Budget ax threatens school nurses

From Syracuse to Wichita to Los Angeles, many school nurses are finding their jobs in the budget crosshairs as school districts slash spending.

"This year, especially, we hear a lot about school nurses being cut," said Martha Bergren, director of research for the National Association of School Nurses. Still, the number of school nurses nationwide has remained relatively stable, in part because many districts threaten to lay off nurses but change their minds when they realize the potential impact, Bergren said.

Though most districts in Pennsylvania and New Jersey have avoided getting rid of nurses, legislators in Harrisburg are considering a measure to allow replacing certified school nurses with nurses who have less training.

"This bill would, in essence, save districts money by giving them the flexibility to hire someone who can do the same job for potentially less money," said State Sen. Jeffrey Piccola (R., Dauphin). Opponents say it could jeopardize student safety because health care for students is much more complex than it was years ago.

Pennsylvania requires one certified school nurse for every 1,500 students. Some school districts supplement certified school nurses with less-trained staff, such as registered nurses.

Certified school nurses must have a bachelor's degree in nursing and complete 24 graduate credit hours of instruction and 100 hours of supervised field experience. Registered nurses generally have a two-year or four-year nursing degree.

Piccola's Senate Bill 802 would let districts replace certified school nurses with registered nurses who have completed an accelerated certification process.

"It is inaccurate to portray registered nurses - who work in operating rooms, in triage, in emergency rooms, and other high-pressure environments - as individuals who do not have the ability to care for schoolchildren," Piccola said.

The Pennsylvania Association of School Business Officials, which has lobbied for such legislation for years, estimates the bill could save districts throughout the state up to $16 million a year and offer more flexibility in hiring.

According to the association, the state's average pay of a full-time certified school nurse in 2008-09 was $60,239.

"The function of a school nurse is to care for the well-being and health of the students. We think certainly an RN could fulfill that duty, that responsibility," said Jennifer Hoover-Vogel, legislative and research coordinator for the organization.

But the Pennsylvania State Association of School Nurses and Practitioners, which has been lobbying against the bill, argues that school nursing requires the additional training. Pennsylvania and New Jersey have among the strongest requirements for school-nurse certification in the country.

"The Senate bill is based on an outdated view of school health," said Terry Quinlan-Clampffer, health services coordinator for the Lower Merion School District. "School health today looks nothing like it did in recent decades."

Unlike nurses in hospitals, school nurses are typically the sole health providers at schools, said Judy Morgitan, director of the National Association of School Nurses Pennsylvania chapter.

"In the end, our RN colleagues are awesome, but for them to be in a practice where they haven't had the training puts everybody at risk liability-wise," Morgitan said. "You really need that skill to function independently."

School nurses also do a lot more than they did a generation or two ago, nurses say. Nurses must be trained to handle life-threatening allergies, diabetes, seizures, and ventilator suctioning.

Sally Kauffman, a school nurse for 25 years in the North Penn School District, compared school nursing to other professional specializations, such as operating-room or delivery: "If you worked in an emergency room, you wouldn't be able to turn around and work in an operating room until you learned" the specialty, Kauffman said.

Several school nurses said that it is not uncommon for nurses to care for children whose parents lack health insurance they once had. Some parents send children to the school nurse because they are worried about the cost of an emergency-room trip.

New Jersey has talked of legislation to allow schools to share nurses, said Marie Peppas, president of the state's New Jersey State School Nurses Association.

She said the Pennsylvania bill would be a mistake and dangerous. "There are too many children with chronic illnesses in school today that wouldn't be able to be in school without certified school nurses."