Where Are The School Nurses?
By Aaron Holland – April 2019
As a parent, you think — “if my child gets sick at school, there’s no need to worry. My child could just go to the school nurse.” Well, you’re wrong. According to the National Association of Schools Nurses, only about 39 percent of nurses are employed full time at the schools they’re currently employed at.
Since the early 2000s, there have been budget cuts to the public school nationwide, and because of this, there has been a decrease in nurses all over.
Some students in Washington, D.C. schools complain they can go months without seeing a school nurse.
The role is a critical one.
School nurses not only work with the students for basic health care needs through the day, but they provide the preventative care and chronic disease management for students, which can help reduce absenteeism, as well as the number of unnecessary emergency room visits a hospital sees. Chronic conditions, like asthma, diabetes, allergies, mental health, requires and involves a complicated system of care, teaching the student to self-manage as well, – all of this managed care and support of student’s well-being takes a significant amount of time and medical knowledge. In fact, some hospital systems have begun to funnel community outreach dollars into helping schools fund on-site nurse positions.
“School nurses are the medical person who can catch things they see in students that educators will miss, but because of the declining education budgets across the country, school districts often have to decide between having a teacher in the classroom or a school nurse for their building,” said Margaret Cellucci, spokeswoman for the National Association of School Nurses. “It really becomes a difficult choice for districts to have to make.”
The choice can have dire consequences. According to Melissa Sporn, a psychologist in Fairfax County, Va., there has been a rising number of teenagers as young as 13 coming in for therapy.
“Anxiety, depression, and other things are the norm nowadays,” said Dr. Sporn. “Cutting is cool in a number of these cases, and the kids with mental health problems are most frequently found in inner cities.”
The numbers back her up. According to the NASN paper, “The case for school nursing,” the top five health problems among students are mental health issues, not physical ones. One in five children and adolescents has a diagnosable mental health disorder in the course of a year. Five percent have issues that are considered extreme. Twenty percent have undiagnosed mental health problems that may cause academic difficulties. School nurses spend a third of their time providing mental health services.
That makes the job of school nurses more critical and a frontline position in identifying potential problems at the very time their numbers are in decline.
The population of school nurses has been dropping steadily. Speaking to the Urban Health Media Project, a veteran school nurse in Connecticut who declined to be identified because she had not cleared it with superiors, said she has been in the profession 14 years working in K-12 schools. She explained the student populations of those schools ranged in the thousands, and she was the only nurse on staff.
“It can be tough,” she said. “I can’t just turn them away.”
In less than a year, she has worked as a nurse in about four schools, playing multiple roles.
“The student body is now more diverse than back then when we were kids,” she said.
Kids come to her with different issues. Some are there because of medical issues they want to talk about, and others come in for domestic or mental problems. A lot of times students come to her office just to talk to her, sometimes because they just want to be out of class or other times they’re going through something at home or school.
The school nurses who are working and in trauma-plagued communities find themselves grappling with far bigger issues than a cold or flu. The Connecticut nurse recalls one teenaged girl who scratched “Help Me” into her arm.
Cutting back on the nurses places a greater burden on other staff, usually personnel who are not trained for the problems.
“When there is a school nurse in the building, teachers and office staff can focus on their job of teaching students and managing the school rather than spending a significant part of the day dealing with student health,” said Cellucci. “School nurses are medically trained and educated and bring to the school the health care knowledge that promotes health and learning.”
A lot of parents are afraid to seek help because of fears they will be reported to child protective services. Parents have concerns they will be judged, part of a cultural sensitivity that is a huge issue because of demographics and family makeup. She said, for example, if a child with a mental health issue tells a nurse or therapist, “my parents beat me with a stick when I do something bad certain people might think, ‘Oh, that’s not bad, my parents used to beat me with their hands for disciplinary problems.’” But, others might say, “It’s abusive to lay a hand on my child that could harm them in any way. Already, this stops from some kids or parents seeking any type of help for their child.”
Beyond the cultural issues surrounding discipline in certain schools, she has worked at lacked the proper education for health. This lack of education has led to a higher percentage of high school students/ teenagers using drugs and having more sex.
The Connecticut nurse stated that she has even worked in some schools where they lacked proper education for health.
The statistics and statements from those in the profession raise questions about why the local Department of Health and other governmental entities are not doing more, especially since one result is untreated mental health and self-injury.
The Washington D.C. City Council recently passed a law that requires a full-time nurse in every public school, but Council Health Chairman Vincent Gray told students with the Urban Health Media Project they would need $7-8 million not currently budgeted to fund this for the next school year.
Cellucci called the legislative action “a hopeful sign for our nation’s children if districts across this country would support a school nurse in every school.”