By Maria Sonnenberg
The Boy Scout motto of "be prepared" equally applies to today's school nurses, who not only deal with the typical bruises and tummy aches that have always been part of school life, but must now contend with a student population that is increasingly more medically fragile.
As school systems face budget cuts, nurses must also adapt to a "migrant" lifestyle as they are assigned to several schools during a workweek.
"There have been a lot of changes in the last 20 years," said Pamelia Hamilton, community health nurse consultant and school health coordinator for the Brevard Department of Health, which supervises the 160 nurses and health technicians who serve public schools in Brevard County.
According to the National Association of School Nurses, a third of all school districts reduced nursing staff in the past year because of the recession, and a quarter of all school districts in the nation don't have nurses. In these districts, medical emergencies are typically handled by a school's front office staff, the way they were in Brevard until the late 1980s, when nurses were first introduced to local schools.
Brevard's ratio of nurse to students — about 1 per 450 — is exemplary, when considering that Florida, with a nurse-to-student ratio of 1 to 2,537, is at the bottom of the list in the number of nurses in schools. Only Utah, North Dakota and Michigan are worse off in numbers. Vermont, on the other hand, has a ratio of 1 nurse per 396 students.
The National Association of School Nurses recommends a 1-to-750 ratio for well students and 1 to 125 in student populations with complex health care needs.
"People who live here think our nursing program is the norm everywhere, but when they move out, they are in for a shock," Hamilton said.
"What we do is so extraordinary that we've been recognized with several awards."
The health department hires, trains and pays the school district's nurses. In turn, the district reimburses the health department for most costs incurred in running the program.
New responsibilities
The foremost duty of a school nurse is to keep kids learning as long as possible. These days, that can take the form of fixing an accidentally stapled finger or a nasty cold, as it did years ago, but it can also entail helping a pregnant teen stay in school and teaching them to become a good mother. Brevard's Teen Parent Program, for example, assists about 250 pregnant girls at Palm Bay, Eau Gallie, Titusville and Cocoa high schools.
"We explain to them what is happening to their bodies and train them to care for their babies," Hamilton said.
School nurses today also go beyond the traditional boundaries of kindergarten to high school students. Nurse Travia Williams and her team of technicians travel through the county's Head Start program sites to provide the screening, physicals and related services necessary for the little ones to be better prepared when their school days start.
Other nurses are devoted to one-on-one care with medically needy students who otherwise would not be able to attend school.
School nurses are also tasked with managing children's increasingly complex medical conditions and chronic illnesses. A child may have a tracheotomy or require nasal gastric tube feeds by an experienced nurse. Nurses may be required to monitor students' insulin pumps and keep track of inhalers and EpiPens. In some instances, Medicaid pays for a private duty nurse to be with the student one-on-one throughout the school day.
"Professional responsibilities have not changed overall," said Carolyn Duff, president of the
National Association of School Nurses. "What has changed is the increasing number of students with chronic health conditions, including asthma, diabetes and severe allergies. All of these conditions have the potential for life-threatening emergencies. What this means for school nurses is an increasing need to train and maintain a competent team of unlicensed school personnel to prevent, recognize and respond to emergencies.
"Another change is a welcome change," Duff said. "There is now a greater emphasis on prevention and wellness in health care."
"School nurses are identifying students at risk for both health and learning problems at an early age and are able to initiate early referrals for intervention and treatment."
The National Association of School Nurses lists data that underscores why school nurses' duties are so varied these days. Among students ages 12 to 19, pre-diabetes and diabetes has increased from 9 percent in 1999 to 23 percent in 2008, and 32 percent of children ages 2 to 19 are obese. More than 10 million children suffer from asthma. The prevalence of food allergies among children younger than 18 increased 19 percent from 1997 to 2007.
Mental health issues among students are on the rise. School nurses estimate they spent about a third of their time providing mental health services.
Overall, 15 percent to 18 percent of children and adolescents have a chronic health condition, nearly half of whom could be considered disabling.
ACA's impact
The enactment of the Affordable Care Act could provide an opportunity to strengthen a nurse program that serves the nation's 52 million school-age children. For many of these students, the school nurse is the sole provider of access to health care.
Health care reform's emphasis on wellness dovetails with the goals of school nurses, who provide continuity of care and promote healthy lifestyles for students during their most critical developmental years. They perform early intervention services such as periodic assessments for vision, hearing and dental problems with the goal of removing barriers to learning.
States are testing different health care models for high value rather than high cost and high volume. School nurses are included in the plan.
"Health care reform will lead to greater opportunity for school nurses to successfully connect students from low-income families to medical homes, because more students will be insured," Duff said.
"More widespread access to medical homes will provide greater opportunity for school health services to focus on prevention and wellness and tighter management of students with chronic disease."
Source: USA Today