Lack of Worcester School Nurses Putting Children at Risk

Friday, June 01, 2012

Ashley Klann, GoLocalWorcester Contributor

Public health officials say that Worcester Public Schools are putting students in danger by not funding positions for full-time nurses. Currently the ratio of nurses to children across the district is far below average state recommendations, which suggest that there be one nurse to every 200-500 children. For the current fiscal year, Worcester Public Schools budgeted for 42.5 school nurses, one nurse coordinator and 1.5 nurse supervisors in the district, and with 24,000 students enrolled, that leaves a ratio of one nurse to 564.7 students. According to the school district's office of nursing, "The ratio varies from school to school, and not every school follows the recommendations."

School nurses play a crucial role in keeping schoolchildren safe, especially those with allergies, in need of an EpiPen, they say. Due to state guidelines regarding administration of medication for an emergency allergic reaction, school nurses are critical in keeping schools safe, and Worcester Public Schools are providing minimal numbers of nurses.

“It’s a huge issue – the lack of school nurses and having them be responsible for multiple schools,” said Sharon Schumack, Director of Education the Asthma and Allergy Foundation of America Foundation: New England Chapter. “A larger problem is absolutely caused if there is no nurse, partly because of access to medications. Sometimes when there isn’t a school nurse, questions come up about who has the required medication, and it’s locked up somewhere.”

A Hot Topic

City Councilor Sarai Rivera briefly raised the problem of so many students using EpiPens in schools at the most recent City Council meeting. In discussing the school budget, she said that the issue was a whole other topic to deal with, but not when shown in context of the school budget. In following up on the issue, she said, "I have talked to some of school nurses and that’s an issue that they face. It’s scary to not have a nurse. I know if my son had an EpiPen at school I would be nervous. One reason I brought it up is that one thing the data seems to show is that the absentee rates go down when there are nurses. When you look at it as a whole, it’s going to be helpful to the kids in school."

Funding for school nurses arose at the meeting. Superintendent Dr. Melinda Boone requested an additional $330,000 to support six additional elementary school nurse positions, which would raise the ratio across the district to one nurse for every 495.8 students, at the current level of enrollment.

According to Schumack, nurses at elementary schools are particularly important.

“Depending on the age of the child, we like to see them able to carry their own medication, but obviously with a kindergartener they cannot be. In the absence of a school nurse, the question comes up who is trained enough,” she said.

Struggling for Local Support

Patricia Rivers, Worcester parent and local advocate of allergy awareness, has been struggling to find support in the area for her six-year-old son at Roosevelt Elementary School, and while the school does have an on-site nurse, Rivers knows that things have not been so easy. "Food allergies are everywhere in a school, and it’s not just food that we worry about. If he gets stung out on the playground, that’s also a concern,” she said. The most common allergens, Rivers said, are peanuts, tree nuts, milk, egg, soy, shellfish, and wheat.

Raising a child with allergies has been difficult, and she hasn’t been able to find help in the area.

“When my son was first diagnosed, there was no support,” she said. “I had no idea what I was getting into. I wanted someone I could talk to, go to, somewhere kids can go in a safe environment.” Rivers is currently in the process of garnering advocacy for an allergy support group.

“It’s very important. I’d put it up there with buckling your seatbelt. People just need to be aware that it is a very big health concern and they can die in a matter of minutes,” Rivers said.

Why it Matters

Thanks to guidelines in Massachusetts, the administration of epinephrine in schools is closely monitored, and from these numbers, the Mass. Department of Health has surmised that 25% of those have occurred during first time reactions.

“Food allergies are a growing national concern. A recent paper demonstrated that about 8% of US children have food allergies,” said Michael Pistiner, a Pediatric Allergist who is also a voluntary consultant for Mass. Department of Public Health’s School Health Services.

“Schools deal with two kinds of situations: kids who have been prescribed epinephrine where parents have provided it for the school. In that case, the school keeps it on hand and ready for the child,” Schumack said. “And the other case – a child or teacher not diagnosed may be out at recess or have some food that was brought in, and they have a reaction and do not have their own EpiPen.”

“Making sure the schools are safe is very difficult. That’s another reason why having fulltime nurses and keeping the EpiPens in the schools is a very important issue,” said Rivers. “It has to go through the chain of command. If the school nurse isn’t there, who is then to issue the medicine? Who makes the call? Who is EpiPen certified? Unfortunately, not all the teachers are EpiPen certified.”

Pistiner practices with Harvard Vanguard Medical Associates and is an instructor at Boston Children’s Hospital. He and a colleague have tried to create a tool to augment the training that a nurse gives staff, and the rest of the school community. His website, Schools.allergyhome.org is designed to help raise food allergy awareness in school staff, parents and students.

Photo courtesy of gregfriese

“It really drives home why school nurses are so important,” he said.

The unpredictable nature of allergies is also a major concern.

“You can never predict the severity of the reactions. That’s why it’s important to have it available when needed. It can become life threatening if not treated,” Schumack said.

A Low Budget and High Guidelines

The city’s lack of budgeting for these school nurse positions is coupled with strict state guidelines for who is certified to administer epinephrine. In cases of first-time incidents (which account for 25% seen in schools) that role is key.

“The only person who can treat a first-time allergic reaction is a licensed school nurse or a physician, making the role of a school nurse absolutely imperative,” Pistiner said. “If there is a reaction, there is no one who can administer the epinephrine treatment for these first timers.”

“In Massachusetts, we have in place when a nurse is not available, in the case of a known allergy, there are trained personnel like a teacher who may be trained to give the epinephrine, but without a school nurse in those first-time situations, contacting 911 is really the only thing they can do,” Pistiner said. “That really drives home how important the school nurse is.”

With the Worcester Public School budget debate moved back another week, parents, students, and teachers will wait to see if this extra funding comes through to provide schools with school nurses.