Teachers, staff help nurses as needs rise

Student-to-nurse ratios

The National Association of School Nurses recommends one school nurse for every 750 students. These are the ratios of local school districts with more than 2,000 students, from best to worst. Only four meet the national guideline.

* Districts with a nurse at each school building. Sources: Student counts are from the Ohio Department of Education, 2009-10 school year, and nursing totals are from individual districts.

At a time when more children require medical care for chronic conditions, most Dayton-area schools do not staff on-site nurses.

In fact, most local districts fall well short of a student-to-nurse guideline of one nurse for every 750 students set by the National Association of School Nurses and supported by the Ohio Department of Education.

“(The ratio) is a good gauge for districts,” ODE spokesman Patrick Gallaway said. “Districts need to assess the needs of individual students and be sure they are prepared to accommodate the various needs that arise.”

To address these needs in lieu of staffing, most school nurses are assigned to multiple buildings and their districts train teachers, secretaries and other personnel to administer medication and respond to emergency medical needs.

Training takes place before school starts in the fall, is regulated by the state and often is conducted by district nurses or city EMTs.

Although many teachers and staff members are amenable to this training, some say the care they are expected to provide can extend beyond their comfort level.

“The teachers are so concerned about doing what’s best for the student, and they are concerned they won’t do something right,” said Nicole Bouas, a Northmont teacher and president of the teachers’ union. “What if something goes wrong?”

Meanwhile, many parents want a nurse present at their child’s school.

“When we were young, you got sent to the school nurse when you were sick — now they send you to the office,” said Holly Simmons, a Kettering parent. “With all the money we spend on schools, we should always have a school nurse on hand.”

More chronic conditions

One argument for more nurses might be the fact that local school districts report seeing a steady increase in “medically fragile children” due to chronic ailments in the last 10 to 15 years.

“More students than ever before require medical care such as tube feeding, diapering, suctioning, catheterizing, occupational and physical therapy,” said Jude Cohen, the school nurse coordinator for Kettering City Schools. “(They also require) medication for acute seizure disorders, asthma and diabetes.”

A recent study in the Journal of the American Medical Association showed that chronic conditions in children increased from 12.8 percent in 1994 to 26.6 percent in 2006.

These conditions include diabetes, epilepsy, severe allergies and asthma.

This increase is attributed to multiple factors, including scientific advancements helping more children born with disabilities survive and attend school, and the stark rise in childhood obesity.

The Centers for Disease Control and Prevention reported that obese kids are at an increased risk for diabetes, asthma and heart disease.

The CDC added that the number of people diagnosed with asthma grew by 4.3 million from 2001-09, with the rates among black children rising nearly 50 percent.

At local schools, nurses deal with these conditions as well as the more traditional childhood illnesses, injuries and wellness needs, such as immunizations, hearing and vision screenings, and scoliosis checks.

Some hiring

Beavercreek, Troy and Springboro are the only large local school districts that staff a nurse at each school building.

Most districts have maintained consistent nursing staffs as needs have increased, but some have been able to hire. Centerville has added nurses gradually to treat specific students and now has 14, 11 of whom serve the general district population.

Huber Heights has three nurses for 10 buildings, but that is an increase from two in previous years. It also, like Trotwood-Madison, employs clinical aides.

In districts with fewer nurses than buildings, nurses visit schools on a regular basis and as needs arise.

Vandalia-Butler has three nurses for six school buildings, and officials believe their needs are met.

“Our buildings are pretty close together,” said Dan Heaton, director of pupil personnel for the district. “I think, even if we had all the money in the world, we would still do it this way.”

However, according to the NASN, staffing is not adequate in the vast majority of area districts. Only four of 20 local districts with 2,000 or more students fall within the recommended guideline of one nurse for every 750 students, and five districts have fewer than one nurse for every 1,500 students.

Teachers, secretaries and other school personnel are trained to address needs caused by this nursing deficit, and many are receptive to this protocol. But there are others who fear being placed in these potentially life-or-death situations.

Asking too much?

Marianne Urban of Dayton Public Schools said of her district: “Teachers and staff are very uncomfortable with the full responsibility to administer medication or treatments to students.”

In Centerville, a teacher speaking on condition of anonymity said she has a student whose condition could require her to administer emergency medication via anal syringe. She said the school board and teachers’ union told her she is required to be trained.

“When I asked my legal rights, they said if I refused to be trained and the student needed medication, I would be fired,” she said.

Dr. David Roer, a pediatrician and a member of the Centerville school board, said firing would be the last resort.

“It is difficult to allow a teacher not to treat a child because the implication is, where does it stop?” he said. “Teachers are on the front lines, and are often the first person there. It’s not that we don’t empathize with the teacher, but the reality is that we have to have these teachers trained.”

Jenny Birtle, communications director for Mad River, agreed. She said her staff would prefer that a school nurse administer all medication, but they do what must be done.

“Even with a nurse in the building there could be an emergency that would require the staff member with the student to give emergency medication,” she said. “It is all about the health and safety of our students.”

Comfort levels

Most parents “prefer having a nurse meet the health care needs of the child,” Urban reported.

Simmons said she has been called to her daughter’s school six times for medical issues, and only one of those times was a school nurse present.

“I work, like lots of parents, and I would like to have a nurse there to take care of my daughter if something happens,” she said.

Marcia Watts, director of student services at Miamisburg, acknowledged parents are sometimes concerned about the district not having enough nurses on staff, but that educating them about the plan goes a long way.

“I walk them through it and show them the people who are going to help,” she said.

Officials did not report any major incidents attributed to current staffing, but most agreed that districts could use more nurses.

“If we had the funding to put a nurse in every building, that would be fabulous,” Bouas said. “It would take a lot off our secretaries and principals, and our teachers.”

Some fear impending state funding cuts could compromise staffing further.

“Without a doubt, all areas of the budget are being reviewed and evaluated for their impact on student health, safety, as well as the quality of our students’ education,” Birtle said. “However, our district has a long history of supporting the health and safety of our students and I don’t see that changing.”