Fewer school nurses face growing array of duties
September 15th, 2008 By Online Nursing Category: Nursing SchoolMelissa Barber isn’t a nurse, but she often performs the duties of one. Barber, a teaching assistant in a special-needs class at Bush Elementary School in Salem, is one of a number of teacher aides, secretaries and school office workers who find themselves dispensing prescription medications, such as Ritalin, to children and helping with medical emergencies.
On a recent day, she performed a tube-feeding procedure on 7-year-old Ivan Pedraza, with assistance from school nurse Lynn Lanham. It wasn’t the first time Barber had done that.
“At first, it was kind of intimidating, but now I feel a little more confident, so that’s good,” she said.
“More and more these days, the role of a school nurse is to train nonmedical people how to care for medically fragile children and to work with chronic illnesses such as asthma,” said Lanham, a registered nurse in Salem-Keizer School District who transitioned into a school environment after working in hospital settings for almost 25 years.
Training lay people to care for sick school children and children with serious disabilities highlights a shortage of school nurses in Oregon and across the nation.
This year, Willamette Education Service District struggled to find nurses for a few schools it serves in Marion, Polk and Yamhill counties, said Carol Andersen, the coordinator of health-sensory services for the WESD, which does not staff nurses in Salem-Keizer School District.
“It isn’t as simple as putting an ad in the paper and hoping someone will call,” Andersen said. “It’s a challenge to find nurses because there just aren’t enough of them.”
The service district has five nurses who work in 21 schools this academic year. Three of those work full time five days per week, and two are employed part time, Andersen said.
Salem-Keizer School District at times also has had difficulty finding school nurses, said Kelly Evans, the district’s coordinator of health services.
“We are fortunate to be able to recruit talented (registered nurses) into our nurse positions,” said Evans, whose job it is to hire nurses for the district.
The district employs 13 registered nurses and one program associate.
The number of schools that nurses serve ranges from two to seven, depending on the size of the school and the medical needs of the students, Evans said.
For example, she said nurses assigned to middle schools and high schools cover two schools, while those serving elementary schools generally cover four to seven schools. None serves outside the district.
The average nurse pay in Oregon schools ranges from $47,899 to $60,000, according to the National Association of School Nurses.
But even with a nurse on staff, schools aren’t likely to have a nurse on campus for an entire school day. Most have disappeared as a full-time presence in schools. Many are able to spend an hour or two per day at any given school.
These days, nurses do a lot more than dole out aspirin, clean scraped knees, wipe tears or dispense medicine for an upset tummy.
Many find themselves responsible for thousands of children, performing medical procedures such as insulin injections, tube feedings and even catheterizations for less money than they’d make at a hospital.
Add to that the growing number of children with serious disabilities such as autism, multiple sclerosis, Down Syndrome, cerebral palsy, spina bifida and bipolar disorder, who previously were educated with other disabled children but who now are in mainstream classes in some schools.
“School nurses have caseloads that are far in excess of the recommended national standard, making it impossible for them to do very much at any single school,” said Susan King, a registered nurse and the executive director of the Oregon Nurses Association.
Federal guidelines call for a school nurse to be assigned to no more than 750 students. Oregon surpasses that figure by nearly 1,700 students.
According to the National Association of School Nurses, Oregon averages a single nurse per 2,444 students, ranking the state 46th in the nation in student-to-school nurse ratios.
Part of that is because state law does not require every public school in Oregon to have a staff nurse, said Leslie Currin, a registered nurse and school health specialist with the Oregon Department of Education.
As a result, a nurse’s aide, teacher’s aide, teacher or a secretary can administer care to a sick child, dispense medication or evaluate symptoms. To do so, they are required by law to take a one-hour class.
The lack of school nurses comes as a surprise to some Bush Elementary parents.
“I think the law should be changed,” said Andriana Alavarez, whose daughter is a first-grader at the school. “What if they give the wrong medication to a child?”
“That’s very dangerous,” said Coleen Winans, whose daughter is in third grade. “I think we as parents should be looking into to this, maybe push for more money to help schools hire more nurses.”
Amid growing concerns about the lack of school nurses, the 2007 Legislature established a task force to study and assess the availability of nursing services in the state’s public schools.
This month, the task force sent its findings to the Interim House and Senate Committees on Education. It recommended the state mandate and increase funding for additional school nurses so as to provide “safe and healthy learning environments” for Oregon public school students.
In a recent nationwide survey of more than 600 school nurses by the University of Iowa, 75 percent said unlicensed people administer medications to students at their school or schools.
The researchers also found that unlicensed personnel are three times more likely to make an error when dispensing medication to children.
In Oregon, it’s up to school nurses to decide whether a certain medication, such as insulin, can be given safely by a nonlicensed person.
“Each student is considered individually,” Currin said.
“I understand there are a lot of families who would love to have a nurse in every school, but that’s not possible because we don’t have enough nurses,” said Lanham.
The key to ending the school nurse shortage is to pressure elected school officials to fund school nursing positions adequately, King said.
“If the positions were better funded, and the workload approaching a realistic level, there might be more nurses to practice in school environments,” King said.
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