School Nurses Serve Many Low-Income Students’ Medical Needs
Focus on Safety, Wellness & Access to Health Careby Erin Albanese
Editor's Note: The Burden of Poverty: A Backpack of Heartache is a continuing series examining the problems poverty creates for students and their families, plus the schools and strategies that are helping disadvantaged students succeed
A student stays home sick because of problems with asthma. Comstock Park Public Schools nurse Tina Rodriguez is on the phone with his parents reviewing medications and making sure his Asthma Action Plan is up to date in case of complications at school. She asks when he needs to use an inhaler, and checks if he has seen a doctor.
It's a process she goes over again and again for students who have asthma, allergies, seizure disorders and diabetes. Everything needs to be in place to respond to the health needs of every student, she explains, and the protocol has become more demanding.
"Struggling families tend to have difficultly obtaining primary prevention care, sosometimes the school nurse is the one that works with the parent in directing and navigating them through the medical system," Rodriguez said.In schools where students have a high level of need, school nurses are doling out more than Band-Aids and medication. They are often the main conduit for parents to receive healthcare services for their children.
See the SNN Series on Poverty: The Burden of Poverty: A Backpack of Heartache
If medical needs are met, students have better attendance, which leads to improved academics, she said.
"On the whole since I came to this district, the kids needs are more complicated. Due to poverty, a lot of our families don't even have cars," said Rodriguez, who has worked in the district for 10 years. "Ultimately what you're doing is making sure people know how to use and access the healthcare system. If you can have kids that are well cared for, your attendance is better."
In Comstock Park, the number of students who qualify for free or reduced lunch is 54 percent, up from 13 percent a dozen years ago.
Rodriguez is employed through Spectrum Health's Healthier Communities Division, which places nurses in districts based on risk population and need. Other Kent ISD districts that contract with nurses through the program are Cedar Springs, Godfrey-Lee, Grand Rapids and Kentwood.
Still, many districts go without a nurse. Recent national data indicates 45 percent of public schools have a school nurse all day, every day, while another 30 percent of schools have a school nurse who works part time in one or more schools. Wide ratio disparities exist from state to state, and within school districts, and between urban and rural schools, according to information from the National Association of School Nurses.
In Godwin Heights Public Schools, where 80 percent of students qualify for free or reduced lunch, Superintendent William Fetteroff sees a glaring need for a district-wide nurse. Godwin Heights has gone eight years without one, after cutting nursing from its budget. He had recently hoped to obtain a grant to hire a nurse, but did not receive it.
"The need is evident in the socio-economic composition of our community," Fetteroff said, "There is no clinic or agency proximal. Our area represents generational poverty. Hospitals are too far; community college is too far; grocery stores are too far; dental clinics are too far."
In Sparta Public Schools nurse Amy Roelse said poverty factors into the medical needs she sees, and a nurse's presence in school can make a big difference.
"Children from lower-income families do not receive health care services as frequently or urgently as students from higher-income families for several reasons. There may be a lack of education in the home that prevents the parents from realizing their child needs medical attention or there may be a lack of health insurance coverage that prevents parents from taking their child to the doctor as frequently or as needed because they are concerned about the cost," she said.
Lack of basic healthy practices like good hygiene and nutrition and can cause secondary medical concerns such as frequent illnesses, obesity, and injuries, Roelse said.
Growing Demand for In-School Services
In Grand Rapids Public Schools, where 78 percent of students qualify for free or reduced lunch, a full-scale school nursing program has been maintained through the economic recession and district budget cuts, said Stephanie Painter, GRPS director of Health Services, who has worked in the district since 1988.
"The school administration has recognized that good nursing care is important for students to be able to attend, and for teachers to focus on learning," Painter said.
All GRPS students have access to a whole team of healthcare workers. Registered nurses lead teams including licensed practical nurses, community health workers, and other school staff members to provide comprehensive services.
The level of care schools have provided is greater than ever, she said, and there are other factors besides poverty. While asthma is one of the most common health problems among students, some students require gastrostomy tubes, tracheostomies or ventilators. Schools are legally required to accommodate for students' individual needs.
"In my career, the care needs for children have increased dramatically. Many children are surviving that used to die as infants or because the technology was not available," she said.
Patients are now treated at home or school instead of hospitals or institutions' and more medications are available.
"These improvements create a burden of responsibility for parents and school personnel. Often decisions about care need to be made quickly to avoid complications or death," she said.
Expertise is key to managing the heavy caseload.
"School nurses have the skills to manage this responsibility. Children need safe care while attending school. School administrators and teachers can be assured that if a nurse is in place, they can focus on teaching and learning. All children deserve safe care and a good education," Painter said.
At many Kent County schools, secretaries work as the main "point of triage" for students coming into the office with fevers and bellyaches, while nurses assigned to entire districts help keep records organized, staff trained, and make sure students receive follow-up care or mental health services, Rodriguez said.
In Wyoming Public Schools, a new grant-funded health care plan specialist is filling a role similar to Rodriguez's. The state grant, which targets improving attendance students at-risk of academic failure. About 73 percent of Wyoming students receive free and reduced lunch rates.
Amy Loftis-Tuitel, who started in the position last March as the district's health care plan specialist, was hired to address increasing need for medical services. Loftus-Tuitel worked as a registered nurse in labor and delivery for Spectrum Health for 12 years. She has also worked for Early Head Start, conducting home visiting for infants and toddlers.
Loftis-Tuitel spends a day per week in each of the district's four elementary schools and Wyoming Intermediate School, getting health plans in place and up-to-date. She also responds to medical needs, applying bandages, taking temperatures or listening to congested lungs.
"The biggest thing is I'm creating and obtaining health plans for all the students in the district that have a health concerns," she said. "I want to provide a road map of what to do for a healthy and safe school."
Superintendent Tom Reeder said students' health needs have grown.
"Several of our students struggle due to ongoing or a particular one-time health concerns. Having a health advocate to help the student, family, and school personnel can significantly reduce issues that come with health concerns, such as absences, stress, and general poor health that makes learning a greater challenge," he said. "Having the expertise to review and support our efforts make them more effective in accomplishing this for our students."
A Community-Wide Initiative in Sparta
In Sparta, school nurse Amy Roelse, said it's a community effort to keep children healthy.
Roelse credits a team called the Core Crisis Committee, which includes herself, and representatives from the Sparta police and fire departments and Emergency Medical Services for avoiding an error that could have proven fatal for a middle-school student.
A student who has a automatic internal defibrillator (AID) to correct a cardiac disorder was home alone with his brother after school. He passed out and his AID alarm was going off. The student's brother ran over to the neighbors to call 911.
Roelse said EMS may have responded to the student's condition by treating him with epinephrine.
"Epinephrine would exacerbate his cardiac condition and it could be fatal," she said.
But responders knew they had access to student records, for which Roelse keeps copious notes and constantly updates.
"They pulled up the student's name, and read medical alert which said 'No epinephrine," she said.
"It was a team (that avoided the mistake). It's the whole Core Crisis Committee and how we are working with community first responders," she said.