School nurses are spread thin
It’s a problem in nearly every California school district, and Tahoe Truckee Unified is no exception: A shortage of school nurses is putting undue responsibility on the shoulders of secretaries and teachers, and placing sick children at risk.
“This district does their best to provide the staff with all the training they can, but children’s health problems have become more complex,” said school nurse Eunice Requenez. “Students’ lives are put at risk. Secretaries or teachers are the ones who give medications out, and they are under so many interruptions that they could easily be distracted.”
On any given day, 70 percent of California’s students don’t have a nurse working at their school site, according to the California School Nurses Organization, and it’s about the same in Tahoe Truckee Unified.
With only three part-time nurses serving about a dozen schools and three state pre-schools over a 720-square-mile area, nurses are able to serve just one school each day, and their ability to respond elsewhere is minimal.
“There are three main issues,” Requenez said, “a high nurse-to-student ratio, a large work load, and extensive travel.”
And while the number of school nurses is decreasing due to districts’ budget cuts and low pay ” on average, school nurses earn $20,000 less than nurses working in hospitals even though they often have higher qualifications ” children with chronic illnesses, such as severe food allergies, asthma and diabetes, are on the rise.
“There are more diabetics in our district now than there ever was,” said school nurse Lisa Abrahams. “It’s a national issue.”
At just one of Truckee’s elementary schools there are 20 asthmatics, three diabetics, and three students with allergies so severe that a simple peanut or bee sting could send them into anaphylactic shock.
And that’s not including other students in the district who have seizure disorders, eating disorders, cerebral palsy and a slew of other conditions.
“We are not first responders. If you have a problem, you call 911. This isn’t a hospital, it’s school district,” Abrahams said. “Our responsibility is to make sure that there are emergency or medical action plans in place for the event of a seizure or an asthma attack.”
School nurses like Abrahams and Requenez are the ones who train teachers and staff to respond, but there are no California mandates that require teachers and staff to participate in training. Even CPR is optional, according to district nurses.
Teachers have the right to refuse to provide specific health care to a student, though the district is required by law to provide someone who will accept responsibility.
“You have to be constantly looking for someone who can give the best assistance,” Abrahams said.
In many districts, that extra assistance comes in the form of health aides.
“What would really help at the elementary and middle school sites are health aides that could help on a daily basis with injuries and parent phone calls,” Abrahams said. “Our district has discussed it, and would like to do it, but it’s all about the budget.”
As it stands now, secretaries are often the ones taking care of the aftermath of recess.
“I get six to a dozen interruptions a day for kids wanting Band-Aids and ice,” said Alder Creek Middle School secretary Lynn Altieri.
But Band-Aids and ice aren’t really the job of the school nurse anyway. The true responsibility of school nurses is to make sure that the district is in compliance with state mandates, Abrahams said.
And that list of mandates is a long one, including vision testing for all students when they enter the school system, and again every three years. It’s the same for hearing testing. Then there is scoliosis screening in seventh and eighth grades, dental screening, medical reports for special education students, and a growth and puberty class for fifth graders.
“It’s massive amounts of planning and scheduling,” Abrahams said.
And yet the piles of paperwork and shortage of nurses doesn’t seem to bother some teachers and principals who say that most medical conditions can be managed by the staff.
“I have the fire department right next door, and I familiarize them with the kids here that have medical needs or allergies, so I feel pretty comfortable,” said Glenshire Elementary Principal Kathleen Gauthier. “If I had to prioritize, I would want more reading intervention teachers before I would want a full-time nurse; I don’t feel that our kids are that sick.”
“Bottom line,” said Abrahams “The student’s safety and health comes
first, and if there is a problem, you call 911.”