Editorís note: This is the third in a series about education issues locally and nationwide. Because it is our annual health care edition, Lindsey has focused on school nurses this month.School nurses were first introduced in the United States in late 1902, as a way to intervene with the health care needs of students and families and reduce absenteeism related to communicable diseases. According to the National Association of School Nurses, the role of the school nurse has expanded and evolved from its original focus, but the goal to keep kids healthy and in the classroom is a constant.ìWe feel our biggest duty is to try to keep the kids in the classroom as much as possible,î said Marla Haynes, charter school nurse with Falcon School District 49. ìWe try to address the issue they bring us and then get them back to the classroom to continue their learning. Theyíre at school to learn.îWhile the goal of school nurses hasnít changed, the role has broadened to encompass overall wellness education ó prevention to avoid acute illnesses, said Cassandra Reese, school nurse/co-lead/Medicaid coordinator for Academy School District 20.ìThrough the Affordable Care Act, thereís been an emphasis on wellness, which is a move in the right direction,î Reese said. The focus should be on primary prevention rather than on tertiary care, she said.Haynes said school nurses are required by state regulations to conduct annual vision and hearing screenings on students. Nurses are responsible for rescreening students who have shown possible issues in either area, and school nurses must provide resources for parents who might not be able to afford hearing aids or glasses for their student, she said.One major difference between the original scope of school nurses and the current one is that nurses now have a much higher number of students who present illnesses or disabilities, Haynes said. ìWe have a higher acuity of the types of illnesses, or multiple handicapped students who didnít used to come to school,î she said. ìBefore, parents would keep them home, but now we have students coming in that require a lot more care. We have kids with gastrointestinal tubes and catheters, and parents send their students to school with nebulizers ñ- things they didnít send their students with 20 years ago.ìWe used to not hear about every other student having peanut allergies and now thatís more the norm. If the parent doesnít send the medication for a student with a peanut allergy, the nurse has to take the time to call the parents to find out about their medications.îDiabetes is another chronic health issue that school nurses are seeing more of today, Haynes said. ìAlmost every school that I know of has diabetics,î she said. ìWe are seeing a lot more of type 1 diabetes.îAccording to the National Center for Educational Statistics, about 52 million students attend school each day in the United States, and 15 to 18 percent of them have chronic health conditions. With so many more students presenting health issues, school nurses are spread thin, Haynes said.Budget restraints have kept many districts from being able to afford a nurse at every school, every day, Reese said. ìIn the ideal environment, it would be nice to have a nurse in every school,î she said. In reality, nurses at D 20 rotate through several schools each week, spending one day at each school, Reese said.Haynes said she also rotates through several schools each week. ìOf course, if schools could afford to have a nurse, it would be ideal; but itís not feasible.ìTwenty years ago, nurses normally had one school. They were able to give medication and had standing orders to give medications like Tylenol and Pepto Bismal. Over the years, that has changed. Now, most nurses are nurse consultants, which means we have several schools.îHaynes said she has four different schools that she rotates through, plus the D 49 Patriot Learning Centerís night school. ìI normally have at least one full day at each of my schools, and then we usually allow one day a week to have nurses meetings and do miscellaneous things. All the schools (in D 49) get at least one full day of our time.îìItís just an estimation, but about 10 years ago when I started (as a school nurse), the nurse-to-student ratio was about one to 3,000,î Reese said. ìIt was huge. Weíve brought it down to about one nurse to every 2,000 students, give or take, based on the programs involved.îWhile that ratio is an obvious improvement, itís a far cry from what the United States Department of Health and Human Services has set as a nationwide goal: one school nurse for every 750 students. The NASN recommends a ratio of one nurse to no more than 225 students when students with special health needs are mainstreamed with other students. The ratio is further amended to one nurse for no more than 125 students for severely chronically ill or developmentally disabled student populations, according to the NASN.On May 7, 2013, the Student-to-School Nurse Ration Improvement Act was reintroduced in the U.S. House of Representatives. The companion bill, the Nurses for Under-Resourced Schools Everywhere Act was introduced on May 7, 2014, in the U.S. Senate. Together, these bills would create a pilot demonstration grant program that allows federal assistance for schools most in need of improving their student-to-school nurse ratio.ìAs times change and needs change, staffing ratios change,î Reese said. ìItís a time issue, but I think weíre moving in the right direction.î
