Short on nurses, District considers how to plug health service holes
Since 2011, the number of nurses in the Philadelphia School District has dropped by 40 percent, leaving many schools uncovered by nurses for most days each week. This fact, according to Meredith Elementary principal Cindy Farlino, a presenter at the School Reform Commission meeting Monday night, has caused high anxiety for non-medical school personnel, like principals, who must administer inhalers and give medications on those uncovered days, praying that things will work out.
Building capacity for student health services was the topic of last night’s meeting, where I, a school nurse, acted as a facilitator for group discussions. The meeting began with an overview of the issue; we heard that school nurses had 257,000 visits from students for illness or injury last year. Over 147,000 doses of prescription medication were administered. The impact of asthma in schools was highlighted — it affects 36,000 students. Then, in the first of two panel discussions, a school nurse and a principal addressed the various responsibilities and challenges that each faced in providing health services to students in need.
Rodney Abary, nurse at Chester Arthur and McDaniel Elementaries, spoke about running to three buildings each week. Principal Farlino listed the very real, fearful and painful comments of her fellow principals, who she said were forced to devote huge chunks of time to nursing rather than monitoring teaching and learning. It became clear that the problems that the meeting was trying to address exist solely because of cutbacks in nursing service (including 100 laid off in 2011, before Superintendent William Hite’s tenure began).
The breakout sections that followed the panel discussion were also revealing. One of the school nurses at my table, Pat Westerfer, who works at three schools, spoke about barely being able to keep her head above water. She is forced to leave her assignment each day, leaving sick children behind to administer insulin at other schools. Community services providers, so sought by the School District as a means of bridging the severe gaps caused by decreased school nurse services, commented on the fact that it was becoming increasingly difficult to maintain reasonable contacts with schools that have no nurse present on most days.
The second panel of speakers presented possible solutions to plug holes left by missing nurses: one a school-based clinic, another, school-based dental services. As one member of the community stated at the conclusion of these presentations, the Philadelphia area is actually “saturated” by health care providers.
Putting clinics in schools, where perhaps one child out of 100 may need to see a doctor, is a waste of scarce health-care dollars. In addition, just about every condition that appears in the health room can be handled by a school nurse — if he or she is on site that day.
So how does the School District build capacity within school health services? Certainly not by further eliminating school nurses.
All of last night’s presenters agreed that school health needs to remain within the purview of the School District and is best administered via the services of school nurses. Outside resources — like the Eagles’ Vision Program or the Oral Health Impact Project or nursing students from nearby universities — might flesh out services, but they do not and cannot replace the model of school nursing which cares for every single child in the School District of Philadelphia.
Eileen M. DiFranco, R.N., is a certified school nurse who has proudly served the schoolchildren of Philadelphia for 23 years. She is a lifelong resident of Philadelphia.
The opinions expressed are solely those of the author.