As funding continues on a downward spiral, educators and administrators are faced with the daunting task of keeping schools staffed and operating. While the laying off of teachers grabs the majority of school budget-cut headlines, there is a whole other group that is just as vital to kids’ success in schools and whose numbers are also dwindling: nurses.
Today’s school nurses do a whole lot more than just dispense Band-Aids and take temperatures.
“The nurse is an essential part of success in the classroom,” says Marilyn Wyant, a registered nurse and director of health services for the 6,500-student Maricopa Unified School District. “Seventeen percent of our school population has diagnosed chronic health conditions. My nurses write health care plans on all of those kids. They do trache care, they have tube feedings going on, we have kids on monitors, on oxygen. We’ve got kids that are in chemotherapy, in remission from cancer.”
Although nurses, administrators and school board members all agree on the importance of properly staffed health offices at schools, the method of achieving that goal varies from district to district. Nurses say money is the chief factor in deciding how many registered nurses a district employs, but self-advocacy and parent involvement also figure into the equation.
Shirley Rodriguez, president of the School Nurses Organization of Arizona, says, “We try to explain to school board members and school administrators the role of the school nurse and how we impact the education of students. Bottom line, legislators are cutting school budgets right and left and that only leaves so much money in the pot. Granted, they need money for teachers, but we are another piece of the puzzle trying to keep kids in school.”
Rodriguez, a registered nurse and coordinator of health services for the 2,400-student Yuma School District 1, says she needs to look no further than her own district, which she says saved more than $600,000 by eliminating several nurse positions two years ago.
“We’re losing school nurses across the state. My district went from sixteen to five,” she says. “I had a nurse in every school in my district two years ago. Now we each oversee three to four health aides in addition to taking care of our own schools.”
Another point of contention among the state’s school nurses is the use of health aides in schools in place of registered nurses and licensed practical nurses. Rodriguez says these unlicensed assistive personnel (UAPs) only require minimum training and it’s perfectly legal for schools to hire them.
“They can hire someone off the street with high school education or GED, teach them CPR and first aid and then they can be in the health office in the school,” Rodriguez says. “Sometimes they call themselves a school nurse, which is illegal. They don’t know what they don’t know.”
Nerissa Emers, school nurse coordinator for the Arizona Department of Education, confirms the state doesn’t have laws dictating requirements for school nurses.
“There is no mandate in our state for what credentials an individual has to have in order to man the health office,” she says. “The schools, with local control, can make that decision. The best practice is to have a licensed nurse manning the health office.”
However, nurses also face the challenge of convincing their school board of their value to the education process. In Arizona, success on that front is a mixed bag.
“When they made the decision to cut the 11 nurses, one of the board members said ‘all we need to do is train them for three days and then they are good to go,’” Rodriguez says. “Well, hello, that just barely scratches the surface.”
Kimberly Purdy is preparing to begin her fourth year as a nurse at Constitution Elementary in Deer Valley Unified School District. The 37 schools in that district are each staffed with either an RN or LPN, which she says is a result of sacrifice and parent involvement.
“District employees voted about two years ago to take a pay cut rather than have them cut jobs,” she says. “I’m not working for the money. I make half of what I could make in a hospital.
“We also have strong parent support,” she adds. “I have had parents tell me they will remove their kid from this school if there is no nurse.”
Ann Ordway, governing board president for Deer Valley Unified, agrees with Purdy’s assessment of the vote. She says the district looked for feedback from parents by distributing a list with possible areas to make reductions. One group’s inclusion on the list hit a nerve.
“Parents were absolutely enraged that nurses were even on that list,” says Ordway, whose two children – an eighth grader and a high school junior – attend schools in the district.
Ordway, who says her district is “doing excellent” in maintaining nursing care for students, says nurses do much more than just hang out in an office. “The nurses are not just there for the students,” she says. “Teachers do not like to miss school. The nurses are really there for everyone.”
Like many educators, Ordway shies away from the idea of the state mandating a registered nurse in each school. “It is a school board choice but, we make our decisions based on the needs of the students,” she said.
Emers, of ADE, says the lack of a mandate likely plays a part in school health office staffing. “I’m sure not having a mandate for who is staffed in the health office helps to guide districts in making those decisions.”
She points out that nurses are in the same classification pay-wise as teachers. “The salaries that are normally paid to nurses in the health offices are no different than any other certified staff member in the school,” Emers says. “It’s not like traditionally the nurses are getting paid an exuberant amount of money.”
Sharon Roland spent the past 21 years of a three-decade nursing career in Murphy School District #21 in southwest Phoenix. Her district made the choice to let her go in April, replacing her with a certified nursing assistant.
Roland, who is the School Nurse Organization of Arizona’s director to the National Association of School Nurses, doesn’t buy the short-money argument. “I don’t believe it’s a funding issue, because the money is there,” she says. “There is not a shortage of school nurses, there is a shortage of funded positions for school nurses.”
In 2008, Roland, a staunch advocate for a state mandate for registered nurses in every school, was part of a group pushing a bill that would do just that. She says legislators saw the measure as hiring more nurses at the expense of teachers.
“Legislators’ first question was ‘who’s going to fund it?’” she says. “They would ask something like ‘is it more important to have another teacher or a school nurse?’”
Then-Rep. David Lujan, who sponsored the bill, said it failed because of bad timing.
“The purpose was just to get more registered nurses in schools because there were a lot of schools that weren’t able to have them,” he says. “We introduced it pretty much the same year that the state’s revenues disappeared. At a time when you’re having to cut education, there was just no way that any legislation that was going to ask for more money was going to get through.”
Donna Williams, who has spent 15 years as human resources coordinator for Murphy School District #21, says ultimately school districts try to the best they can for their communities. “As a parent, I want the best services to be provided for my children,” she says. “Bottom line, I think that’s what our parents want as well. They want to know their children are going to be safe and secure. And we’re doing everything we can possibly do,”
Murphy, which has about 1,400 students spread between four schools, currently employs one RN, one LPN, one certified assistant and four health workers. It wasn’t always that way though. “In years past we had a nurse on every campus,” she says. But when it came time to make cuts, the district tried to spread it around equally. “Everybody was reduced. The district office, classified staff, we all got cut back.”
As for the proposal by Roland and others for a statewide mandate, Williams says it all comes back to money. “It’s always nice, but how do you achieve that? Where is the money going to come from? You still have to service the children inside the classroom,” she says. “We just got to a point where you have to let some things go and you just have to try to figure out some other roads to take and still do the best you can do at servicing our community and our children.”
Ultimately, all school employees, including nurses, must roll with the tide of state funding booms and busts. Emers, of the Department of Education, says in an era of fiscal restraint, nurses aren’t a bad investment.
“Not only do the school nurses represent the school health office, but they play multiple roles in the school’s function,” she says. “Nurses are so broadly utilized in schools, that for one individual position, you’re getting quite a bang for your buck.”