While educators and politicians debate the best ways to measure student achievement, Susan Kroupa is focused on the fundamentals: Public school students need to be in school to learn. They can’t be in school if they’re sick. And they can’t stay well if they have no access to health care.
“It’s vital that the child is healthy and safe so they can effectively learn,” said Kroupa, a public health nurse who works in the Wake County Public Schools.
For years, Wake County schools have faced a shortage of nurses. On Monday, the Wake County Board of Commissioners is scheduled to vote on a 2015 budget that would include an allocation for 10 additional public health nurses to work in the schools. If funding is approved, they would be the first nursing positions added to the schools since 2008.
The N.C. Department of Public Instruction, the N.C. Public Health Taskforce and the state Division of Public Health have adopted the standard ratio of one school nurse to every 750 students. Statewide, the ratio has trended downward from 1:2,198 in the 2000-2001 school year to 1:1,201 in 2010-2011.
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But in Wake County, where the student population has continued to grow, the ratio has gotten more out of whack, going from 1:2,172 in 2000-2001 to 1:2,317 in 2010-2011.
The county’s 170 schools share a total of 62 nurses, who help students, teachers and staff deal with acute issues during the school day, but also try to prevent problems by making sure students get the vaccinations they need; get enrolled in available health care programs; get diagnosed and treated for potentially serious illnesses such as diabetes, asthma and severe allergies; and learn to manage those to minimize the days they have to miss school.
Much of what nurses do in school is education, such as training staff how to administer an EpiPen to stop a major allergic reaction, the most common medical procedure performed in the Wake County schools Or they may train teachers to recognize the difference between a cough that lingers from a cold and one that might indicate pertussis.
Nurses in Wake County schools administer anti-seizure medications. They conduct tube-feedings for students who require it.
“People think we just sit here waiting for the next accident,” said Kroupa, a 17-year Wake schools veteran who serves as the diabetes specialist for the system. “We do a lot more than just hand out Band-Aids.”
State Senate budget cuts nurses
Ten new nurse positions would cost the county $727,098 a year. Both Democrats and Republicans on the Wake County board support the proposal.
Of the 62 nurses now working in the schools, seven are paid by the school system and one is paid by the state. The state Senate has approved a budget that would cut many school nurses, but it remains to be seen what the final budget will look like after the House and Senate work through their different versions.
Giang Le, director of Children, Youth and Family Services for Wake County, said the county’s plan is to add 10 nurses in each of the following three budget years, just to keep pace with the student population. That would bring the total number of nursing positions to 102, still not enough for each school to have one.
With 153,000 students, Wake is the state’s largest public school system. Mecklenburg County’s Board of Commissioners, which appropriates funds for the state’s second-largest school system, voted Thursday to fund 33 additional nurses and three supervisors so that each Charlotte-Mecklenburg school will have a full-time nurse.
Public health nurses play a critical role in ensuring that children do well in school, Le said.
A nurse at school may be the only health professional some students ever see, said Donna Daughtry, the county’s school heath program manager.
A nurse one day a week
But some schools only have a nurse on site one day a week. If a child tells the teacher he or she isn’t feeling well, and gets sent to the office, if there is no nurse on campus that day, the office staff most likely will call a parent to come and take the student home. If the child is in great distress – suffering an asthma attack, for example, and has no rescue inhaler – the school will call 911.
If the nurse had been there, she might have been able to administer an inhaler to stop the asthma attack, so the student could go back to class. If it’s a headache or upset stomach, a nurse might notice if this was a complaint the student had made often before and missed several days of schools with similar symptons. Asking the student the right questions, and following up with a social worker and a parent – maybe making an after-hours visit to the home – might reveal an ongoing issue that can be resolved.
For example, Daughtry said, Wake County schools have more than 400 students who have been diagnosed with diabetes. The diagnosis may have been made after the child ended up in the hospital. After a few days, the student was sent home and the family was given instructions on how to manage the disease.
That can be overwhelming, Daughtry said. A family must learn how to care for and support a child with diabetes, helping the child make the right decisions about what and when to eat until the child is mature enough to manage the disease alone. A public health nurse at school can be critical in that process, helping the child monitor blood sugar, training teachers to watch for problems and to help the child feel comfortable eating a snack if necessary to maintain blood sugar levels.
A link to health care
Nurses often are the link between students and regular health care, Daughtry said. Following up on a child who came to her office, a nurse can ask the student’s parents if the student has been to see a doctor about the problem.
No? Why not?
If the family doesn’t know any doctors, or has no transportation to a doctor’s office, the nurse can get a referral and may be able to find a church that helps with transportation to medical appointments.
No money to pay for a visit, and no insurance?
The nurse can help the family apply for coverage through HealthCare.gov.
Adding public health nurses also would allow the county to expand the hours they’re available at high schools, Daughtry said, where students are less likely to suffer falls or have unmanaged diabetes, but more likely to experience mental health issues such as anxiety and depression, or to get concussions from sports play.
At every grade level, and with nearly every medical issue, the more contact a student has with a nurse – and the follow-up care they help pursue – the better the student feels.
“They’re just like us,” said Kroupa, who was filling in as the nurse at Barwell Elementary in Southeast Raleigh on Friday. If the county’s budget plan is approved, that school will go from having a nurse for a day and a half each week to having one three days a week.
“If I don’t feel well, I can’t really function all that well,” Kroupa said. “I can’t concentrate, I can’t make the best decisions. Students are the same way.”