A Shrewdness of Apes

An Okie teacher banished to the Midwest. "Education is not the filling a bucket but the lighting of a fire."-- William Butler Yeats

Friday, August 01, 2008

Teachers as nurses. This is scary.

How would you like to be responsible for carrying out medical procedures on your students?
During the past two school years, teacher Julia Keyse had to enforce an unusual rule in her kindergarten and first-grade classroom: No interrupting while she pricked Caylee's finger to check her blood sugar and adjusted her insulin pump.

"They were so good. They would just sit and wait," Keyse said of her class at Etowah Elementary School in Henderson County, N.C.

It's a task Keyse never imagined when she became a teacher, but medical duties have become a part of the job for educators across the country as schools cut nursing staff or require nurses to work at multiple locations. The change comes at a time when more students are dealing with serious medical conditions, such as severe allergies, asthma and diabetes.

It's a change that's unsettling for teachers, school nurses and parents.

"We don't want to pretend to be doctors or nurses," Keyse said. "I would have gone to school for that."

Federal guidelines recommend that schools employ one nurse for every 750 students, but the national average is one nurse for every 1,151 students, according to Amy Garcia, executive director of the National Association of School Nurses. A quarter of schools in the nation have no school nurse.

Although there is no historical data regarding the number of school nurses nationwide, members of the profession say there are fewer nurses doing more work, while teachers and other school workers pick up the slack. The average nurse splits her time between 2.2 schools, according to the association.

"Teachers deserve a school nurse because their time should be spent teaching," Garcia said.

Meanwhile, the workload of school nurses has increased since 1975, when the federal government mandated that schools accommodate disabled students, clearing the way for children with feeding tubes, catheters and other serious medical conditions to attend school. Today, 16 percent of students have a condition that requires regular attention from the school nurse, Garcia said.

Many parents and school administers don't realize that nurses are handling life-threatening conditions as well as performing vision, health and diabetes screenings, said Barbara Duddy, president of the Tennessee Association of School Nurses in Memphis.

"They think the school nurse is nice little job where you take care of boo-boos," she said. "School nurses work very hard to make sure every child gets exactly what they need."

Garcia blamed shifting priorities, shrinking budgets and a misunderstanding of the school nurse's role for the loss of jobs.

The Southern Humboldt Unified School Board in Garberville, Calif., blamed a reduction in state funding when members voted in June to eliminate one nursing position and reduce the other position to 10 hours a week for the upcoming school year.

"The nurses provide great services for our students, but so do all the other positions that we've cut," said Susie Jennings, associate superintendent for the 800-student district.

Robin Correll, the remaining nurse, worries how she will oversee the district's seven schools. She was already struggling to perform annual health and vision screenings.

"It will be impossible to do all the work," she said. "It breaks my heart. Kids deserve better."

Correll, like many nurses around the country, has already trained teachers and secretaries to dispense medication, give shots of adrenaline and help children use inhalers. So far the district has stopped short of asking nonmedical personnel to administer insulin.

The thought of someone without a medical background managing Brandon Merrell's diabetes makes his mother, Amy Merrell, very uncomfortable. The Gilbert, Ariz., woman wants assurances that her 8-year-old son will be properly cared for while he's at Coronado Elementary School.

"There needs to be somebody in there that knows what they're doing," she said.

She and her husband, Doug, are among the parents speaking out about the issue. After they and other parents objected to a plan to cut the number of school nurses from nine to two, the Higley Unified School District decided in June to maintain five nursing jobs.

In Keyse's North Carolina district, Barb Molton told county commissioners that she worried her diabetic 13-year-old son, Brice, had access to a school nurse for only two mornings a week.

"It can be scary dropping your child off at school wondering if that will be the day they might have a medical emergency and wondering if that is the day you might be lucky to have a school nurse there," she said at the hearing.

The commissioners agreed to fund two additional nurses for the upcoming school year.

School nurses, who have spent the last decade defending their jobs, are happy to see parents take up the cause, said David Schildmeier, spokesman for the Massachusetts Nurses Association.

"That's how the change happens," he said. "That's how this issue gets solved."

