anya Martin

Staff Writer

August 16, 2010


Whether your child is in good health or not, a registered nurse at school can recognize medical issues you may have missed and be a powerful advocate to ensure your school has life-saving equipment.

But thanks to strapped education budgets, many schools today don't employ a full-time nurse. And in schools that still have nurses, they're faced with more specialized tasks, making it important for parents to ask questions at the start of the school year, experts said.

In 2007, about 45 percent of public schools had a full-time nurse and 30 percent had a part-time one, according to the latest data from the National Center for Education Statistics. One in four schools had no nurse at all.

This fall, more school systems have cut back on registered nurses, assigned them to cover more schools or delegated health-care activities to less-qualified health professionals including licensed practical nurses, school secretaries, health administrators and teachers, said Amy Garcia, executive director of the National Association of School Nurses.

"Nineteen states actually have mandates (requiring school nurses), but only four of those provide enough funding at the state level to local school districts," Garcia said. "It becomes a tough problem - what do we choose? A math teacher, a coach or a school nurse?"

When Jeannie Edwards started as a school nurse 20 years ago, she said she expected to patch kids up with bandages after minor playground falls, monitor their vaccinations and decide when sick children should be sent home.

Instead, the Dawson County, Ga.-based nurse said she was surprised to find that most kids with sore throats also had teeth problems and needed dental referrals. And though many tasks are routine, school nurses also play a critical role in helping kids survive emergencies. Edwards discovered that during her first year on the job in 1990, when she tried to save a seemingly healthy kindergartener who collapsed on the playground and died.

"I was devastated because I knew I was there immediately to administer CPR and I had failed," she said. Edwards kept in touch with the child's parents, who eventually discovered their son had a rare genetic disorder that causes the heart to stop beating suddenly.

When it comes to your child's health, the key difference training makes is that a registered nurse knows how to recognize the difference between minor and major health crises, calculate medication amounts and use specialized medical devices, said Monica Collins, school nurse liaison/consultant for Children's Healthcare of Atlanta, which includes three pediatric hospitals and 16 neighborhood clinics.

Registered nurses must have two to four years of training and take continuing education classes to maintain their license, while an administrator placed in a health-care role could have eight hours of CPR and first-aid training, she said.

The National Association of School Nurses advocates for a ratio of at least one full-time registered nurse for every 750 well students, with more nurses needed for student populations with more complex health-care needs, Garcia said.

Only 12 states and the District of Columbia met those recommendations in 2009, and 11 states had ratios of one nurse to 2,000 students or more, including Georgia, which has one RN for every 2,317 students.

Vermont topped the list, with one nurse to every 311 students, while Michigan had the worst ratio, with only one nurse for every 4,836 students.

School-nurse positions may be funded from local and state taxes, state-run children's Medicaid programs, and community sponsors, according to NASN.

Reductions in school nurses come at a time when the need for them is acute because about 30 percent of children have chronic conditions such as asthma, diabetes or high blood pressure, Collins said.

About 32 percent of children, age 5 to 17, are overweight or obese; 9.5 million children, or 13 percent, use prescription drugs for more than 90 days; and 7 million children, or 9.4 percent, have asthma, according to the Centers for Disease Control. About 125,000 children have type 1 diabetes and some are being diagnosed with type 2 diabetes, according to the National Institutes of Health.

Nurses are the ideal leader for preventive education programs to reduce childhood obesity and its health consequences, and their role should be expanded, said Ken Thorpe, executive director of the Partnership to Fight Chronic Disease.

"I know the schools are financially pinched, but they are cutting out some really vital things such as recess, exercise time and school nurses," Thorpe said. "All of those affect the health of kids, and we know healthier kids are better-learning kids."

What parents should do:

Parents should find out who is providing health services at their child's school, and what their qualifications are, said Joyce Allers, manager of school health at Children's Healthcare.

Also ask whether the school nurse works full- or part-time and, if the nurse divides time among several schools, how quickly she can be onsite in case of emergency, Garcia said. "Parents should ask 'why does the neighboring school district have nurses and we don't?'" she said.

If your school has a nurse and your child requires medications or treatments during school hours, get to know that nurse prior to the first day of school, if possible, so your child can check in immediately, Garcia said. Most school nurses are back at work by the beginning of August and many work through the summer.

Children with health conditions that require special accommodations during school are entitled by federal law to an individualized care plan, called a 504 plan for the section in the Rehabilitation Act which mandates it. This plan should outline in detail daily medical needs during school hours, protocols during field trips and steps to take in an emergency, Edwards said.

If a school lacks someone with the training to treat and manage your child's specific condition, consider transferring your child to another school that does, she said.

Don't hesitate to contact the school nurse any time you have health concerns about your child and need help deciding if a doctor's visit is needed, Garcia said.

Finally, don't forget to tell the nurse about issues going on at home such as a divorce or an unemployed parent that may cause a child to have stress-related ailments such as headaches or depression, she said.