School Nurse Shortage Influences Student Health Care
August 11th, 2008 By Online Nursing Category: Nursing Information, Nursing ShortageSchool nurses are key health educators, with access to young people at a formative time in their lives.
“There is more to it than first aid,” says Mitzie Walker, RN, BSN, MSHSA, MAEd, interim director of school support for Chicago Public Schools (CPS). “We serve as a healthcare liaison from the medical profession to the schools, and we also identify health concerns in children that prevent them from learning.”
Despite the vital role school nurses play, there are not enough of them.
“There is a shortage of school nurses,” says Cam Traut, RN, NCSN, incoming president-elect of the Illinois Association of School Nurses (IASN) and a certified school nurse at Libertyville (Ill.) High School. “There should, optimally, be a school nurse in every building, but I know that is not happening.”
Linda Gibbons, RN, MSN, IL/NCSN, school nurse program coordinator at National-Louis University in Wheeling, Ill., explains that funding for nurses typically comes out of the local school district budget. In some states, public health monies help pay for school nurses, but not in Illinois.
CPS employs 336 RNs and LPNs. With 415,000 students in more than 600 buildings, the nurse-to-student ratio is one nurse per 1,235 students, well below the Healthy People 2010 goal of one nurse per 750 students. In many cases, a nurse is assigned to multiple schools.
“The allocation is based on the needs of the students,” Walker says. For instance, if a child at one school is on a ventilator or insulin pump or requires tube feedings, that school is assigned the nurse.
“School nurse ratios and coverage differ widely from district to district,” says Martha Dewey Bergren, RN, DNS, NCSN, FAASN, clinical assistant professor at the University of Illinois Chicago (UIC) College of Nursing. “I see a lot of schools doing without. There are rural schools with no nurse, period, not even one in the district. Nonlicensed people are making medical decisions about medications and diabetic care.”
Students seeking health services are less likely to be sent home if evaluated by a nurse, rather than an unlicensed person. A study completed in the Midwest and reported in the Journal of School Nursing (December 2005) found 57% fewer students seeking medical assistance left school early after contact with a school nurse. Bergren explains the nurse can assess the situation, find an answer to the problem, and send the student back to class.
“Nurses can make children optimally ready to learn and make sure kids understand proper hygiene. Something as simple as hand washing will reduce the number of absences,” Bergren says.
School nurse certification
Bergren coordinates the school nurse master’s program at UIC. The college and National-Louis University offer two of the four school nurse certification programs in Illinois.
Certification as a school nurse allows the healthcare professional to influence the individual education plans of children with special needs.
In the past, many children who had disabilities or who were undergoing cancer treatment did not attend public school. Today school nurses help these students succeed and become as independent as possible, Walker says.
A certified school nurse might recommend checking a diabetic child’s blood sugar before a test to make sure he or she is in the normal range and his or her brain is able to function well, Gibbons says.
Certified nurses also can teach in the classroom. Nila Hawkins, RN, CSN, president of the IASN and a nurse in the Centralia City School district, tailors her curriculum to different grades and instructs students on topics such as growth and development, HIV prevention, hygiene, and dental health. The nurses bring a global perspective about safety to the school or may develop policies and procedures for emergency response, Traut says.
School nurses, without certification, can assess minor injuries and screen for vision and hearing difficulties and chronic conditions.
Attracting school nurses
School nurses find the work satisfying, but they generally earn less than their hospital counterparts. Often salaries are in line with teachers’ pay, Hawkins says, which deters some nurses from entering the field.
“[School nurses['] salaries are] about 23% less than [those of] hospital nurses,” Gibbons adds. “Typically, you start all over at the bottom of the pay scale because the school is not willing to give nurses credit for nursing experience like they give teachers for teaching experience.”
Walker recommends nursing schools include rotations in public schools as part of their clinical program to generate interest early in their careers.
Nurses who are aware that schools lack a dedicated school nurse tend to avoid the specialty, fearful of caseloads that might include several thousand students in multiple schools, Gibbons says.
But school nursing also has it benefits. The nurses work Monday through Friday, and some make the transition because they are tired of the hospital environment.
“School nursing is a way to practice very holistic nursing and deal with the whole child and the family,” Gibbons says. “It’s an independent kind of practice.”
