Schools plagued by nursing shortage

Published 12:00 am Saturday, September 17, 2011

By Sarah Campbell
SALISBURY — During a recent afternoon at Millbridge Elementary, school nurse Sharon Beck held a blood glucose monitor steady while second-grader Kayla Woods pricked her own finger.
The two chatted until the device beeped, an indication the results were ready.
Kayla’s blood sugar was high, so Beck asked the type-1 diabetic a few questions.
“What did you have for lunch?”
“Did you eat all of your lunch?”
“Wasn’t your blood sugar low this morning?”
It turns out Kayla ate almost every bite of her burrito lunch that day.
After Kayla returned to class, Beck called her father to give him a heads up.
During the call, she asked when the 7-year-old’s next appointment with a doctor was and suggested checking to see if her diet needed to be adjusted.
But most days Beck isn’t around to help Kayla with her blood sugar checks, leaving the school’s administrative assistants to handle the task.
Each week, Beck travels between Landis Elementary School, Millbridge Elementary and Knox Middle.
And she’s not the only one.
With 11 nurses to serve all 35 schools in the Rowan-Salisbury School System, the caregivers have to take on at least three schools, some even have four.
The school system is down one nurse this year due to state budget cuts, which leaves one nurse for every 1,800 students. The American Academy of Pediatrics recommends one nurse per 750 students.
“More students per nurse means we have to go around putting out fires and doesn’t leave as much time for preventative education,” lead school nurse Susan Thomas said.
And when they aren’t putting out fires, the nurses spend the majority of their time training staff how to properly administer and monitor procedures ranging from cauterizations to blood sugar checks.
“Our main job, since we cannot be in each school, is to train the staff to take care of the children,” Thomas said.
Getting ready
Beck said the start of the year is one of the most hectic times for school nurses.
“We may not be getting a classroom ready, but we are getting things ready so the classrooms can run smoothly,” she said.
The nurses schedule meetings with parents to get filled in on their children’s health needs. They also train primary and back-up staff to work with students who need care on a daily basis.
“There are a lot of health needs in school that sometimes people don’t realize,” school nurse Wendy Marchinko said.
Marchinko works with China Grove Elementary, China Grove Middle and Bostian Elementary.
“This time of year is so busy because we are doing a lot of training,” she said.
That training not only includes getting school staff prepared to care for students with chronic diseases, but also things like how to use an EpiPen in case of a severe allergic reaction, as well as bloodborne pathogens and CPR training.
The nurses also spend the first several months making sure students have the proper vaccinations before moving on to do vision and hearing screenings for elementary students.
The need for more
When Thomas began working for the school system in 1992, there was only one other school nurse, and both women spent most of their time working with exceptional children.
But today, Thomas said, there is more of a need for nurses in schools because the number of children with chronic illnesses, such as diabetes and asthma, has grown substantially.
“Back then we only had two insulin-dependent diabetics in the whole school system. We have at least 50 now,” she said.
Thomas said there is also a need for more nurses because of the severity of health conditions that require feeding tubes and catharizations.
“Because of those things, we need someone overseeing the health routines that children need, and that needs to be a registered nurse,” she said.
State law requires school nurses to be registered nurses and receive national certification within three years of their hire date.
At its peak in 2008, the district had 14 school nurses. That number has dwindled with the expiration of grant dollars and budget cuts, Thomas said.
School nurses perform a vital service to the health and well-being of students, according to Superintendent Dr. Judy Grissom. “The challenge for our district is that the medical problems for students have increased while at the same time funds have decreased,” she said.
Ideally, Marchinko said, there would be a nurse in every school.
“We work hard to do the best we can with what we have, but I do think we need more of us,” she said. “I could stay busy at every school every day.”
Marchinko said her role would be different if she was only assigned to one school.
“I would be the primary person that does the procedures,” she said. “My role now is making sure the staff can handle these situations when I’m not here.”
Beck said although staff members are trained to give insulin shots and change catheters, having a nurse at every school would remove that pressure.
“A lot of times they are given medical tasks and they feel overwhelmed, but they learn how to do them because they care about the kids,” she said.
A nurse in every school
Both the Kannapolis City and Cabarrus County school districts have a nurse at every school thanks to a partnership with the Cabarrus Health Alliance, the county’s health department.
Betty Braxton, community relations director for the Health Alliance, said the school health program is funded through the agency and allocations from both school systems.
She said the Cabarrus Medical Society Alliance, a nonprofit organization run by physicians’ spouses, has also raised more than $175,000 through an annual golf tournament in support of the program.
The Health Alliance originally started out with two nurses covering all the schools in both systems in 1988, but expanded to include a nurse at every school in 1999.
“We had a program where a school nurse visited a school once or twice a week, but we knew there were more demand and needs than we could meet with an occasional visit so the desire was to have a more comprehensive program,” Braxton said.
Braxton said the Health Alliance recognized that students perform best when they are healthy.
Cabarrus County is the only county in state to have developed a comprehensive school nurse program for each public school using a public-private partnership model.
Grissom said although the Rowan-Salisbury district doesn’t have a partnership with a local health care provider, that doesn’t mean it doesn’t want one.
“Our district has and will continue to have discussions with area health care providers to seek assistance during the economic downturn that is causing many areas in public education to be hit with critical losses,” she said.
What more nurses would mean
Thomas said if the Rowan-Salisbury School System had more nurses, there would be a greater continuity of care.
“I’d love to be able to just focus on one group of kids,” Beck said.
Beck said although most nurses dedicate one day per week to their assigned school, not having to travel between three would lend more time for health promotions including lessons about nutrition, the importance of physical actively and proper hand washing procedures.
“I think the whole level of wellness at the school would improve overall,” she said.
Marchinko agrees that increase preventative care practices would yield healthier students.
“Of course we want to help people when they are sick, but we want to help keep them from getting sick in the first place,” she said. “I feel strongly that we make a difference because if you don’t feel good you aren’t going to be ready to learn.”
Contact reporter Sarah Campbell at 704-797-7683.