School Nurses in Short Supply

If swine flu reappears in schools this fall, it’ll probably be a school nurse who first discovers it. But nationwide, the ratio of nurses to students falls short of the federally recommended standard, raising concerns that the shortage could undermine efforts to catch and control what could be a deadly flu season.

A USA TODAY analysis of Census data from 2005 to 2007 suggests that each school nurse cares, on average, for 971 students. In 13 states, the ratio is more than 2,000 to 1.

In its own 2007 survey, the National Association of School Nurses found the ratio was 1,151 students per nurse.

In either analysis, the workload exceeds the recommendation from the Centers for Disease Control and Prevention (CDC): one nurse per 750 students.

“Either way, it’s not good for kids out there who have no safety net,” says Amy Garcia, executive director of the National Association of School Nurses.

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Further, the association recommends a 1-to-225 ratio for schools that require “daily professional school nursing services” and 1-to-125 in schools with “complex health care needs.”

Data from the Department of Education, which examines only schools that have nurses, show that workloads for elementary school nurses have remained essentially unchanged since 1999 at about 455 students per nurse. But in secondary schools, workloads have grown 14%, from 733 students per nurse to 835.

Nationwide, an estimated 45% of public schools have a full-time nurse on staff, the nurses association says. Add part-time nurses and the figure jumps to 75%. That leaves 25% of schools with no nurse at all.

CDC guidelines released last week discourage schools from closing even if the H1N1 virus, or swine flu, strikes. Homeland Security Secretary Janet Napolitano said only schools with “high numbers of high-risk students” showing symptoms should consider closing, but she warned that shutting down a school, even temporarily, “causes a very significant ripple effect” in the community.

Instead, the new CDC guidelines say ill students should be kept out of school until 24 hours after their fever subsides.

Schools’ first line of defense: frequent hand washing, coughing etiquette, routine cleaning and close monitoring of symptoms. In schools where students show symptoms, Education Secretary Arne Duncan says, educators should set aside a room for students, “a safe place for them to stay” until they can go home.

© YellowBrix 2009