Nurses' Offices Overburdened
Wednesday, June 25, 2008
Caseloads for school nurses exceed federal guidelines in much of the Washington region at a time when campus clinics serve growing numbers of students with severe disabilities or chronic conditions such as diabetes and asthma.
As health-care needs multiply, school nurses are struggling to keep up and finding less time for preventive education on public-health issues such as childhood obesity or substance abuse. Many still dispense bandages and bags of ice, but they also counsel pregnant teens and manage complex medical plans for children with seizure disorders or feeding tubes. Schools often hire unlicensed aides for help.
"Children today come to school with conditions and treatments that would have kept them at home or in the hospital years ago," said Amy Garcia, executive director of the National Association of School Nurses. "We are concerned about the safety of these children and their ability to be ready to learn."
The association and the federal government recommend at least one registered nurse for every 750 students -- a target some local government officials say is hard to meet in a time of increased budget pressures. The ratio in the Fairfax County school system, the area's largest, is one for every 2,800.
Since 1993, the portion of students with chronic medical conditions has more than tripled in Fairfax schools, rising from 8 to 27 percent. Nursing positions have doubled in that time, but a 2002 task force report for the Fairfax County Board of Supervisors and the county's School Board noted "severe understaffing." A follow-up review to be released soon made similar findings.
Montgomery County has one nurse for every 1,600 students; Prince William and Arlington counties have one for every 1,000.
Other systems fare better: Alexandria schools have a 1-to-600 ratio. Prince George's County schools have a ratio of 1-to-700. D.C. officials could not supply a precise ratio, but staffing levels indicate the city's schools meet the federal guideline.
Nationally, the ratio is about 1 to 1,150, with the average nurse tending to students at two or more schools, the school nurse association reports. About one in four schools has no nurse, with responsibility for care given in many cases to teachers or school secretaries.
In some states, scarcity of medically trained staff has become a safety issue. In Utah, which the association reported had the nation's leanest supply of school nurses in 2007, with one for every 5,500 students, a 10-year-old girl overdosed on asthma medication three years ago at a school without a nurse or health aide available. Her mother has campaigned since for the state to fund a nurse for every school.
Fairfax relies on unlicensed aides for most day-to-day needs while nurses coordinate care for more complex cases. County health officials, who run the program, said it keeps children safe, with emergency calls low and school attendance rates high.
Still, the limited supply of school nurses is a public-health concern for a generation of students whose life expectancy, scientists say, might be shorter than their parents'. Nurses could lead efforts to prevent obesity, asthma, diabetes or substance abuse. But many are too overwhelmed by immediate needs to try.
With millions of children uninsured nationwide, many students wait until Monday to get help for a hacking cough that developed over the weekend. They are more likely to have untreated or undiagnosed conditions. The widespread inclusion of students with disabilities in the public school mainstream has also increased demand for care. Nurses perform or monitor procedures such as changing catheters or suctioning tracheotomy tubes.