We've all patched up the minor boo-boo or diagnosed strep infections or --gulp--pink-eye and called parents to take kids to the doctor. I am known as having a "Mama hand" that can pretty accurately predict what a kid's temperature is going to be. But handling catheters? Testing blood sugar? Nononononono. Hell, no. I won't dance. You can't make me. That is just too frightening. Think of the liability. Think of how a child could get hurt!

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At 8/1/08, 7:01 AM, Blogger Mike in Texas said...

The Republicans in Texas actually tried to legislate this foolishness by withdrawing funds for school nurses and trying to create a law saying school personnel could "voluntarily" be used to administer diabetes testing as well as other medications.

Luckily their attempts failed.

At 8/1/08, 10:14 AM, Blogger Mrs. T said...

I'm with you. I don't want the liability, nor would I want someone as unqualified as I am to administer medical procedures to my own children.

At 8/1/08, 3:25 PM, Anonymous Anonymous said...

Medical procedures should be done by nurses or doctors not teachers. Teachers in my district can administer inhalers and set doses of medication on field trips.

But if a child requires blood sugar to be checked, injections, food via a feeding tube, or carries an epi pen the school nurse is required to go on the field trip. At our school that means another nurse must be on campus, because we have a life skills class and several other medically fragile children that are in regular ed.

Last year we had 3 kids with feeding tubes (2 life skills, 1 regular ed)

At 8/1/08, 8:47 PM, Anonymous Ivory said...

Ironic then that they do not let students who know how to administer their own treatments carry inhalers and asprin. Honestly, I'd rather have my kid keep their inhaler with them than make them try to find a secretary every time they have an acute attack.

At 8/1/08, 9:16 PM, Blogger Mrs. Bluebird said...

One of my first subbing experiences was in a little country school smack in the middle of a cornfield. The teacher left a note that very specifically said to give a student his meds at lunch, and they were in her desk. Which was locked. I was in a panic, and ended up getting a hold of the school secretary, who got a hold of the principal, who somehow busted her desk open and gave the kid his meds himself. I want to have NOTHING to do with giving kids meds, no how, no way...the liability scares the hell out of me.

At 8/1/08, 10:20 PM, Blogger Jaqui said...

This year we had a kid with seizures whose medicine had to be administered rectally. Guess who got trained to do it? We dont have a full time nurse, our nurse comes to visit for an hour a day or so, which is much better than the last nurse whom I never did see. We share our nurse with 1 middle school, and 3 elementary. BTW-our high school has 2500+ kids.

At 8/2/08, 9:42 AM, Blogger Redkudu said...

Add me to the list of teachers who do NOT want this type of responsibility. It's good to see parents are already getting involved in this. Like someone already pointed out, if I were a parent, I wouldn't want a teacher providing routine medical services.

At 8/2/08, 6:11 PM, Blogger graycie said...

I wonder if there is legal recourse for teachers forced into medical responsibilities. I think that if push came to shove, I'd find a lawyer to protect me from an employer who required me to endanger a child due to my lack of medical knowledge and expertise.

At 8/3/08, 10:28 PM, Blogger Fred said...

I'm not one to sue, but I would have used every single legal remedy possible to avoid having to pretend to be a nurse.

At 8/4/08, 2:07 AM, Blogger TeacherDee said...

Besides the liability (which is a huge factor), I wish people had more respect for our profession. I am a highly trained professional teacher. Doing my job takes enough of my time and mental energy without having to worry about blood sugar and feeding tubes.

At 8/5/08, 11:11 AM, Blogger Jennie said...

It's not merely a question of liability; it's a question of safety. Now, I worked long and hard to get a masters and a teaching credential, nowhere in there did I take even a class on how to test for blood sugar/when to give meds/the appropriate use of an inahler--this is one of those ways that districts seem to be saving money but are actually putting their students (and teachers!) at significant risk.
Never mind my poor resource/ADHD students who can never seem to make it to the nurse's office on time to get their lunchtime meds. By the time 2nd lunch came along, she was already off to another school site--with the meds behind the locked door.


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