Nurses' Offices Overburdened

Cathy Jimmo, clinical aide at Fairfax County's Saratoga Elementary School, updates her medical log as 12-year-old diabetic Tyler Nichols checks his blood sugar. Shelby Williams, left, whose daughter attends the school, talks to nurse Diane Allen, who also works at three other facilities. (By Jahi Chikwendiu -- The Washington Post)
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Some area school systems and health departments are bolstering services. The District, through a partnership with Children's National Medical Center, expects to staff a full-time nurse in nine of every 10 schools this fall, up from 37 percent of schools in 2006. The District also is renovating school health facilities, some of which have lacked running water or secure storage for medications, according to a 2006 D.C. Department of Health report. Its $19 million annual school health budget is funded partly by Children's Hospital.

The Prince George's budget for the just-ended school year included $13 million to provide a nurse in every school. Montgomery increased its school health budget from $18 million to $21 million for the coming fiscal year, helping to fund four campus health centers with doctors or nurse practitioners where students can get physicals or mental-health care.

Fairfax's $10 million school health budget will increase little in the fiscal year that starts July 1. Rosalyn Foroobar, director of patient-care services for the Fairfax County Health Department, said the agency is requesting funding for a dozen more school nurses in coming years.

Foroobar said a 1-to-750 ratio is hard to maintain in a system with nearly 200 schools, some of which serve 3,000 students or more. Nurses are assigned by need, she said. Centers for severely disabled students have a dedicated nurse, and more than a dozen medically fragile students usually have full-time nurses (through separate funding).

Fairfax Board of Supervisors Chairman Gerald E. Connolly (D) acknowledged the number of students per nurse is "way too high. But the question is resources." He said that the county cut many services this year and that school nurse staffing will have to be "addressed over time."

For now, 59 registered nurses supervise more than 200 clinical aides assigned full time to the schools. The nurses manage about 45,000 health-care plans, many for conditions ranging from severe food allergies to spina bifida, epilepsy or cancer.

One May morning, visitors to Saratoga Elementary School's health clinic in Fairfax County included a smiling kindergartner clutching his front tooth, a headachy second-grader resting behind a curtain and two students with juvenile diabetes, stopping in for a pre-lunch blood-sugar check.

Under the supervision of clinical aide Cathy Jimmo, Nasara Moore, 10, and Tyler Nichols, 12, pricked their fingers, read the numbers on their monitors and injected doses of insulin through the skin on their stomachs.

Saratoga Elementary shares nurse Diane Allen with another elementary school, a middle school and a high school.

Allen assesses students and creates and monitors their health plans. She also trains teachers and other personnel to perform emergency procedures, including administering rectal valium in case of a prolonged seizure or injecting epinephrine to stabilize a student who has a severe allergic reaction. If she had time, she said, she would focus more on preventive care, including hand-washing, breast cancer screening and nutrition.

Aides are trained to provide first aid, medication and care for chronic medical issues. Jimmo's medicine closet has 45 inhalers, four asthma nebulizers, nine epinephrine pins for allergic reactions and a shelf of Benadryl, eye drops and prescription medication.

Jimmo refers to a detailed flip chart with directions on what to do in an emergency. She also draws on her experience raising six children. She is generous with hugs and affection, calling children "sweet love" or "precious," and student portraits fill her bulletin board.

Jimmo had four diabetic students in the just-ended school year. She is adept at interpreting monitors and reading body language to determine whether blood-sugar levels are high or low.

Shelbee Williams, who fretted at first about leaving her insulin-dependent daughter Nasara at school, said she has been reassured.

Williams recalled that Allen noticed a frequent dip in Nasara's blood sugar that led the mother to adjust her insulin pump.

"It's nice to know they realize how critical her care is," she said, "just like I do."