School nurses in short supply nationwide
Student needs range from physical to psychological
The health clinic at her son’s Colorado high school is “the best thing ever,” Hannah Chupp says.
“My teen can go there for advice and private help when he is too uncomfortable to discuss something with me,” Chupp says. “I am fine with him seeking help from someone other than myself. It’s part of growing up.”
The Chupps’ school in Cortez has a clinic that includes a nurse plus a nurse practitioner, who can prescribe medication and perform exams. Chupp’s son got his sports physical from the nurse practitioner. If he has a migraine, he can get crackers, ibuprofen and a place to rest from the school nurse, Chupp says.
As complex and often-chronic health conditions soar among children, worsened in some areas by the return of diseases largely eliminated by vaccines, full-time school nurses remain hard to find. About 40% of schools have only a
part-time nurse, and 25% have no nurse at all, the National Association of School Nurses says.
“School-based health clinics,” which are typically run by hospitals, are an increasingly attractive solution, growing by 20% from fall 2010 through fall 2013, according to the School-based Health Alliance. At that point, there were 2,315 of these clinics.
School nurses and parents who rely on them say the clinics – rare as they are among the 100,000 public schools in the USA – aren’t enough. Along with the primary care services the clinics provide, more school nurses and mental health professionals are needed, say groups representing the health care providers – especially as teen and even preteen suicide rates increase.
Role of school nurse has evolved
Treating everything from severe allergies and concussions to suicidal thoughts and gender transition, the role of the school nurse has come a long way from caring for colds and cuts. Among their other jobs, nurses say they serve an important role to triage and refer students to other health providers.
“The intensity of needs of students is a change,” says Donna Mazyck, executive director of the NASN and a former school nurse. “There’s an inverse relationship between the growing need and the funding.”
Though schools increasingly offer mental health services, demand still outpaces supply. School nurses and psychologists or social workers collaborate.
“When school budgets get tight, health services are tending to be on the chopping block,” says Laurie Combe, NASN president.
Against that backdrop, slightly more than half of students in public schools live in poverty, Mazyck says. That increases the risk of household and neighborhood trauma, which can exacerbate conditions such as anxiety and asthma. School shootings and the security measures adopted in response also heighten students’ anxiety.
“Our bodies’ response to trauma comes in many forms,” Combe says.
Students at Richard Wright School for Journalism and Media Arts in Washington come from the lowest-income wards of the nation’s capital and “have a lot of things going on mentally,” school nurse Belinda Millner says.
When teens come in with physical complaints, referrals to the school psychologist or social worker might be in order.
“We have to use our nursing judgment, as it could be something else they are having issues with,” says Millner, who started in October. “We’re kind of like the gatekeeper with the children.”
Her background as a paramedic and emergency room nurse didn’t prepare her for everything that comes up. Students who identify as transgender have asked for advice, including on which bathroom to use.
“I’ll say, ‘Hey, I’m still learning these things, too. Please explain what your feelings are,’ ” Millner says. It’s far different from the “bumps and scrapes” she treated as an elementary school nurse.
Suicide, stress and addiction may steal the headlines when it comes to teen health, but there are growing physical health problems as well. Combe, who managed health services for her school district in Houston, says hospitals save premature infants at earlier ages, and some have health needs that follow them through life. Some students,
she says, have feeding tubes in their stomachs and “need health care provision within the walls of the school.”
Americans’ increasing obesity has ensnared the schoolyard set, too. Type 2 diabetes is becoming far more common among overweight children and teens, and Type 1 afflicts students beginning at about 14 years old.
Denie Gorbey-Creese, a Maryland nurse who splits her time between two schools, has four diabetic students at one elementary school. She and her health assistants see them several times a day. The ones with insulin pens rather than pumps sometimes need to have the dosage for their insulin calculated based on what they had for lunch.
Health assistants aren’t legally allowed to calculate an insulin dose, so if Gorbey-Creese is at the other school, they have to call her, tell her what the blood glucose level was, how many carbohydrates the student ate and possibly even the child’s activity level that day. Then the assistant can administer the insulin.
“If I’m busy with an emergency at my other school, I’m not available right away,” Gorbey-Creese says. “So it might delay their care some.”
Nurses and the clinics save children and parents time away from classrooms and jobs, which could otherwise mean lost wages for hourly workers.
Strengthening health literacy
Although the hospital-run clinics are often proposed as a solution for the school-nurse shortage, the NASN recommends schools have a nurse even when there is a health clinic, a combination that Chupp agrees is important. Having both has made her son far more self-sufficient when it comes to his health, she says. Her college-age children, who didn’t have access to health care in high school, “call me for advice all the time and are afraid to make their own doctor appointments,” she says.
In Cincinnati, there are 26 schoolbased health centers, including three run by Cincinnati Children’s Hospital. Vaccination rates at schools with these clinics are far higher than at schools without them.
“We are meeting children and families where they are,” says Lisa Crosby, the nurse practitioner in charge of the hospital’s health centers.
Like Chupp, Crosby has seen how the clinics improve health literacy. The “best story ever” is when her former students tell her they’re paying closer attention to their children’s health because “I saw what you did for me.”
In Washington, schools are required to have nurses under a law that was sponsored by former Mayor Vincent Gray, who is chairman of the City Council’s health committee.
At the Richard Wright charter school in D.C., CEO Marco Clark says that when it came time to pay for a school nurse, which he had long wanted, “I didn’t want to rob Peter to pay Paul. But it’s money well spent.”
Cosandra Wright, whose four children have all been patients at one of the Cincinnati clinics, says she doesn’t think her oldest two kids would have graduated if not for the clinic. “It made it possible for them to learn and focus in school,” she says.
Of the staff, she says, “My children love them because they’ve always taken care of them.” Contributing: Hilary Lane and Andrew Merlis, “CBS This Morning” If you or your children are struggling with issues mentioned in this story and you would like to connect with others online, join USA TODAY’s “I Survived It” Facebook support group. This story is part of an education reporting partnership with “CBS This Morning.”