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School Nurses Spread Thin By Staffing Cuts

Aired 11/15/12 on KPBS News.

The days when every school had a full-time nurse are long gone for San Diego Unified School District. There was even more of a squeeze on the district’s remaining nurses when school started this year.

— When Corinne McCarthy started as a nursing coordinator for San Diego city schools, she drove a large SUV. Now, she shuttles between schools in a Honda Fit.

Corinne McCarthy, a San Diego Unified nursing coordinator for schools from Linda Vista to Tierrasanta, prepares to give a Carson Elementary student a hearing screening, Oct. 25, 2012.

Her gas bill was just too much in the larger car. But when school started in September, McCarthy had a bigger problem – not enough nurses for the schools from Linda Vista to Tierrasanta, where she coordinates the health services. Sixteen of the schools in the area did not fund any nursing hours in their budget for this year.

“At that time I only had another half-time itinerant (nurse) for 16 schools," she said. "It was almost a relief because I thought, well, no one can absolutely expect me to do all of this. But since then we’ve gotten some more help and I’ve been able to hone in on – ‘what’s the priorities here?’”

One recent morning, the priority was a student with a new inhaler at Serra Mesa's Wegeforth Elementary. The nurse on-call for the school one day a week is assigned somewhere where today and can’t get away to sign the new medication in.

“We can’t just let whoever is designated by the principal give the medication until we verify, this is the right medication, it’s in the right bottle," she said. "And then we sign it off and we train them specifically on 'this medication with this kid.'”

Wegeforth has a health technician instead of a nurse this year. She can give out band-aids and ice packs, take students’ temperatures, but she can’t verify that medications are right, oversee catheterizations or give insulin injections without a nurse's direction.

Checking in the new inhaler, and confirming the health technician's inkling that she can't give the students cough drops the parent brought in, takes just 10 minutes this time. But when the forms aren’t filled in correctly or the medication dosage is wrong, McCarthy said figuring out how to fix the problems can take hours.

Last year, McCarthy didn't do as much running around.

“This year compared to last year is that the elementary schools had a nurse assigned to them for at least four hours a week" she said. "And that was their anchor –- their go-to person when they had questions and that sort of thing.”

San Diego Unified gives principals more discretion over their school’s budgets than many districts. The idea is that the school's committee of parents, teacher and administrators are better equipped than central office administrators to target resources where any individual school needs them. But as state funding shrank, principals had to choose between things like librarians, office clerks, art teachers and nursing time.

With more flexibility on nursing funds this year, some schools chose less expensive health technician hours. Thirty-four schools across the district are just paying for needed services from roving nurses instead of a health technician or nurse, and the school secretary maybe the one getting trained to give students inhalers or EpiPen shots if needed.

At a Board of Education meeting earlier this fall, Trustee Scott Barnett said the experiment hadn’t worked.

“We in some ways created an unfair Sophie’s Choice for principals having to choose between librarians and nurses and other things," he said. "And they are obviously not health professionals, they’re trying to meet the needs of the site."

He and the other trustees later voted to return to a more centrally-planned nursing staff. Where the district will "say there needs to be a bare minimum of staffing and that will be the bottom line in the next budget,” Barnett said.

For this year, Michelle Bell, the district’s new head of nursing services, was told to bring back the 18 nursing positions lost to the school site budget decisions. She said budgets can't get in the way of students’ well-being.

“Even if a principal didn’t purchase or didn’t assign nursing time at her school, the bottom line is that if her school or his school needs nursing time, then we need to provide it," she said. "That’s what my directive has been to the nurses - that we have to be flexible for this year and we have to meet the needs of our students. Bottom line.”

After leaving Wegeforth, McCarthy's next stop is Linda Vista’s Carson Elementary, where she'll give students sight and hearing screenings they need for special education services.

McCarthy says screenings, insulin injections and catheterizations may not actually take very long, It’s getting drawn into the unscheduled needs that can keep her at schools for hours.

“You get caught at one school and then while you’re there they say – ‘oh, could you take a look at this kid and this kid?’ And of course you do because the kid is standing right there and of course I want to see this kid.”

Once inside Carson’s health office, McCarthy can’t help herself. She sits down next to a boy who just came in from the playground and is holding an icepack to his leg.

But the boy isn’t forth coming about what happened. So, McCarthy is back on track, looking for the first student she’ll screen today.

Next year, when the district staffs nurses based on the number of students at each school and the severity of their health needs, most schools will not have the extra funds for a full-time nurse. According to McCarthy that means there are some things they just can’t do anymore - like health and sex education. And – the medical sleuthing some students need.

“You’d be in the health office, so they’d start coming in and you’d start asking the questions," she said. "You could look through all the paperwork. We can pick up things that someone else would look past."

But she said, they’ll continue to do they best they can to identify what students need and provide it.

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