Friday, Aug 29, 2008
Once a comforting presence in most public schools, full-time nurses are increasingly scarce. Now teaching assistants, secretaries and other nonmedical personnel are trying to care for sick children -- with often tragic results.
Sep 29, 2005 | On June 2, 2005, 15-year-old Clare McKenna was gripped by an asthma attack in the middle of her class at City Honors High School in Buffalo, N.Y. Within seconds McKenna -- an avid volleyball and softball player -- was gasping for breath. The teen collapsed as two friends helped her to the nurse's office, where her asthma medication was stored. Terrified, the students struggled to carry her the rest of the way. When they finally reached the office, however, the door was locked and nobody was inside.
Unfortunately, this was business as usual. In its last round of budget cuts, the Buffalo Public School District had slashed nursing staff from 40 full-time employees down to 15, which meant some nurses could only spend as little as 45 minutes a day at one school. Slumped on the floor, McKenna began to hyperventilate. School staff, looking frantically for the key to the health office but unable to find it, called 911, then Clare's mother. Ann McKenna raced to meet her daughter at the hospital as ambulance workers used a nebulizer to blow life-saving medication through an oxygen mask into Clare's lungs.
It was her daughter's fifth asthma attack at school. "I was praying, 'Dear God, please help my daughter,'" McKenna says. "I found myself thinking, Is it going to take a death for this community to start taking children's health issues seriously?"
But even children's deaths may not be enough to expand nationwide funding for school nurses. A full nine years before McKenna's close call, fifth-grader Philip Hernandez, who had asthma, began having trouble breathing in class. He made his way to the nurse's office at Lee Richmond Elementary School in California's Central Valley: By the time he reached it, he was in the middle of a full-blown asthma attack, according to court documents. The nurse, however, was at another school. Paramedics arrived and found Phillip on the floor in her office, surrounded by school staffers, his face and lips a purplish hue and his pulse failing. The paramedics tried to revive him, to no avail. The youngster died on May 13, 1996, four months shy of his 12th birthday.
School nurses -- once available every day in most public schools -- have virtually disappeared as a full-time presence in many schools around the country. At the same time, chronic illnesses among schoolchildren have mushroomed. Although there are no precise figures, experts say anywhere from 10 to 15 percent of schoolchildren suffer a chronic health condition, many of which require treatment during the school day. In West Virginia schools, for example, more than 16,000 children required healthcare plans in 2002, more than double the number six years earlier. These illnesses include life-threatening asthma and food allergies, diabetes, seizure disorders and cancers as well as mental health problems like severe depression and attention deficit hyperactivity disorder (ADHD).
It's well-known that the academic testing demands of the Bush administration's No Child Left Behind program has forced many already financially strapped school districts to make deep cuts in music, art and physical education. There's been little outcry over the impact the legislation has had on school nursing -- perhaps because few parents realize that a school nurse may be at their child's school as little as once a week, if at all.
But in this era of high-stakes testing and local budget constraints, "unless there is big pressure from parents and other community members, student support services such as nursing become vulnerable, because any extra money goes to academic support," says Julia Graham Lear, the director of the Center for Health and Health Care in Schools, based in Washington.
In place of nurses, teachers and other medically untrained staff are being put in the thankless position of overseeing the illnesses and emergencies of schoolchildren -- sometimes with severe or tragic consequences. Government reports say the nation has 60,000 full-time nurses to cover the approximately 90,000 elementary and secondary schools. Just how much time they spend at a school, however, is unclear. "Our best guess is that some schools have a full-time nurse, many have a part-time nurse, and many have no nurse at all," Lear says.
The likelihood that school nurses are often unavailable is particularly alarming because of the sheer number of children taking regular medication. Nine million students, about 13 percent of children between kindergarten and 12th grade, take medication regularly for at least three months during the year, according to a recent report by the Centers for Disease Control and Prevention. The types of medication can run the gamut from several kinds of inhalers and inhalation therapy by machine for asthma, to insulin pumps, glucagon or insulin injections for children with diabetes, to suppositories for children with seizure disorders and epinephrine for children with food allergies. Some schools allow children to medicate themselves. Because of budget constraints, the immediate health needs of schoolchildren are often put in the hands of school secretaries, minimally trained health clerks, teacher's aides, teachers and other school staff who lack medical training. If caught in a bind, they try to page a school nurse, who may be miles away.
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