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The student population includes 221 students with asthma,
44 with life-threatening allergies, eight with diabetes,
19 with seizure disorders, one with cystic fibrosis,
four with heart defects and two with cancer.
Van Ouwerkerk recommended that any school nurse who
receives a layoff notice request a hearing and fight
it. "I realized that I had to do it for the kids,"
she said, "because if I didn't stand up, the kids
would have had one nurse for 8,000 students."
No one knows what the nurse-to-student ratio is in
Oregon, another state whose education budget has been
hit especially hard. The state does not have a school
nurse consultant to gather that kind of information,
Hootman said. Some districts have a nurse for every
3,500 or 4,000 students, she said. Others might have
one per 1,800 students. None come close to the recommendations
of the National Association of School Nurses, she said.
"Unfortunately, we've hit rock bottom," Hootman
said, describing education budget cutting so severe
that schools have shortened the number of days in the
school year. Some districts are deciding to hire nurses
for fewer days as well. "The economy is so challenging
right now that everybody is having to make hard decisions,"
she said. "Right now, they're just looking to keep
schools afloat."
In Iowa, the situation is not as drastic, but could
become so, school nurses report. In 2001-02, the state
had one nurse per 877 students, but the situation varied
widely from district to district, and the number of
school nurses decreased last year for the first time
since the 1980s, said Charlotte Burt, MSN, RN, school
nurse consultant for the Iowa Department of Education
in Des Moines.
"Probably that's an indication of what's happening
now," Burt said. Forty percent of the school districts
reported ratios of at least one nurse per 750 students,
she said. The other 60 percent had fewer nurses per
student.
School nurses across Iowa, responding to an e-mail
request from Barb Allen, RN, president of Iowa School
Nurse Organization, reported everything from supportive
school boards and no fears of cuts to overworked and
dangerous conditions that seemed to be getting worse.
"My health associate was eliminated due to budget
cuts," wrote Diana Duffy, RN. "I cover three
buildings and approximately 1,000 children. I have kids
with diabetes, requiring blood glucose checks and monitoring
of snacks, and kids with cystic fibrosis, who require
enzymes before eating, monitoring of caloric intake,
weight monitoring and nebulizer treatments. I have kids
who require tube feedings, asthmatics requiring nebulizer
treatments, not to mention the others who have injuries
or other occasional health needs.
"Routine screenings are not done as often as a
result of staff shortages, so some kids who may need
glasses, etc., may not be discovered until later. The
secretaries cover for me when they are able, but don't
have the assessment skills or knowledge base to do much
more than dispense meds and provide basic first aid."
Many Iowa nurses reported difficulty in establishing
prevention and health education programs, saying they
felt like they were constantly responding to crises
and "putting out fires."
Most schools in Texas have at least one nurse, Rendon
said. In rural areas, a nurse might visit two or three
schools. "A lot depends on the district and how
their nurses are valued," she said.
Because of budget cutting, some districts have opted
not to replace retiring RNs or to replace them with
LVNs. "That's our biggest concern," she said.
Even states that have traditionally supported school
nurses are fighting threats from budget cuts this year.
School nurses in New York, where 99 percent of the
districts have a school nurse and the ratio is one nurse
for every 600 students, excluding New York City, Buffalo
and Rochester, are pressing the Legislature for a law
mandating school nurses to ensure against future cuts.
In Delaware, which has a state law requiring one nurse
for every 40 "teaching units"-traditionally
about 40 students each-nurses are concerned about growing
class sizes and want to change the ratio to one nurse
per 35 classes.
In Massachusetts, where a state advisory committee
has recommended ratios of one nurse per 500 general
population students and where almost all schools have
at least one nurse, the governor cut state funding for
school nursing by nearly 40 percent in January. Nearly
500 school nurses were laid off.
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