A Nursing Shortage As School Needs Rise

These are overwhelming times for the nation's 50,000 school nurses, as they cope with school budget cuts, a nationwide nursing shortage and a growing number of students with serious medical needs. Federal guidelines suggest that each school nurse be assigned to no more than 750 children, but 59% have more students than that in their care. In 11 states, including California, Colorado, Illinois and Michigan, the average school nurse cares for more than 2,000 kids, according to the nonprofit National Association of School Nurses.

"As parents, many of us assume that because our schools each had a nurse when we were young, that this is still the case," says Gail Milgram, executive director of the Johnson & Johnson School Nurse Fellowship Program at Rutgers University. "In actuality, a lot of nurses today are working out of their cars, driving between schools."

Many kids with disabilities are now mainstreamed, so nurses are busy inserting feeding tubes or monitoring children with multiple handicaps. They also have to deal with the burgeoning population of kids with asthma or allergies, while overseeing a parade of students taking medications for attention-deficit disorder or depression.

About 20% of students today have medical issues that require regular encounters with a school nurse, says Amy Garcia, the nursing association's executive director. Though the group says it has no reliable historical statistics regarding school nursing levels and duties, the consensus in the nursing community is that the burden has increased considerably over the past two decades.

Through weeklong training sessions, the Rutgers program helps school nurses navigate some of their new responsibilities. At many schools, for instance, nurses must create medical-care plans to deal with school violence or terrorism. Based in part on the experiences of the nurse at Columbine High School, nurses in the Rutgers program learn to put together a "Go Box," in case they have to run from the school. It contains items such as a school map to help emergency responders, and medical information on students who might be trapped inside.

To cope with their workloads, many school nurses have stopped doing certain routine tasks. They call it "selective abandonment." Robin Harvel is a nurse at Fort Sam Houston Elementary in San Antonio, Texas. She used to screen all students' teeth for decay. "I don't have time to do it anymore," she told me in a phone interview this week. She then put me on hold because her office was crowded with students about to take a field trip to a pumpkin patch.

When she got back on the line, Ms. Harvel explained that 110 students were going on the trip. Twelve of them needed inhalers for asthma, three needed medication for cystic fibrosis, seizures or feeding-tube maintenance, and another with severe allergies had to get an EpiPen autoinjector to use in case of an emergency. When Ms. Harvel became a school nurse 23 years ago, "I wouldn't be sending any kids out with inhalers," she says.

Aware of the obligations school nurses face. Some parents are getting proactive. They're lobbying school boards to protect nurses' jobs from budget cuts, or they're questioning whether school staffers are well-enough trained to give medical aid if a nurse isn't available. Because of demand for nurses in hospitals and clinics, some schools can't even find nurses, and can't pay them what they can earn elsewhere. So parents are asking hard questions: Should a school fund, say, a top-notch football program when it can't earmark enough money to hire a qualified nurse?

Source: Wall Street Journal, Jeffrey Zaslow, 7/2007