School Districts Cut More Nurses

(Wall Street Journal) The battle for shrinking school-budget resources has a new front: the nurse’s office.

School nurses, a fixture in many American schools for more than a century, are being cut from Philadelphia to San Diego, as public schools struggle to provide basic services while continuing to slash budgets. Los Angeles has cut its number of school nurses by 13% since 2008, and more nurses and thousands of other employees are on the chopping block as the district faces a $390 million budget deficit.

The cutbacks come as nurses are increasingly being pressed to serve a student body with a growing number of complex, chronic health problems—from diabetes and life-threatening allergies to asthma and obesity, according to school officials, parents and nurses.

A school nurse “is sometimes the only medical professional our families see,” said John Deasy, superintendent of schools for the Los Angeles Unified School District, which serves about 664,000 students enrolled in kindergarten through 12th grade—three-quarters of whom are in federally subsidized lunch programs.

About three-quarters of U.S. schools have a nurse for at least a few hours a week, according to the National Association of School Nurses, a professional group. Most states don’t require schools to have a nurse on site every day; in those states, teachers or school administrators tend to sick or injured kids when nurses aren’t around.

A 2003 study in the Journal of the American Academy of Pediatrics found that off-site nurses consulting by phone and video “can be an effective strategy to improve access” to medical care for students in some situations.

Ohio’s Cleveland Metropolitan School District began cutting school nurses last year. The district laid off 55% of nursing staff, leaving 28 nurses to cover 45,000 students this year. Most of those nurses were assigned to 17 schools to meet the needs of chronically ill children, and parents can relocate such children to a school with a full-time nurse or make other arrangements for their child’s care.

When there is a serious injury at school or some other type of emergency, school officials in Cleveland now call an ambulance. The child’s parent, insurance company or Medicaid is billed.

In Philadelphia, which cut 98 school-nurse positions last year, leaving 185 nurses for 152,000 students, teachers and administrators are being trained to administer medications. In San Diego, which this year cut half its school nurses, medical staff will be centralized and nurses deployed to schools as needed.
Donna Mazyck, executive director of the school-nurses association, said teachers and administrators shouldn’t substitute for trained nurses. But, she added, students’ “needs don’t disappear when the nurse is not there.”

This month, teachers-union officials and parents filed hundreds of complaints with the Los Angeles school district saying recent cuts to the nursing staff—to 520 nurses as of last year from about 600 in 2008—endanger student health. (The majority of school nurses aren’t represented by teachers unions, but it varies from state to state, according to the nurses’ group.) A school-board inspector general’s report in February said the district’s move to cut school-nursing services to one or two days a week compromises student safety and makes it difficult to meet state-mandated health requirements.

Parents and administrators say that they realize cutting nurses isn’t ideal but that with increasingly tight budget cuts, it is hard to avoid.

A few weeks ago, Susan Kovinsky, the Los Angeles mother of a fourth-grader, said her son hurt his finger playing at school. His school had cut back on on-site nursing, so a school administrator taped up her son’s finger. “I don’t think a nurse could do any better,” she said. “If you have an OK kid, you can live without it. If I had a kid with a peanut allergy, I’d be worried.”

Health services have “been terribly impacted” by budget cuts, Mr. Deasy, the superintendent, said. But he added: “What do I do? Make kindergarten classes 45 to one?”