NursingLink

Reading, 'riting and Ritalin: Teachers are asked to take on nursing duties as schools cut back












Brandon Merrell, 8, holds his insulin needle at his home Friday, July 11, 2008, in Gilbert, Ariz. The thought of someone without a medical background managing Brandon's diabetes makes his mother, Amy Merrell, very uncomfortable. (AP Photo/Matt York)



07-15-2008 5:16 PM

By MELISSA KOSSLER DUTTON, Associated Press Writer

(Associated Press) --  During the past two school years, teacher Julia Keyse had to enforce an unusual rule in her kindergarten and first-grade classroom: No interrupting while she pricked Caylee's finger to check her blood sugar and adjusted her insulin pump.

"They were so good. They would just sit and wait," Keyse said of her class at Etowah Elementary School in Henderson County, N.C.

It's a task Keyse never imagined when she became a teacher, but medical duties have become a part of the job for educators across the country as schools cut nursing staff or require nurses to work at multiple locations. The change comes at a time when more students are dealing with serious medical conditions, such as severe allergies, asthma and diabetes.

It's a change that's unsettling for teachers, school nurses and parents.

"We don't want to pretend to be doctors or nurses," Keyse said. "I would have gone to school for that."

Federal guidelines recommend that schools employ one nurse for every 750 students, but the national average is one nurse for every 1,151 students, according to Amy Garcia, executive director of the National Association of School Nurses. A quarter of schools in the nation have no school nurse.

Although there is no historical data regarding the number of school nurses nationwide, members of the profession say there are fewer nurses doing more work, while teachers and other school workers pick up the slack. The average nurse splits her time between 2.2 schools, according to the association.

"Teachers deserve a school nurse because their time should be spent teaching," Garcia said.

Meanwhile, the workload of school nurses has increased since 1975, when the federal government mandated that schools accommodate disabled students, clearing the way for children with feeding tubes, catheters and other serious medical conditions to attend school. Today, 16 percent of students have a condition that requires regular attention from the school nurse, Garcia said.

Many parents and school administers don't realize that nurses are handling life-threatening conditions as well as performing vision, health and diabetes screenings, said Barbara Duddy, president of the Tennessee Association of School Nurses in Memphis.

"They think the school nurse is nice little job where you take care of boo-boos," she said. "School nurses work very hard to make sure every child gets exactly what they need."

Garcia blamed shifting priorities, shrinking budgets and a misunderstanding of the school nurse's role for the loss of jobs.

The Southern Humboldt Unified School Board in Garberville, Calif., blamed a reduction in state funding when members voted in June to eliminate one nursing position and reduce the other position to 10 hours a week for the upcoming school year.

"The nurses provide great services for our students, but so do all the other positions that we've cut," said Susie Jennings, associate superintendent for the 800-student district.

Robin Correll, the remaining nurse, worries how she will oversee the district's seven schools. She was already struggling to perform annual health and vision screenings.

"It will be impossible to do all the work," she said. "It breaks my heart. Kids deserve better."

Correll, like many nurses around the country, has already trained teachers and secretaries to dispense medication, give shots of adrenaline and help children use inhalers. So far the district has stopped short of asking nonmedical personnel to administer insulin.

The thought of someone without a medical background managing Brandon Merrell's diabetes makes his mother, Amy Merrell, very uncomfortable. The Gilbert, Ariz., woman wants assurances that her 8-year-old son will be properly cared for while he's at Coronado Elementary School.

"There needs to be somebody in there that knows what they're doing," she said.

She and her husband, Doug, are among the parents speaking out about the issue. After they and other parents objected to a plan to cut the number of school nurses from nine to two, the Higley Unified School District decided in June to maintain five nursing jobs.

In Keyse's North Carolina district, Barb Molton told county commissioners that she worried her diabetic 13-year-old son, Brice, had access to a school nurse for only two mornings a week.

"It can be scary dropping your child off at school wondering if that will be the day they might have a medical emergency and wondering if that is the day you might be lucky to have a school nurse there," she said at the hearing.

The commissioners agreed to fund two additional nurses for the upcoming school year.

School nurses, who have spent the last decade defending their jobs, are happy to see parents take up the cause, said David Schildmeier, spokesman for the Massachusetts Nurses Association.

"That's how the change happens," he said. "That's how this issue gets solved."

There definitely is a major issure here. Teachers are there to teach not to provide medical care. I think if they care about the kids education they should care about their health and well-being and have a nurse at each school.

