School Nurses Decline as Duties Increase (OH)
February 15, 2011
A little girl with pigtails poked her head into the school nurse’s office at Roll Hill Elementary School in North Fairmount.
"My throat hurts," said Kennedy Drake, 6.
It was around 9 a.m. on a Thursday. Nurse Angela Mullins’ busy day was just beginning. Ten minutes later, a 7-year-old girl limped in to get an injured toe wrapped. Then a boy came to take his medication before a girl with asthma stopped in to report she was having a hard time breathing.
By 10:15, Mullins had treated eight people, including a teacher. She’d also called several parents, entered data into her computer for each patient and started checking immunization records of the school’s nearly 600 students so she could schedule home visits to those whose children need shots.
Roll Hill is in a high-poverty area where many families don’t have easy access to health care . As is the case with many Cincinnati Public schools, the school nurse is the primary health care provider for many students.
Mullins is the school’s only nurse. But her position will be gone come June, a victim of city budget cuts that will end funding for school nurses.
In December, to help close a $54 million deficit, Cincinnati City Council voted 5-4 to cut funding to its public health department by 25 percent. The city will save about $2 million annually ($1 million in 2011).
The city currently covers about 60 percent of the school nurse program. The school district funds the other 40 percent. The cuts mean about 35 of the 50 nurses that staff Cincinnati Public’s 42 elementary schools will be laid off by June, leaving many of the district’s more than 33,000 students without access to health care at school.
The district hasn’t determined how it will cover the losses.
Many city council members believe the school district should fund the program.
"It should be the responsibility of the school system and should be included in any levy in order to pay for the cost of it," said Vice Mayor Roxanne Qualls. "I don’t think anyone voted for this because they thought nurses weren’t valuable. It was because we had to balance our budget."
Cincinnati Public is unique in that more than half of its school nurse program is funded by the city. About 72 percent of registered nurses working in Ohio schools are employed by school boards, according to the Ohio Department of Health’s 2008 School Nurse Survey. Only 13 percent work for public health departments. The rest work for contract agencies or educational service centers.
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The district projects a $20 million to $50 million budget gap by June 2012. School Board President Eve Bolton said the district has not decided how it will cover the shortfall. Even if it seeks a levy in November – and voters approve – the funds won't come in time to save the nurses for 2011-12.
Parents, educators and the broader health-care community worry about the cuts’ impact.
They say fewer nurses would lead to a higher absenteeism, lower academic achievement and a bigger drain on community resources because chronic conditions will go unchecked. Parents will be called more often to pick up sick children. An asthma attack – something a school nurse currently handles – may turn into a 911 call.
Supporters will rally at City Hall Wednesday, seeking to get city council to restore the funding.
"We have to let the community know what this means," said Larry Hill, president of the Ohio School-based Health Care Association and former dental director for the Cincinnati Health Department. "In one blow we saved jobs of police and firefighters at the quiet loss of school nurses. If the health of kids isn’t our top priority, what does it say about our community?"
While Cincinnati Public is the only district in Greater Cincinnati and Northern Kentucky facing such dramatic cuts, but others may follow suit as they work to plug recession-driven budget shortfalls, react to failed levies or make up for state cuts to education funding.
In Arizona, state education cuts forced districts to eliminate nurse positions and replace them with more affordable health assistants.
The lack of full-time nurses in every building has resulted in delayed s creenings and assessments, and higher absentee rates, said Shirley Rodriguez coordinator of health services for the 18-school Yuma Elementary School District and president of the School Nurses Organization of Arizona.
Ohio doesn’t mandate school nurse programs, thus making it a local burden. Less than one-fourth of the state’s public schools staff a full-time nurse, according to the Ohio School Nurse Association.
In Northern Kentucky, districts have not had to make dramatic reductions in nurse staffing yet. But a few districts have cut a position or two in recent years.
Others, including Erlanger-Elsmere schools, worry about the future as grant money runs out.
"More and more students in the Northern Kentucky have no health insurance and no family doctor," said Superintendent Kathlyn Burkhardt. She said her district may lose one of its three nurses when a Health Foundation grant runs out this year.
"This is something many legislators are overlooking when they ask schools to keep cutting."
The cuts come at a time when school nurses’ duties are expanding. Nurses increasingly handle severe illnesses that decades ago might have resulted in a child being schooled at home.
They administer tube feedings, dole out daily doses of medication to a growing number of students with chronic health conditions such as insulin-dependent diabetes, sickle cell and asthma. They even catheterize some students.
"You see the band aid, but it’s also helping people manage chronic stuff," said Susan Tensing the sole school nurse at the 1,400-student School for the Creative and Performing Arts.<br /> ;
"Just because the majority (of students) are healthy doesn’t mean you can just kick the rest to the curb,” Tensing said. "The ones who do need nurses need them desperately."