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School Nurse Shortage

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The tragedy unfolded with startling speed. Ten-year-old Mercedes Mears arrived at Clover Creek Elementary School, in Tacoma, WA, short of breath. Her sister ran into the office to get help. According to later accounts, Mercedes was in a panic. The school knew she was both asthmatic and suffered from food allergies—a plan detailing emergency treatment was on hand, as was a supply of her asthma medication and an EpiPen (a shot of the stimulant epinephrine, a drug that minimizes allergic reactions by relaxing the muscles of the airways). The plan had been signed by the school nurse. But the nurse came to Clover Creek only a few days a week—and that day wasn't one of them. Filling in was a “health clerk,” a former lunch server and playground supervisor with no formal medical training. When Mercedes collapsed to the floor, the school staff called the paramedics, but no one gave her an injection from the EpiPen, nor did they attempt any form of CPR or mouth-to-mouth resuscitation. When paramedics arrived, six minutes later, Mercedes was in full cardiac arrest and she died of an acute asthma attack.

Mercedes's parents have filed a lawsuit against the school district, and the case is scheduled to go to trial in June. “The important thing here is that Mercedes wasn't a kid they didn't know about. She had a health plan in place that authorized the school to give her medication when she couldn't breathe,” notes Thaddeus Martin, the lawyer representing the Mears family. Might things have gone differently that day if the school had had a registered nurse on duty?

Missing in Action

That's a question every parent should ask, for today a missing school nurse isn't the exception but the rule. According to the National Association of School Nurses (NASN), only 45 percent of the nation's public schools have a full-time on-site nurse. Thirty percent have one who works part-time—often dividing her hours between multiple school buildings—and a full 25 percent have no nurse at all. The implications are sobering. No school nurse can mean that kids who have or develop a serious health problem may not receive immediate diagnosis or treatment. Those who depend on daily medications may receive them from staff who have no medical training. Physical or emotional problems may go unnoticed. Healthy kids may miss out on lessons in hygiene and nutrition. Everyone loses.

There's no shortage of people willing to do the job, says Sandi Delack, president of NASN; the issue is funding. Districts everywhere are under pressure to raise academic test scores, and to do so with ever-shrinking budgets. When inevitable cuts come, the first to go are programs not required by law. And, strikingly, very few states mandate that a nurse be in every school; individual districts decide if it's a priority.

Children come to school today with health-care needs that go far beyond bandaging a skinned knee. More than 300,000 school-age children have epilepsy. About 4.5 million have ADHD. Some 15,000 kids are diagnosed with Type 1 diabetes each year Three million suffer from food allergies, and 9 million have been diagnosed with asthma.

Add to this equation the children whose families don't have adequate health care and may come to school with problems like untreated ear infections, along with a constant parade of youngsters suffering from scrapes, falls, and upset stomachs. “There's a line of kids outside the health office before the school day even begins,” says Patricia Gomes, R.N., who coordinates health programs for the Central Unified School District, in Fresno, CA.

Yet in many locations, registered nurses must divide their time between school buildings that are miles apart, talking to one office while in another, figuring out which crisis is the most serious. Meanwhile, teachers, school secretaries, and health aides must step in to fill the gap, and the potential for mistakes increases. An anonymous survey conducted at a California School Nurses Organization conference asked members to describe medication errors made by health “aides.” One nurse wrote about a student who'd died after having a seizure and hitting his head when he was home alone. She later checked his school medication card and saw that in the weeks prior, he'd missed nearly half his regular doses of medication because office staff hadn't called him in to take it.

Another incident involved an aide who didn't insist a child wash his hands before diabetes testing, which resulted in an abnormally high blood-sugar reading because there was jelly on the tested finger, and the calculated amount of insulin was too much. Even a seemingly routine problem may require skilled evaluation, says Gomes. “We see a lot of kids who've fallen and hit their heads. You have to know when a bump's just a bump and when it may be a critical injury.”

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