Five minutes into recess at William R. Sullivan Elementary School, petite kindergartner Lily bursts into school nurse Sharon Roland’s office, clutching her elbow and crying.
“Denise pushed me!” she chokes out between sobs, her face flushed and her hair matted with tears.
In less than 45 minutes, the half dozen chairs that line Roland’s office are filled with fidgety, tearful, sniffling students clutching various body parts.
Roland, who splits her time between this and another elementary school in the Murphy School District, is spread thin overseeing the care of more than 1,200 children.
However, she’s one of the more fortunate school nurses in the state.
Budget cuts have pushed district leaders across Arizona to eliminate school nurse positions and replace them with more affordable health assistants.
“How do you get it all done in time? You don’t,” said Roland, who frequently works late into the night and has to rely on outside clinics to manage some cases.
The extent of the cuts affecting school nurses won’t be clear until personnel data can be collected from districts across the state, a process that will likely take a few years, according to Nerissa Emers, school nursing coordinator for the Arizona Department of Education.
In the meantime, nurses like Shirley Rodriguez have spoken out.
Rodriguez, president of the School Nurses Organization of Arizona and coordinator of health services for Yuma Elementary School District, said her 18-school district cut 11 nurses last year.
“It’s happening all over the state, and it’s happening a lot more than we would like,” Rodriguez said.
Assuming students don’t have special needs, the national recommended ratio for school nurses is one for every 750 students.
The current ratio in Arizona is one nurse for every 1,022 students, according to a national report updated in June.
Rodriguez is responsible for more than 2,000 children in four schools, some of whom need specialized attention. She is also the only nurse immunizing the 9,501 students in her district.
“It’s just crazy busy every day,” Rodriguez said. “I had one little girl who came to my office with her heart beating so fast I couldn’t count it. At one of the other schools, we have a kid with seizures. And we have tons of asthmatics.”
To combat gaps in health services while nurses trek from school to school, districts are hiring health assistants, who typically have basic first aid and CPR training.
Health assistants working unsupervised have concerned nurses across the state, because most aides simply don’t have the expertise to handle every medical situation they may encounter, said Emers, the school nursing coordinator.
“When you have (a student) with a fragile health issue like asthma or diabetes, the health aides can do certain things that they’re trained to do,” Emers said. “But when it comes to emergency assessments, that’s just not their area, no more than someone who’s not trained to do surgery could walk in and do surgery.”
Maria Elena Duarte, a full-time health aide at William R. Sullivan Elementary School, started five years ago as Roland’s assistant. Now, she runs the health office alone every other day.
Duarte put her comfort level when a nurse is not present at zero.
“I prefer to have a nurse there because we never know what’s going to happen,” she said.
When Duarte encounters a health problem she is not able to solve – she cannot dispense over-the-counter medications or examine injuries that require the removal of clothing, for example – she has three options: call the nurse, call the child’s parents or call 911.
Duarte said she often receives calls from frustrated parents wondering why she “can’t just give (their child) a Tylenol” or why there is no school nurse with whom to speak.
Roland said parents trust that their children will have care at school. “It’s scary to them when no one’s there,” she said.
The problem is compounded at schools serving lower-income areas, where uninsured families rely on nurses to assess whether a student needs to get to a doctor immediately or can do without, Roland said.
Michelle Ogden-Shields, a first-grade teacher at Jack L. Kuban Elementary, the other school Roland serves, said changes in school nurse staffing have yet to affect the classroom.
“We’re still able to send them to that health assistant, and then she takes it from there,” Ogden-Shields said. “But who knows what will happen, if teachers will always have that resource to go to, or if we’ll eventually be the ones calling parents.”
Despite challenging circumstances, Roland said she and other school nurses will “keep on trying.”
“As difficult as things seem, we’re very fortunate that in many cases we’re still able to get these kids the help they need,” she said.
Recommended ratios for school nurses:
• One nurse to every 750 students in populations that do not require special care.
• One nurse to every 225 students in populations that may require daily professional school nursing services or interventions.
• One nurse to every 125 students in populations with complex health care needs.
• One nurse to one student may be necessary for individual students with multiple disabilities.