Nursing Notes

October 10, 2011

Hire education Unfilled school nurse positions jeopardize school healthcare

old school room

Image by Caitlyn Willows via Flickr

Here is an article from Nurse.com about the lack of school nurses and the effect it is having on our childrens health.  Be sure to click over and read the entire article and while you are there leave them a comment.

This is just another example of how the state and federal budget cuts are affecting the innocent and the unprotected in this country.  Our children have no one fighting for them in Washington.  The parents fight for them at the local level, but we all know how effective that is.  Do we really want our next generation to be unhealthy and uneducated?  What does that say about us as a nation?

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By Cathryn Domrose
Monday September 26, 2011

Two years ago, Susan Zacharski, RN, BSN, MEd, was one of five school nurses in an urban school district in Michigan caring for a general population of students in 14 buildings, developing care plans, administering vision, hearing and dental checks and coordinating with community groups to provide health services to children who needed them.

In June 2009, budget cuts eliminated all five general nursing positions, and Zacharski was moved to a building that serves students with special health needs. “No one covers the other buildings at all,” she said. But it could be worse in a state that averages one school nurse for every 4,411 students, the worst ratio in the country. “I’m the only nurse in this district,” Zacharski said, “but there are far more districts that don’t have any nurses at all.”

Though the overall number of school nurses nationwide has increased through 2009, it has been far eclipsed by the increase in students with complicated medical conditions, said Martha Dewey Bergren, RN, DNS, NCSN, director of research for the National Association of School Nurses. Many cuts have been made in the past three years, she said, and though they are uncertain what the economic crisis will bring, school nurse leaders say school health systems already are cut to the bone. “We really need to be looking at another way of funding school health,” Bergren said. “We have to look to the healthcare system.”

Student needs surpass funding

Getting money for school nursing always has been difficult, said Sally Schoessler, RN, BSN, MSEd, interim executive director of NASN, but it becomes even more challenging in a poor economy. Though statistics won’t reflect the effects of the latest recession for one or two more years, Bergren said, “this is the year the districts are really getting hit by [cuts in] state budgets. This is the year we’re hearing anecdotally about the number of nurses who are losing their positions.”

In some places, the damage already has been done. School nursing in California took a hit about five years ago when the state’s Medicaid funds — which used to help pay for school nurses — were slashed, said Barbara Miller, RN, MSN, PNP, past president of the California School Nurses Organization. “I don’t know what more they can cut,” she said.

Ironically, some districts report difficulty filling positions because of the uncertainty of the job or cuts in salary or benefits, Bergren said. For the first time in the more than 20 years she’s been in student health, Lisa Kern, RN, MSN, NCSN, said she has had to scramble to fill nursing positions in her Florida school district. A number of nurses left to go into private sector nursing “where they can earn more money than working as school nurses,” said Kern, supervisor of health services for the Pasco County School District just north of St. Petersburg, Fla. Facing potential cuts in positions, furloughs and increasing pension contribution requirements, “they’ve had to go where the money is,” she said.

Meanwhile, school nurses report seeing increasing numbers of students who need specialized healthcare. The percentage of children younger than 18 with asthma more than doubled from 1980 to 2009, according to the Centers for Disease Control and Prevention. The percentage with food allergies rose from 3.3% in 1997 to 3.9% in 2007. The CDC estimates more than 200,000 children and teens have diagnosed diabetes. The percentage of students in federally supported special education programs increased from 8% to 13% between 1977 and 2008, and within that group, the rates of children with health impairments more than doubled between 2002 and 2008, according to the National Center for Education Statistics. Higher rates of NICU survival mean schools are seeing more medically fragile children requiring ventilators, tube feedings, medication and other complex nursing services, according to NASN reports.

Regulatory mishmash creates confusion

Federal law requires schools to accommodate all students, regardless of health status. But state laws on who cares for these students vary greatly. “It’s not like healthcare, where you go to the hospital in California versus New York” and get the same level of care by licensed providers, said Barbara J. Zimmerman, RN, PhD, CNS, FNASN, professor and coordinator of the school nurse certification program at Millersville (Pa.) University, and co-author of a study of school nurse regulations and requirements across the country. Some states leave it up to school districts, which may allow unlicensed clerks or teachers to administer medications because they can’t afford nurses. And state school nurse education requirements vary from a BSN degree with a school nursing accreditation to nothing, Zimmerman said.

Funding also varies widely, coming from a combination of school districts, state budgets, Medicaid, public health, and federal funds for mandated programs, according to Zimmerman’s study. And funding even for mandated programs is not guaranteed. For example…[read the rest of the article here]

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