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School Nurse Shortage

School budgets cuts mean that school nurse jobs are disappearing across the country, leaving children at risk
By Carol Mithers,1

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The tragedy unfolded with startling speed. Ten-year-old Mercedes Mears arrived at Clover Creek Elementary School, in Tacoma, WA, short of breath. Her sister ran into the office to get help. According to later accounts, Mercedes was in a panic. The school knew she was both asthmatic and suffered from food allergiesa plan detailing emergency treatment was on hand, as was a supply of her asthma medication and an EpiPen (a shot of the stimulant epinephrine, a drug that minimizes allergic reactions by relaxing the muscles of the airways). The plan had been signed by the school nurse. But the nurse came to Clover Creek only a few days a weekand that day wasn't one of them. Filling in was a health clerk, a former lunch server and playground supervisor with no formal medical training. When Mercedes collapsed to the floor, the school staff called the paramedics, but no one gave her an injection from the EpiPen, nor did they attempt any form of CPR or mouth-to-mouth resuscitation. When paramedics arrived, six minutes later, Mercedes was in full cardiac arrest and she died of an acute asthma attack. Mercedes's parents have filed a lawsuit against the school district, and the case is scheduled to go to trial in June. The important thing here is that Mercedes wasn't a kid they didn't know about. She had a health plan in place that authorized the school to give her medication when she couldn't breathe, notes Thaddeus Martin, the lawyer representing the Mears family. Might things have gone differently that day if the school had had a registered nurse on duty? Missing in Action That's a question every parent should ask, for today a missing school nurse isn't the exception but the rule. According to the National Association of School Nurses (NASN), only 45 percent of the nation's public schools have a full-time on-site nurse. Thirty percent have one who works part-timeoften dividing her hours between multiple school buildingsand a full 25 percent have no nurse at all. The implications are sobering. No school nurse can mean that kids who have or develop a serious health problem may not receive immediate diagnosis or treatment. Those who depend on daily medications may receive them from staff who have no medical training. Physical or emotional problems may go unnoticed. Healthy kids may miss out on lessons in hygiene and nutrition. Everyone loses. There's no shortage of people willing to do the job, says Sandi Delack, president of NASN; the issue is funding. Districts everywhere are under pressure to raise academic test scores, and to do so with evershrinking budgets. When inevitable cuts come, the first to go are programs not required by law. And, strikingly, very few states mandate that a nurse be in every school; individual districts decide if it's a priority. Children come to school today with health-care needs that go far beyond bandaging a skinned knee. More than 300,000 school-age children have epilepsy. About 4.5 million have ADHD. Some 15,000 kids are diagnosed with Type 1 diabetes each year Three million suffer from food allergies, and 9 million have been diagnosed with asthma. Add to this equation the children whose families don't have adequate health care and may come to school with problems like untreated ear infections, along with a constant parade of youngsters suffering from scrapes, falls, and upset stomachs. There's a line of kids outside the health office before the school day

even begins, says Patricia Gomes, R.N., who coordinates health programs for the Central Unified School District, in Fresno, CA. Yet in many locations, registered nurses must divide their time between school buildings that are miles apart, talking to one office while in another, figuring out which crisis is the most serious. Meanwhile, teachers, school secretaries, and health aides must step in to fill the gap, and the potential for mistakes increases. An anonymous survey conducted at a California School Nurses Organization conference asked members to describe medication errors made by health aides. One nurse wrote about a student who'd died after having a seizure and hitting his head when he was home alone. She later checked his school medication card and saw that in the weeks prior, he'd missed nearly half his regular doses of medication because office staff hadn't called him in to take it. Another incident involved an aide who didn't insist a child wash his hands before diabetes testing, which resulted in an abnormally high blood-sugar reading because there was jelly on the tested finger, and the calculated amount of insulin was too much. Even a seemingly routine problem may require skilled evaluation, says Gomes. We see a lot of kids who've fallen and hit their heads. You have to know when a bump's just a bump and when it may be a critical injury.