Fortuntely, our small city in Texas has an RN at each of its 5 campuses.  When many of us were kids, there was no "OSHA", no "CDC", no problems with community acquired infections, and quite a few less children.  Things have changed a lot since the 60's, and both parents working is one of the major ones.  Mommy is no longer home to see to the medical care of her children, so the teachers and nurses become, to a large extent, surrogate day-time parents. 

There needs to be a nurse to assess and treat the increase in cases of asthma (from increased pollution, o-zone, etc.), diabetes (overeating; less exercise), and we're seeing an increase in the number of students not having received immunizations prior to entering the school system (education needs; no insurance), etc, etc, ad nauseum.  We've also got the Disability Act and the rights of disabled or children with needs to have a regular education, therefore presenting a need for injections, breathing treatments, assessments, tube feedings, etc.

I just listed the tertiary needs.  There are also the preventive and primary needs of oral, visual, auditory screenings.  Height/weight, lice, and scoliosis assessments.  Insuring all immunizations are up to date is necessary.  There is increased sexual activity in pre-adolescence and adolescence, so the obvious problems there.  The nurse also cares for the staff and teachers when they have health questions, diabetes complications, COPD, falls, hyper or hypotension, and on and on.

Then you give the nurse 475 pre-K to 4th grade students who have not yet been diagnosed with diseases or deficiencies, and he/she may be the first person recognizing the problems, notifying the parents, and coordinating community resources.

So, I support our school nurses and there needs to be someone speaking up for the under-respected group of fellow nurses!!  IMHO. LOL

Unfortunately, it is a necessary evil. We are very low on school nurses in NC. Part of our problem is that in Onslow County, you MUST have a BSN to even be considered for a position. This is a stupid rule and I feel has contributed to our school nurse shortage. 

In our county, it is the school nurses your do the training.

I went on a field trip with my son's class when he was in 2nd grade. One of the kids was on Ritalin. The teacher kept it in her unlocked desk. Everyone had access to the drugs in her classroom!

This was about 9 or 10 years ago, so I am hoping things are different. I have not been in a position since to have a similar incident occur

I wont say the name of the school but i know a Teacher who was promoted to school nurse after getting a medical assistant certfication???

I am a Registered Nurse and also a high school Health occupations teacher. I feel the pain so badly here!! We had one RN in our school system (for 4 schools) up until last week when she quit. Each school had a school " nurse" (I use that VERY lightly here because they were all CNAs) but the RN had to be there to administer the insulin and such. She quit because of the legalities behind her job. If there was an emergency at one school and a child at a different school was scheduled for insulin and she couldn't make it back....well, her job (and license!) was in jeopardy.

I have worked in the clinic during my planning periods to help the nurse out with all the little things she does. I also send some of my CNA students up to help her with the little things like filing paperwork and such. Unless you've been there, you really don't know what all the school nurse does. It's amazing what all they do for the little pay they get. I used to whine about my hospital salary until I saw that there are others who fare much worse.

I have been called on several times to leave my classroom to take care of a sick child. That leaves me in a catch 22 as a teacher though. I was hired by my school system to be a teacher and not a nurse. If I leave the classroom, there has to be another adult available to stay with my students while I care for the sick student. It puts me as the RN and the teacher in double jeopardy.

However, I'm not one bit comfortable with a guidance counselor or school secretary handing out Ritalin or any other kind of medication to students. I wouldn't even want them bandaging up a wound, because it could be an issue a lot more serious than "just a wound". That's my 2 cents worth. It's a scary world in school these days. That's one reason I choose to homeschool. ;)

in NYS LPN/LVNs are not allowed to assess yet we have NLP's doing it daily in schools....why aren't LPN's hired to do non assessment tasks???? DDSO also uses alot of NLP and their med error rate is through the roof

My school was fortunate enough to have someone in the role of "nurse" on each campus, whether it be a CNA, LPN, or RN. As of yesterday, the governor of Georgia has decided that school nursing is one area that can be cut back in order to reduce expenditures. I about fell out of my chair when I read that notice from my school superintendent. The school system that I teach for has a "year of wellness" theme. Now, how good is it looking to have a year of wellness without a school nurse?!?! I am a RN but my job there is to teach and not nurse, although I teach CNA classes. I am also the chairperson of the wellness committee. This will definately be a hot topic at our next wellness meeting for sure!!!

NLPs are Non-licensed personnel