School nursing is no walk in the park: Budget cuts leave some school nurses overwhelmed



Most of us have a few presumptions about the easy life of a school nurse.  We think about enviable hours and summers off.  After all, we reason, how hard can it be to dispense band-aids, Tylenol, ice packs, and hugs? But school nurses, particularly in the counties surrounding Washington, D.C., are quick to dispel prevailing myths about working in school settings.

When school districts look for ways to tighten the belts of ever-constrained budgets, children's healthcare services often take significant hits.  There are simply too few budgeted dollars to employ appropriate numbers of school nurses.  In spite of the federal government's recommendation that schools hire one registered nurse per 750 children, the national average, as reported by the National Association of School Nurses, is one nurse per 1,500 children.  In Fairfax County school system, for example, there is one registered nurse for every 2,800 students.  In Utah the nurse-to-student ratio is most daunting: one nurses is responsible for 5,500 children.

These overburdened school nurses are also often simultaneously monitoring at least two schools.  According to the Association, gaps in student care and treatment are filled by aides, teachers, or secretaries, unlicensed individuals without the training or nursing skills to conduct effective management of individualized student healthcare plans. 

The situation is further complicated by the escalating enrollment of chronically ill children and children with complex medical issues into public schools.  Conditions that previously would have required inpatient or at-home nursing care are now commonly managed in school settings.  In some counties, school nurses change catheters, suction tracheotomy tubes, and manage medical conditions such as diabetes, epilepsy, and cancer.

In his June 25, 2008 Washington Post article "Nurses' Offices Overburdened"

Michael Alison Chandler wrote, "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."  As nurses struggle to keep up with children's routine and emergent needs, they are unable to address prevention measures that could cut down on future, long-term health problems.  Nurses are frustrated by the trends they see in their student populations, knowing that early intervention could reduce the eventual development of issues such as obesity or teen pregnancy.  School nurses are in an ideal position to lead health education initiatives around nutrition, substance abuse, safe sexuality, infection prevention, and exercise, but most of them simply do not have the time to do so. 

Adding to the problem is the number of children in the US without health insurance.  According to the Center for Disease Control, rates of children without healthcare coverage range from 3.7% in Massachusetts to 18.7% in Texas.  These children receive the bulk of their healthcare in their school nurses' office, a tactic that sometimes delays necessary treatment overnight or through a weekend. 

Some school nurses in Washington D.C.'s greater metropolitan area have trained teachers and support staff to perform emergency procedures during times when they are unavailable.  Health officials argue that this is not the way healthcare should be delivered in schools, but nurses say that they are left with little choice.


Copyright 2008- American Society of Registered Nurses (ASRN.ORG)-All Rights Reserved


Articles in this issue:


  • Masthead

    Editor-in Chief:
    Kirsten Nicole

    Editorial Staff:
    Kirsten Nicole
    Stan Kenyon
    Robyn Bowman
    Kimberly McNabb
    Lisa Gordon
    Stephanie Robinson

    Kirsten Nicole
    Stan Kenyon
    Liz Di Bernardo
    Cris Lobato
    Elisa Howard
    Susan Cramer

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