There's a real link between nursing, health, and education, says Delack. It's pretty simple: Nurses help keep kids healthyand when kids are healthy, they're more likely to stay in school and learn. If there is shortage of nurses in a school theres a great problem seen. For example if a public school doesnt have a clinic or school nurse and an emergency happen no one knows how to handle it properly but the nurse. Nurse is an important employee of a school, company and hospital. A nurse is indeed the fixer of a health problem. Finally, schools with nurses can help keep kids well. Nurses who have time to pay individual attention to children can recognize early signs of trouble, whether it's depression, drug use, or trouble at home or school. Nurses offer vision and hearing screening exams, teach kids to wash their hands properly, and give guidance in nutrition

Why are school nurses important?
12 April 2013 Last updated at 23:50 GMT
By Philippa RoxbyHealth reporter, BBC News School nurses were once seen simply as nit seekers, but children's safety and emotional wellbeing are now their primary concern. The government has announced that children will help to train school nurses in how to provide the best support as part of a "strengthened and more tailored school nursing service". Yet there are only 1,200 of them in England, and about 20,000 primary and secondary schools. So why is their role still so important? The poor health of army recruits in the 1890s is thought to have created the need for nurses to look after the health of children and young people. In the early 1900s, these public health nurses were concerned with hygiene and the spread of disease, frequently dealing with outbreaks of flu and cholera. White coats The first school nurse worked in Bolton, caring for the poor in their own homes, and then in the 1960s and 70s school nurses began wearing white coats, answering to doctors and brandishing nit combs.

School nurses are approachable and non-judgemental. We're in a position to be able to support young people. Helen Rossschool nurse But the "Nitty Nora" image of school nurses combing through children's hair is one the profession has long been trying to shed."The role has always been about promoting public health with children and families," says Sharon White, professional officer with the School and Public Health Nurses Association (SAPHNA), which represents school nurses."But their work now covers around 50 different facets, ranging from acne to sexual exploitation, self harm to sleep problems - all those issues centred around the holistic health of children." Team work Immunising children, measuring their height and weight, running drop-in clinics and teaching part of the PSHE (personal, social and health education) curriculum are just a few more of the jobs they can be asked to do. Depending on the needs of the local population, school nursing resources have to be focused on some areas more than others. They do not work alone either. Qualified school nurses are part of a team of health professionals who help share the load."Sometimes the school nurse may seem invisible, but she is spending time on the neediest, complex families and on safeguarding issues," says Sharon White."And there's a difference between accessibility and invisibility." School nurses say they have a unique position working with children aged from five to 19 years. They can have one-to-one conversations with them in a way that teachers often feel unable to do. They also offer greater confidentiality - and a link between home and school. School nurses can play a massive part in public health but there need to be more of them

Caroline VoogdEditor of the British Journal of School Nursing 'Approachable' Helen Ross is an executive board member of SAPHNA. She started school nursing in 1989 and has seen many changes since then. She and her team now spend 70% of their time on trying to protect children, which she says is the right thing to do following the cases of Baby P and Victoria Climbie,"School nurses are approachable and non-judgemental. We're in a position to be able to support young people - and they have a voice we must listen to." The Department of Health's new vision for school nursing wants to take this further by making nurses more visible and more relevant. It started with a promise last year to make it easier to contact school nurses, by texting them to make appointments. Now 300 young people will be chosen to help shape the services which school nurses provide. Nurse numbers Caroline Voogd, the editor of the British Journal of School Nursing, understands why this is important. "Visibility has been poor. Involving young people ensures that they know the school nurse exists." But it is still a small workforce. While there were 2,415 registered school nurses in England in 2008, according to the Nursing and Midwifery Council, numbers went down to 1,138 in May 2010 - then up again a little to 1,216 by the end of 2012. Even if services are as made as efficient as possible, Voogd believes there should still be more qualified school nurses. "You can increase performance and productivity but that only goes so far. School nurses can play a massive part in public health but there need to be more of them."

Some might think that school nurse is an easy job but it is not. School nurses save lives, increase student attendance and decrease early dismissals. Here's what school nurses do. They:

are the first line of defense against epidemics and disease outbreaks, monitoring the health of the overall population and connecting with public health officials; are the first responders to critical incidents on school property; provide direct health services for students; identify threats to health in the school community (peanut butter, dogs, traffic, broken equipment and facilities, bullies, lack of clean water or hand soap) and work to elimate those problems as a cause of ill health; provide leadership for the provision of health services, health policies and programs; provide a critical safety net for the most fragile students; provide screening and referral for health conditions such as vision, hearing; promote a healthy school environment; enable children with chronic health conditions to attend school; promote student health and learning;