July 8th, 2011
Vision tests, band aids, checking immunization records and offering a place to hide from a dreaded math test by claiming a headache – this is a how I picture a school nurse. Today, that vision couldn't be farther from the truth. School nurses oversee the care of hundreds, if not thousands, of students and all the employees who work in a school. And, the school nurse may be traveling between multiple schools. With all the challenges already listed, school nurses are disappearing.
States, cities, and school districts are all cutting budgets. Nationwide, the arts, physical education, band and vocational training programs have vanished from the public education curriculum. Now, funding for school nurses is being cut. Untrained personnel will man what was once the nurse's office, and it is the health and safety of the children that is most at risk.
Checking The Numbers
According to the National Association of School Nurses (NASN), only 45% of the nation's public schools have a full-time, on-site nurse. Thirty percent have one who works part-time — often dividing her hours between multiple school buildings — and a full 25% have no nurse at all. The numbers are expected to drop even lower with tough budget cuts hitting schools.
When there is a school nurse present, the patient base is often staggering. There is no set ratio of nurse-to-students, and the numbers are different in every state, and in every school district. Federal guidelines deem one nurse for every 750 students is appropriate. In the northeastern states of Vermont, Connecticut, New Hampshire, Delaware and in Washington, DC, there is one nurse for approximately every 400-500 students. This is the ratio that most school nurses feel is safest. But as you move West, the numbers escalate, topping out in Utah and Michigan, where a nurse-to-student ratio of 1-to-3500/4500 students is common.
As if those numbers weren't daunting enough, let's look at the health and wellness demographics of the student population. More than 300,000 school-age children have epilepsy. About 4.5 million have ADHD. Some 15,000 kids learn they have Type 1 diabetes each year. Three million suffer from food allergies, and 9 million have asthma.
Extra Nursing Responsibilities
In addition to assessing student health status, making referrals, administering medication and vaccines, and delivering emergency care, school nurses are often expected to manage insulin pumps, check blood sugars, insert tubes, suction children on ventilators, and counsel pregnant teens.
Other jobs which fall under the purview of school nurses include teaching first aid classes to teachers, conducting drug assessment exams on students believed to be under the influence, weighing and measuring the body mass index of every student from pre-kindergarten to 12th grade, and teaching health-related classes for students and parents.
When no school nurse is present on a daily basis, the implications are serious — and the reports of the dangers of the school nurse shortage are out there. Children have died at schools, and the most publicized cases were at schools where no certified nurse or licensed health professional was present, just a health clerk or helper.
The 2009 epidemic of H1N1 flu would have been even worse than reported if not for the watchful eye of a school nurse in New York City. Had she not been a daily presence at her facility, Mary Pappas, an experienced high school nurse, might not have noticed the escalating number of sick students coming to school. It was her call to the New York City Department of Health that alerted the community to the dangers.
School nurses are often the only source of health care for disadvantaged children. Children whose families can't afford annual checkups can still get their vaccines, be screened for hearing and vision deficits, and learn about hygiene and dental care from the school nurse. Easily treatable health conditions are prevented from becoming major problems with costly long term effects.
Finally, schools with nurses can help keep kids well. Nurses who have time to pay individual attention to children can recognize early signs of trouble, whether it's depression, drug use, or trouble at home or school. "School nurses are the front line," says Dallas pediatrician Susan Sugerman, MD. "Most school nurses notice when something just isn't right. Sometimes, it's not as big a problem as it first appears, but, I would rather have a school nurse tell the parents, even if it seems like an overreaction. I would rather see a school nurse who over rather than under reacts when you are talking about a child's health or welfare."
Why Become A School Nurse
If you had any questions before, this article should make it clear we have a huge need for school nurses. A school nurse provides meaningful services to the school systems for which she works. Healthy children are better students and more successful in their education.
The pay can be good, a nurse's hours are flexible, and summers are free unless you choose to undertake additional nursing work during those months. If you are employed by a school system, your benefits can be attractive as well. Becoming a school nurse means you may become part of a school retirement system, such as SERS (State Employees Retirement System) or PERS (Public Employees Retirement System). As a member you may be entitled to benefits like dental or vision care, disability pay, and retirement income.
"In my opinion, we are seeing a higher quality of school healthcare providers at the primary and high school levels, even at colleges and universities," Dr. Sugerman told me. "As people seek out a better work/life balance jobs like being a school nurse become more appealing. Working in hospitals just gets tougher every day as the patients are sicker and the staffs get smaller. Highly trained nurses are looking for something different."
Right now, the biggest challenge to becoming a school nurse is the lack of funding for the jobs, because there is certainly no lack of need.