Budget Cuts Increase Burden For School Nurses (NC)
June 22, 2011
When it comes to cutbacks on education, the focus has naturally been on the classroom. But they also affect health care. Statewide, there’s one school nurse for about every 1,200 students. That’s much higher than what national guidelines recommend, and that ratio is likely about to get worse.
In the nurse’s office at East Mecklenburg High School, Joyce Kelley-Kramer said the high-pitched whistle from the heating/cooling system usually greets whoever comes to see her. It’s summer break, so it’s the only noise now.
“Several people have tried to fix it and have been unable to do so,” Kelley-Kramer said with a laugh. “I think they’ve moderated the tone a little bit or the intensity over the year, so I’m grateful for that .”
But during the school year, Kelley-Kramer said there are a lot of days when she doesn’t even notice the whistle. She’s too busy.
“I’m responsible for the whole student population,” Kelley-Kramer said.
There are about 1,800 students at East Meck, but Kelley-Kramer is the only school nurse. She just finished her 10th year there, and she said she treats about 25 students a day in her small office.
“Sometimes what we have to do because there might be a line out the door is a quick triage of who’s here, why they’re here, what kind of services I think they need, who’s bleeding, who’s having difficulty breathing,” Kelley-Kramer said.
That’s just the day-to-day, emergency treatment.
Kelley-Kramer also links uninsured and under-insured students and their parents with community health care providers. She creates health plans for students with special needs and chronic conditions, and she trains teachers and staff to carry out those plans and administer medicine because, well, it’s just her, and again, there are 1,800 students.
The head of Mecklenburg County’s school health services, Maria Bonaiuto, said even Myers Park High School has only one nurse. It’s the biggest high school in the county with about 2,700 students.
Bonaiuto said no school has more than one nurse at a time and half the schools only have a nurse every other day.
“The range is from say one to maybe 500 to one to almost 3,000,” Bonaiuto said of the school nurse to students range in Mecklenburg County.
The American School Health Association, along with other national and state health organizations, recommends one school nurse covers no more than 750 students.
But the average school nurse in North Carolina covers about 1,200 students, according to the most recent N. C. School Health Services report. That’s about where things stand in Mecklenburg and Union counties. The ratio is worse in Iredell, Gaston, Lincoln and Stanly counties – about one nurse for every 1,400 students.
“Each nurse has over a thousand kids with needs for management of their chronic health conditions and their immediate needs on a day to day basis that just are very difficult to meet at those large numbers,” Bonaiuto said.
Bonaiuto said the ratio had been improving in Mecklenburg and some other counties until a few years ago. But then the economy tanked, and state and county funding for new school nurses dried up.
Next year’s state budget cuts about $23 million in funding that local school districts use for school nurses. In addition, it eliminates 10 vacant school nurse positions that were state supported.
Mecklenburg County is different in that its school nurses are almost totally county funded. Still, next year the county is cutting two school nurses’ jobs.
Jessica Gerdes oversees school nurse training in the state. She said as school nurses get stretched thin, it reduces the level of care they can provide.
“I think the impact that will be most noticeable is when parents cannot contact the nurses readily for an appointment to discuss their kids needs,” Gerdes said. “Or when a student that the nurse has been seeing a couple times a week needs them, but the nurse is not available.
Bonaiuto of Mecklenburg County says when a nurse isn’t around, it’s another thing that falls on the teachers, teachers assistants and secretaries.
“Basically more falls on the school staff – things that they really are not equipped to take care of,” Bonaiuto said.
Back at East Meck, Joyce Kelley-Kramer said one question stands out in her mind from when she first interviewed for a school nursing job.
&l t;br>”I was asked by one of the program administrators, am I the type of person who has to check off all the boxes and feel like I’ve gotten everything done before the day’s over?” Kelley-Kramer said.
The answer is no because there’s always something that doesn’t get done. That’s especially true today.