The Perfect Storm: Too Few Nurses; Too Many Sick Kids

It’s like the perfect storm waiting to happen.

There’s that creepy thing out there hiding in the shadows called swine flu (H1N1) and way too few school nurses on the front lines to take care of all those kids who are possibly going to contract it. In a perfect world, says the National Association of School Nurses, there would be one nurse for every 225 students in schools that require "daily professional school nursing services." In a school where there are kids with mental, emotional and/or physical disabilities, there should be one nurse for every 125 students.Federal guidelines are more relaxed; they recommended one nurse for every 750 students.

Even at that, most schools don’t even come close to these numbers, according to the association’s 2008 tally. The ratios range from a high of 1–to-275 in Vermont, to 1-to-4,893 in Utah. [Residents in that state have been judged to be among the nation’s healthiest, so maybe they don’t need school nurses.]

Hawaii has no school nurses – and that’s a topic for another discussion.

The global picture is that only about 45 percent of public schools have a full-time nurse, according to the association, and three out of four schools have at least a part-time nurse. That leaves a quarter of all schools with no nurses at all.

Some years ago, I spent a few days with several school nurses so I could write a feature about what it was like for the few who remained after a round of layoffs in one of our local districts. One of the lasting memories of this assignment is the acuity of some of those students – elementary and high school kids who were in wheel chairs, had severe movement and communication disorders, and required regular suctioning, medications and attention for the accidents that seemed to happen with regularity.

I was amazed at how some nurses had to travel from campus to campus, never having time for lunch or a restroom break, and how they remained hours after school to do the paperwork that they weren’t allowed to carry home.

If anything, there are more of these students now than there have been in past decades, and the number of employed school nurses seems to be dwindling. In my area of San Diego County, school nurses apparently are considered dispensable or non-essential because they are laid off regularly. That gives rise – not surprisingly – to battles about what duties non-medical staff can assume in the absence of nurses.

For instance, one school idistrict in the Los Angeles area declared it permissible for an office aide to determine whether diabetic kids are experiencing dangerously high or low blood sugars, then administer or withhold insulin. The dispute went to court and the nurses proved the folly of this.

So back to the present and future, which could prove just how valuable our school nurses are.

If the swine flu rears its ugly head, nurses’ offices will be crowded. But before that happens, nurses should be busy, in between all their other duties, talking about washing hands, using tissues, wiping down desks and using all that Purell hand sanitizer that teachers have requested along with this year’s classroom supplies.