By Betsy Todd, MPH, RN, CIC, AJN clinical editor
by woodley wonderworks, via Flickr.
In the December 1903 issue of AJN (reprinted, with an editor’s commentary, in September 2014), Henry Street Settlement nurse Lina L. Rogers described the impact of the first school nurse program in the United States. Ms. Rogers, who worked with Henry Street founder Lillian Wald to establish the program in New York City schools, emphasized that their purpose was not only to improve children’s health but to decrease missed school days.
Wise community leaders have long acknowledged the importance of school nursing in accomplishing these goals. But in recent years, this hasn’t prevented cutbacks that eliminate or severely limit the care that nurses can provide to their school communities.
An October 10 article in the Philadelphia Inquirer describes an acute shortage of nurses in Philadelphia schools. Detailed here are multi-school coverage by individual RNs, wildly unrealistic caseloads for many of the nurses, and the significant responsibilities for “medical care” now borne by non-nurse teachers and administrators. In the article, Terry Jordan, president of the Philadelphia Federation of Teachers, underscores the complexities of school nurse work, noting, “We have so many families living in deep poverty, and for some of these families, the only medical attention they get is from the school nurse.”
The state of California, on the other hand, is supporting innovations in school nurse programs. Last week, Governor Jerry Brown signed into law legislation that will allow Medi-Cal (the state’s Medicaid program) to reimburse schools for providing a wide range of primary care health services to Medi-Cal–eligible students.
What kind of nursing coverage is available in schools in your own community? As a school nurse and/or parent, what do you think of the state of school nursing in your district?
Our school district uses LPNs at most of the schools and one RN district wide that oversees the RNs. I do not believe that the LPNs are full-time; they obviously don’t work over the summer, which is an attractive bonus for applying. We are a small community in upstate NY. Our local career tech school and community college are always looking for instructors for the LPN/RN programs; so an RN that has many years of experience can often find work with summers off.
In NYC the board of education relies heavily on agency nurses to fill the shortage of school nurses. Maybe if the pay was higher (it’s the lowest paying RN job in NY at 29/hr for 30 hours a week), the shortage would not be so severe.
I live in NE Kansas, and was recently hired by a local school district as a substitute school nurse. I am a R.N., the other sub they hired is also a R.N. The elementary school employs 2 part time nurses and 1 full time nurse, so that there is always 2 RNs in the building at all times (it is a larger school of 1200+ students). One of the part time nurses is a retired APRN. The middle school and high school in the district also each employ 1 RN. This is not the case in a couple of our neighboring districts in which one district doesn’t employ any school nurses, and the other has one LPN that rotates her day between all the buildings. That is not unheard of–and is unfortunately becoming the status quo. As mentioned in the article, for many children the school nurse is their only contact with a healthcare worker. I think having at least one RN per district who can oversee LPN/LVNs or CNAs should be mandated, as the responsibility and accountability of accurate assessments typically lie with the RN. It is this way at any other place of practice; schools should be no different. Just as we are seeing sicker patients in the acute care setting, we are seeing children who are sicker and on more medications in the school setting. At my district, I can name at least 5 insulin dependent students for which we have to manage dosing for with each meal and every snack;1 student who requires thickened liquids due to having a tracheostomy (his same student also requires additional hydration via J-tube); and 2 other students who require scheduled tube feedings throughout the day. Then there are the multiple prescribed medications that we administer, breathing and inhaler treatments for asthmatics, and emergency medications that we keep on hand for our kids with seizure disorders and severe allergies. There are even a handful of staff members who stop on the office to have their blood pressure taken for management of their hypertension, or have their ears or throats assessed if they feel they are getting ill. I agree that an LPN/LVN can administer these types of medications, but a CNA should never do so. We are also the first line of screening for hearing and vision, child abuse, and other illnesses–some of which (such as whooping cough) for we act as public nurses by reporting to county health departments and issuing warnings and information to parents and community members. It is unfortunate that the common [mis]conception of the school nurse is that we “give hugs and put band-aids on boo-boos.” After experiencing the role first-hand, I have a much greater understanding and appreciation for the school nurse role. I feel blessed to be part of a district that values the RN role in school nursing.
As usual, there doesn’t seem to be a nursing shortage in the Midwest. I applied, as an experienced RN, to an elementary school in a small town in Missouri. There was an ad for school nurse, but turns out what they wanted was a nurse aide! I never heard of such a thing, and cannot imagine the liability. But I never heard from them regarding my application. Someone in the office told me that. It seems that RN jobs in Missouri and Kansas are just going away, in favor of hiring LPNs and CNAs in offices and clinics. Many of my previous coworkers who have been laid off are working at nursing homes or home health jobs. I cannot find a job that does not require 12 hr. shifts or part time. At age 61 no one will hire me, and I hear that from many others in the area. What a shame that experienced RNs are being excluded from the workforce.