Rx for school nursing: some districts are trying creative approaches to fill critical nursing needs

School Administrator, Jan, 2003 by Rachel Smolkin

When Sandy Murray became a principal 15 years ago, she never thought she'd need to know so much about ringworm, fever, pinkeye and chicken pox.

Murray had no regular nurse at Plantation Elementary School in Plantation, Fla., near Fort Lauderdale. The Broward County School District provides a nurse only for emergencies, and even then getting a nurse out to the school can take some time. Many days, Murray made a best-guess diagnosis and then decided whether to send a child home.

"Chicken pox is the worst," says Murray, 52, who contracted the disease from her students two years ago. "We can have 15 kids in the office with bumps on them, and we have to stop what we're doing, and then we have to try to contact the parents. That's something the nurse would do."

But by forging some creative partnerships, Murray, who left the principalship in October to become a personnel administrator for the district, alleviated at least some of the burden on her and other school administrators. Plantation General Hospital sends volunteers twice a week to bandage boo-boos or help make phone calls to parents and guardians. The nursing club at South Plantation High School periodically visits the elementary school to chart students' heights and weights. And medical students at Nova Southeastern University volunteer time to staff the school clinic and explain symptoms to concerned parents.

Solutions Emerge

Plantation Elementary is just one of many schools around the country trying innovative ways of attending to student and faculty health needs. Strained budgets, insufficient numbers of nurses and increasingly complex student health problems are forcing schools and districts to embark on community partnerships, demand additional services from existing staff and explore supplementary sources of dollars to finance nurses or other health workers.

Retirements and shrinking numbers of nursing school graduates during the late 1990s have severely tested the availability of nurses. Many schools are facing state and county budget cuts even as new standardized testing requirements take effect. And students once deemed too sick to leave a hospital now attend school regularly. In the absence of regular nurses, school officials must find ways to administer Ritalin and other prescription drugs, help students use asthma inhalers, monitor diabetics' sugar intake, identify depression or other mental health problems and care for children who have no health insurance.

"To have teachers and principals attempt to grapple with those issues on top of standards-based reform is very problematic," says Peg Portscheller, executive director of the Colorado Association of School Executives and a former superintendent. "Districts are finding it necessary to get real, real creative" in meeting the needs of not only students, but also adults.

Solutions to improving health care vary widely according to districts' obligations and resources. Some schools have sought training for administrators to give out medicines or have increased their reliance on health assistants who lack a nursing license. Principals have lured retired nurses back to school part-time and have solicited volunteer services from local medical students. Building administrators have juggled staff positions to squeeze a nurse's salary from a burdened budget or have sought grants from local and federal agencies.

Hospitals, local health agencies and national health organizations also have stepped up efforts to assist schools. Health agencies are supplying medical experts who serve as advisers on school health councils. Hospitals are providing doctors who periodically visit schools to perform checkups. Some national organizations, such as the American Cancer Society, have launched training programs to educate administrators about strengthening and coordinating school health services despite budget limitations.

Turf Fights

At times, the partnerships between schools and outside organizations and agencies can create some friction over control and staffing. But some school officials who have created formal relationships with outside groups have found them surprisingly free of logistical headaches.

"Occasionally, we'll have a county board that wants to have a turf issue," says Don Kussmaul, superintendent of East Dubuque, Ill., Unit School District 119. The county health agency runs a clinic at the high school so that uninsured children and community members can obtain screenings and immunizations. "But normally, if the school and the health agency can work together and leave the politics out of it, it gets solved pretty easily."

Lucinda Mejdell-Awbrey, coordinator of student support services at the Visalia Unified School District in central California, says she helps avoid potential conflicts by preparing written agreements for partnerships. These agreements can specify rules of confidentiality and information sharing as well as insurance coverage.

"You need to clearly delineate what each partner's going to do and have opt-out language in case somebody loses funding and needs to step out," she says. "If another agency is placing a person in the school system to provide services, it's important to state who's going to supervise that person. If either partner has conditions or concerns, they need to be addressed in the agreement."