Nurturing Nurses With Heavy Caseloads And Dwindling Support, School Nurses Are Being Asked To Perform More Roles And Have Less Time For Cuts And Scrapes
School nurse Kathy Reed-McKay got a call from a panicked secretary at Westview Elementary. A student with asthma was gasping, the secretary said. What should she do?
Thirty years ago, Reed-McKay would likely have been there to decide. Today, she gives advice on a cellular phone, across town and a lifetime away from the emergency.
With more than 4,000 students and five schools under her watch, Reed-McKay, like many other school nurses, feels the polar pulls of responsibility and reality.
She should be there, watching the asthmatic student’s reaction to treatment, monitoring her ward’s physical and mental health.
But school nursing falls down the list of Spokane School District’s priorities.
The average nurse case load in Spokane School District is the highest in the state. There are nearly six times as many counselors as nurses.
No students have been jeopardized by the paucity of nurses, they admit. But the potential frightens some.
“When I get paged for a breathing treatment and I’m 25 minutes away in good weather, there’s a certain amount of risk there,” said Reed-McKay, nurse for two Indian Trail schools and three schools on the eastern edge of the district.
The bustle leaves nurses often just one day a week to visit each school. Their case loads are limited to urgent care, which usually requires “nursing with our tongues,” says Linda Bordwell, North Side school nurse.
She remembers her elementary school nurse being as constant as a grandmother, gently rubbing balm on scraped knees and pulling slivers, sweetly doling out lollipops after vaccination shots.
Today, she talks to Child Protective Services more often than she applies Band Aids. She’s counseled 10-year-old expectant mothers, 8-year-old suicide seekers and 5th grade anorexics. She can’t pull slivers because of potential liability, even though she has $5 million in malpractice insurance.
“The needs of students and our job has changed drastically in 20 years,” Bordwell said, her bedside manner calm and understated.
The average case load in Spokane is about 3,500 per nurse, but some nurses are assigned to a single school full-time. (See above story.) Most have more than 4,000, well above the 1-to-750 ratio recommended by the National Board of Education.
The 7,700-student Mead School District has three nurses. Central Valley School District has about five full-time nurses for 10,700 students.
Carole Murphy, Spokane coordinator of health services, says the high case loads are a symptom of tradition.
Nurses were just as stretched 20 years ago, dividing time between 10 schools. But the problems then were simpler and less time consuming, requiring Band Aids instead of referrals to social service.
Nurses make the same amount as teachers. Most have advanced degrees, boosting them up the salary scale.
Nurses are paid from property tax levy dollars, forcing them into competition with school counselors, extra-curricular advisors and coaches.
The schools’ take of property taxes will go down next year. The Spokane School District is preparing to cut $2 million from its budget.
“These are Cadillac people,” said Mary Brown, director of student services, referring to the nurses.
“…In this situation, I don’t see us hiring any new staff.”
Murphy says school health care has improved because nurses now monitor many facets of student health, not just physical maladies.
“Look at the difference between then and now,” said Murphy. “It’s a massive difference. Are kids different? Sure. We also know different things now. And we are saving kids we didn’t save then.”
Because the nurses are on campus usually just once a week, other school officials have had to step up. Busy secretaries dispense medication such as Ritalin between phone calls. Some have been trained to give asthma treatments.
Charla Dunham, Washington state representative to the National School Nurses Association, says that makes nurses nervous.
The errors fall on the nurse responsible for the school, under whose medical license the medication is dispensed.
“That’s a black cloud that hangs over nurses,” said Dunham. “We don’t have a lot of protection.”
All nurses are wired with pagers, cellular phones and voice mail. Nervous school staff can get an immediate opinion.
But in emergencies, an ambulance is often called, thrusting issues of medical insurance and liability onto health care professionals.
“It cuts response time,” said Murphy.
Bordwell avoids using first aid creams because of the potential for a negative reaction and lawsuit. Removing slivers requires the skin to be punctured, a no-no. Forget getting a Tylenol.
“You always err on the side of caution,” said Bordwell.
But parent Teresa Wilhelm discovered the frustration of liability paranoia. Her son, Caleb, developed a staph infection in his elbow, and required a daily injection in an IV tube strapped to his arm.
The school district initially balked, saying a secretary couldn’t give the shot. Bordwell took training and makes a special trip to Regal Elementary each day.
“It’s simple enough that my teenage niece could do it, but the district didn’t want to take on the liability,” said Wilhelm. “They said there was no one there who could do it…. I was under the assumption there was a school nurse there all the time.”
Reed-McKay, Bordwell and others say they would love more time with kids. With more one-on-one monitoring, they say chronic problems - from ear infections to bulimia - could be nipped in the bud.
That occasionally means calls to Child Protective Services. Nurses have a legal responsibility to report suspicious bruises to CPS.
“It’s so sad when you have a 5-, 6- or 7 year-old, and you say, if only we had time to get to that kid,” said Bordwell.
Often students referred to nurses are burdened with difficult medical problems. Students with fetal alcohol syndrome often appear violent and impulsive, and are disciplined.
But they are chemically imbalanced, not bad kids. She reinforces the medical diagnosis to teachers.
“It’s a more complex world with more complex problems,” said Bordwell.
, DataTimes ILLUSTRATION: Color Photo
MEMO: See related story under headline: Garfield nurse provides care to students at risk