Twenty-one of Washington's 124 elementary schools have no nurses on duty at any time to care for students and many others are visited by nursing personnel only two or three times a month, according to a new report by a D.C. school board committee.

The 42 secondary schools are better covered, with nurses available two or three times a week, but overall, the report said, "health services to D.C. public school students are often minimal, uneven, or in some cases, nonexistent."

The D.C. schools currently have 46 nurses and 13 health technicians for a population of 92,000 students, representing a rough student-nurse ratio of about 2,000 to one. Organizations such as the National Education Association and the American School Health Association recommend much lower ratios--between 750 and 1,000 students for every nurse.

But District government officials say that budgetary constraints prevent such ratios here, and their situation is not unique.

Montgomery County, whose student health care personnel are under the jurisdiction of the county's Health Department, has a student-to-nurse ratio roughly equal to the District's.

Said Elizabeth Quinlan, Montgomery's senior community health nurse: "We have 50 nurses for the 92,517 students in the Montgomery schools, but they also D.C. Board Cites Lack of Nurses In City Schools By Ronald D. White Washington Post Staff Writer

Twenty-one of Washington's 124 elementary schools have no nurses on duty at any time to care for students and many others are visited by nursing personnel only two or three times a month, according to a new report by a D.C. school board committee.

The 42 secondary schools are better covered, with nurses available two or three times a week, but overall, the report said, "health services to D.C. public school students are often minimal, uneven, or in some cases, nonexistent."

The D.C. schools currently have 46 nurses and 13 health technicians for a population of 92,000 students, representing a rough student-nurse ratio of about 2,000 to one. Organizations such as the National Education Association and the American School Health Association recommend much lower ratios--between 750 and 1,000 students for every nurse.

But District government officials say that budgetary constraints prevent such ratios here, and their situation is not unique.

Montgomery County, whose student health care personnel are under the jurisdiction of the county's Health Department, has a student-to-nurse ratio roughly equal to the District's.

Said Elizabeth Quinlan, Montgomery's senior community health nurse: "We have 50 nurses for the 92,517 students in the Montgomery schools, but they also provide health care for about 7,000 other students in parochial schools located in the county. Budget constraints keep us from having more nurses."

The number of school nurse positions has fallen nationally by an estimated 25 percent in the last five years, according to the report prepared by consultant Erika Landberg for the school board's committee on student services and community involvement.

The report said Washington's Department of Human Services bureau of school health services, which has managed school health care since 1968, only has seven doctors working on a part-time basis so that "their total time adds up to 2.5 people."

PTAs at some schools that have no health care personnel have resorted to raising funds to hire a nurse each year, according to the report.

D.C. school board members, after reviewing the study, voted last night to begin talks with DHS on possible expansion of health services.

Dr. Mary Ellen Bradshaw, acting chief of the bureau of school health services, said yesterday she would welcome discussion with the school board on the health care situation. "Where staff is available, the care is good," Bradshaw said. "If staff are not available, then it depends on the resourcefulness of school personnel."

Bradshaw said that overall budget constraints were the main factor limiting the number of nurses hired. She added that in the past it has been difficult to hire more nurses because of the city's residency requirements and because salaries, until recently, were not competitive with those offered by private medical facilities. Bradshaw said the current base salary for nurses employed by the city is $21,483 a year.

In an interview with a reporter last week, D.C. Public Health Commissioner Ernest Hardaway said school nurses should be concentrated in the elementary schools with the younger children. They could be made available to high schools when there is an immediate need, said Hardaway. The city also may rely more heavily on private physicians located near the high schools in the future, he said.

Landberg's report also said school nurses are expected to provide 19 services including first aid, diagnosis of minor ailments, and screening of students or school staff for minor illnesses or for damage due to exposure to lead-based paint. But it said restrictions by local statutes seriously limit treatment nurses can provide.