When Suzanne Brown’s daughter was 4, the Forsyth County mother never thought she would be able to drop her little girl off at school without being a nervous wreck.
Four years ago, her daughter, Brooke, began swelling at her school in Tampa after a piece of candy triggered a severe peanut allergy. Brown happened to be on the way to pick her up, arriving in time to give Brooke a lifesaving shot of epinephrine.
“The teachers looked like deer in headlights when I was trying to treat her,” said Brown, whose family moved to Forsyth in 2006 when she became determined to find a school district where every school had a nurse on staff.
Brown's close call illustrates a concern for many school districts as they deal with a $1.1 million reduction in state funding for school nurses for fiscal year 2012 to help close a state deficit of more than $1 billion. It's the latest in a series of cuts in the state, which ranks close to the bottom for the ratio of students per nurses.
School systems have responded to the cuts in different ways as they struggle to balance their financial difficulties against a need to serve a growing number of students with unhealthy, sometimes life-threatening conditions.
Forsyth continues to staff each of its 35 schools with a nurse. Other school systems hold down their costs by making nurses cover more than one school, employing unlicensed health care aides, or cutting nurses' salaries or hours. Gwinnett County, for example, has 11 registered nurses at the district level who provide support to clusters of schools. It also employs 165 clinic aides to tend to 161,000 students in 130 schools. About 50 of those aides are either registered nurses or licensed practical nurses.
"These school systems are doing what they have to do or what they think they have to do," said Lisa Byrns, president of the Georgia Association of School Nurses. "At some point, it's going to compromise children's safety."
With a growing number of chronic illnesses to manage, such as diabetes, asthma and food allergies, today’s school nurses do a lot more than treat scraped knees or upset stomachs. Nurses give insulin shots, provide health screenings and teach parents about medications -- sometimes seeing 50 or more students a day.
In 2009, Georgia ranked 45th in the nation with one registered nurse for every 2,317 students, according to the National Association of School Nurses. The group recommends one registered nurse for every 750 students. The top-ranked state, Vermont, has one nurse for every 311 students.
Nationwide, 45 percent of schools have a full-time nurse, 30 percent have part-time nurses and 25 percent don’t have a nurse at all, said Martha Bergren, director of research for the association.
State funding for school nurses in Georgia has steadily dropped from an initial $30 million in 2001 to $26.4 million for fiscal year 2012.
While the funding declines, the need stays the same or grows.
In Georgia, more than 20 percent of children are obese, which can lead to heart disease, Type 2 diabetes and other serious illnesses, a 2009 study by the Robert Wood Johnson Foundation shows. And last year, roughly 297,000 children in Georgia, or 12 percent, had asthma, up from 10 percent in 2005, according to the state Department of Community Health.
School nurses are the first on the scene to perform CPR, give emergency seizure medications or use an EpiPen for severe allergies, said Connie Trent, health services facilitator for Forsyth County Schools. Forsyth's 35,000 students include 109 with diabetes, 3,717 with asthma, 2,700-plus with food or insect allergies, and an additional 283 with seizure disorders.
"In the old days, these children did not go to school," Trent said.
Forsyth budgets about $1.4 million for its school nurses program, with the state accounting for about 35 percent.
School nurses are the only health care providers some students see, said Byrns, with the Georgia Association of School Nurses and a nurse in the Glynn County School System, where there's a nurse for each of its 22 schools.
In Dawson County, which receives about $75,000 in state funding for its $200,000-plus program, the school system's health coordinator was asked whether it was possible for nurses to cover multiple schools.
"I said, ‘Absolutely not, not if I'm going to be a supervisor,' " said Jeannie Edwards, who is also the director of the Georgia Association of School Nurses. "It's just too dangerous and money is not the bottom line."
In 2008, that risk became reality for a 10-year-old Tacoma, Wash., girl with asthma and food allergies, who died from an acute asthma attack. Though an emergency treatment plan had been in place, school staff failed to deliver a shot of epinephrine and the school nurse, who rotated among schools, wasn't there that day. The state association has not heard of a similar loss in Georgia.
This school year, Clayton County Public Schools employed 69 health care technicians, who have backgrounds in health care but aren't necessarily licensed nurses and are supervised by either registered nurses or licensed practical nurses, spokesman Charles White said. Previously, only the elementary schools had nurses, with two consultative nurses supporting the secondary schools and some special needs nurses, White said.
After researching what other districts do, Clayton switched to health care technicians to cover its 61 campuses, he said. The school system will receive $715,469 in state funding for fiscal year 2011 but spend more than $1.3 million on its nursing program.
Nationwide, school nurses make between $40,000 and $60,000, although wages vary significantly by region, according to a survey by the National Association of School Nurses. But for many, dwindling district budgets and less funding from states or other sources means uncertainty about whether they’ll have a job next school year, said Bergren with the association. “Emotionally, it’s tough to go through that each spring.”
"I wonder every year when I leave in May, ‘Will I definitely have a job come August?' " said Suzanne Webb, a school nurse at Lambert High School in Suwanee.
One morning three weeks ago, Webb, who works in Forsyth County, was asked to come quickly to the hallway, where she found a staff member on the floor without a pulse and not breathing. Another worker did chest compressions while Webb grabbed an automated defibrillator to shock the woman, who had suffered cardiac arrest. Emergency workers soon arrived, and the woman later recovered.
A teacher pointed out to Webb that the school was originally supposed to be closed for an inclement weather day, which had been canceled.
“I’m just grateful she was here at school, not home by herself,” Webb said. “Every moment counts in a situation like that.”
School nursing strategies
Facing tight budgets, school systems have employed different tactics for addressing students needs for medical care. Below is a sample of what some metro Atlanta school districts have done.
School system -- No. of schools -- RNs -- LPNs -- other
Cherokee County -- 40 -- 27 -- 11 -- 5
Cobb County -- 112 -- 83 -- 35 -- 0
DeKalb County -- 145 -- 49 -- 22 -- 35
Fayette County -- 30 -- 26* -- 5** -- 2
Fulton County -- 101 -- 19 -- 0 -- 101
Gwinnett County -- 130 -- 11*** -- 0 -- 165 ****
*16 full-time registered nurses and 10 part-time
** Four full-time licensed practical nurses and 1 part-time
*** Registered nurses who work at the district level
**** About 50 are registered nurses or licensed practical nurses
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