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Salon: "No school nurses left behind"

September 29, 2005 -- Today Salon posted a lengthy, generally good piece by Laurie Udesky about the denursification of U.S. public schools, which has come at a time when the number of children attending with serious, chronic health issues like asthma continues to grow. Udesky's story includes harrowing anecdotes illustrating the "often tragic results" as non-nurse school workers try to care for sick children. Part of the problem, Udesky reports, is the tremendous financial pressures that the No Child Left Behind program and local budget demands have placed on public schools. The piece might have focused more on the views and experiences of the nurses themselves, but it still provides a good sense of the value of nurses and the gravity of the problem.

Perhaps the most compelling theme in the long piece is that schools that have cut back on their nursing staff to meet the testing requirements of No Child Left Behind and retain critical federal funding may actually be jeopardizing their main goal, because of the demonstrated link between student health and student learning. The piece describes the experience of one committed Mississippi superintendent who decided to address the 30% drop-out rate of his low-income district, whose major health problems included diabetes, asthma and obesity, by hiring prevention-focused school nurses and social workers. The drop-out rate dropped to 2%--and the school's state funding increased. This is critical. Even if you think it's not a big priority to give children any more access to care than most adults have at work, this kind of experience shows that failing to take special measures to protect children imperils their ability to learn, and thus the future of the nation.

Udesky lays out the national dimensions of the disappearing school nurse problem. She reports that government data shows that there are now about 60,000 full time school nurses to cover about 90,000 primary and secondary schools. The piece does not pursue this, but this would mean the average school has about 2/3 of a nurse--or, put another way, that the average school student at any given time has about a 1/3 chance that there is no nurse available to deal with her critical health issue. The result is that "teachers and other medically untrained staff," including secretaries, clerks and aides, are often put in the position of trying to provide care, even though chronic illnesses that require frequent skilled attention have mushroomed. These include "life-threatening asthma and food allergies, diabetes, seizure disorders and cancers as well as mental health problems like severe depression and attention deficit hyperactivity disorder." According to a CDC report, some nine million children--about 13% of the K-12 U.S. student population--now take medication regularly for at least three months per year.

What are schools that don't have a full-time nurse missing? The piece focuses on medication. Research shows that common errors when untrained personnel rather than nurses are responsible for giving medication include missed doses, wrong doses, wrong medications, and flawed recordkeeping. Does that matter? The piece includes one story in which a California nurse who had to cover eight schools had trained a school aide to dispense medication. Three weeks after a child with a seizure disorder had died at home alone, the nurse saw from the student's medication card that he had not been called in by school staff to take his medication just prior to his death and that the parents had not been notified--and the child had missed seven of 15 doses.

And then there are the in-school emergencies. We also hear about the California science teacher at a school without an on-duty nurse who watched one of his students fall unconscious and die. A Pennsylvania nurse practitioner who circulates among four to six schools tells of a Ritalin-taking student at a school she was able to visit once a week who had a protrusion on his tongue--not something an untrained person would likely think much of, except that it indicated that the medication was at a toxic level and the student could have died. After a Buffalo high school athlete had a severe asthma attack, the terrified students and staff found the nurse's office closed; fortunately, ambulance workers were able to revive her. A fifth grader in California wasn't so fortunate: he had a full-blown asthma attack and struggled to the nurse's office, but the nurse was at another school, and by the time paramedics arrived, he could not be revived. The Center recently highlighted a newspaper report of a Boston area school nurse who saved the life of a boy who had a severe and completely unexpected reaction to a bee sting.

The Salon piece might have focused more closely on the experiences and views of school nurses themselves; it appears to quote only one. The result is that although the piece does a good job of giving readers an idea of the dimensions of the problem, and a striking sense of how it affects students and their families, the effects on the 60,000 school nurses themselves are left out. What do school nurses themselves think should be done? What does it feel like to rush from school to school, knowing that you can't really do the vital professional job you've been trained to do as well as it should be done? It seems clear that--just as with short-staffed hospital nurses--the inability of short-staffed school nurses to provide students with the care they need would be a tremendous source of stress, and contribute to burnout at a time of critical shortage.

The Center thanks Ms. Udesky and Salon for this important story.

See the article "No school nurses left behind" by Laurie Udesky in Salon's September 29, 2005 edition.

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