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School nurse shortage has widespread impact, says survey

The Philadelphia School District started the school year with a shortage of school nurses. A budget shortfall of more than $700 million resulted in a loss of 100 school nurses. Today, there are 195 nurses serving approximately 200,000 students in the city's public schools.

A survey of parents and school nurses by the Education Law Center in Philadelphia shows that the shortage is having a significant, widespread and potentially long-term impact on students. The survey found that nurses are being assigned to cover multiple schools, which results in a dramatic decrease in the time to provide needed services and interventions, as well as the loss of opportunities to build relationships and trust with students.

As one nurse put it: "There is no room to develop a rapport with our young clients; we are in and out. Without the ability to get to know our students, gain their trust and become aware of their needs, our role is severely compromised. The impact of these cuts may not be fully understood for several years."

The nurses report that students with chronic health conditions requiring daily maintenance are most significantly impacted, followed by children whose families don't have health insurance.

Beyond the immediate health risks, the lack of school nurses places the Philadelphia school district at legal risk.

"The district is legally obligated to provide specific nursing services to children with special education needs and those with qualifying disabilities, such as asthma and diabetes," says the ELC's Maura McInerney, who co-authored the report. "If school nursing services are not provided to ensure that children can learn and are properly accommodated in school, they may suffer discrimination in violation of federal and state law."

In addition, the nurses point out that some nonmedical personnel are handling nursing duties. A school nurse who was surveyed explained the risks of that approach: "Children who have chronic health problems such as asthma, diabetes, or food allergies are not safe in schools without a full-time school nurse. Numerous medication errors have already occurred as a result. If the district continues on the current path, we will soon realize the real cost."

The ELC is recommending that the Philadelphia public schools take the follow steps to fix the current crisis:

  • Conduct a cost-benefit analysis to clarify the value of nurses in the school district of Philadelphia.
  • Adopt a student-to-school nurse ratio on a "per school" basis that accounts for the impact of students with acute and chronic medical needs and special education needs.
  • Eliminate reliance on untrained personnel to perform duties of a school nurse.
  • Utilize nursing students from various local universities to perform discrete tasks with supervision by a registered and licensed school nurse. [Adrienne Coles/Education Law Center press release]

May 9, 2013