School nurses in short supply
Plum High School nurse Barb Manganello arrives at her office at 7:15 a.m. each day to find a line of students waiting.
“They can be there for anything — excuses for skipping gym, which I have to approve, feeling faint because they have not eaten breakfast,” Manganello said. “People think we just hand out Band-Aids and do nothing else. It’s a lot work to stay on top of many students — parents, teachers and guidance counselors.”
The job of caring for school children is getting tougher, school nurses say. Students’ woes — from asthma, diabetes or epilepsy to pregnancies, abuse or emotional problems — are growing more complex. And there are too few school nurses to meet the rising demand, nurses and lawmakers say.
Nationwide, schools have an average of 1 nurse for every 950 students, well short of federal guidelines calling for 1 for every 750. In Allegheny County, the gap is wider — 1 for every 1,035 students, according to state Health Department statistics. The ratios vary widely among the county’s 43 districts — Brentwood has 1 nurse for every 507 students; Quaker Valley has 1 for every 1,486.
State law now requires 1 nurse for every 1,500 students. But that ratio, established in 1949, is antiquated, said state Sen. Joe Conti, R-Doylestown, Montgomery County. He is sponsoring a bill now awaiting a vote in the Senate that would lower the ratio to match the federal guideline.
“What could be more important than student healthâ¢ We need to bring our programs up to date,” Conti said.
Pennsylvania still stacks up well compared to other states, said Charity Istone, a nurse at McKnight Elementary School in the North Allegheny School District and president-elect of the Pennsylvania Association of School Nurses and Practitioners.
“Many states do not even have a required ratio,” Istone said. “We do, which has kept things from getting as problematic as they are in other states.”
In Utah, for example, there is 1 nurse for every 5,834 students, according to a 2004 survey by the National Association of School Nurses. That’s the worst ratio in the nation, experts say. A parent has launched a petition drive to seek state money for more nurses.
Pennsylvania is one of 10 states that require school nurses to be licensed as registered or professional nurses and to have an additional specialty certificate and mandates that districts offer nursing services. Utah is one of a dozen states that has none of those requirements.
Still, Istone and others say the Pennsylvania’s nurse-student ratio is far too high.
“There are increasing numbers of students with complex health issues, and there are increased mandates about health and wellness,” she said.
Laws requiring students with severe health problems, rising rates of drug use and teen pregnancy and advances in medication and treatment all add up to a heavier burden for nurses and higher risk for the students they treat, nurses say.
“There are students who years ago would not even have been in school,” Hampton High School nurse Karen Thomas said. “Their health problems would have either kept them at home or put them in a special school.”
Yet Conti expects his bill to be be watered downeventually.
“The problem has attracted the attention of legislators,” he said. “But there are always problems paying for anything like this.”
The Pennsylvania State Education Association estimates that adding nurses to meet the 1:750 ratio would cost $13 million. A Legislature study puts the figure at $24 million.
“We don’t want this to be another unfunded mandate,” Conti said.
Some school officials cringe whenever they hear of a new state mandate for schools.
“We are never happy with an unfunded mandate, but in the scheme of things, this is nothing compared to having all-day kindergarten mandated,” Pine-Richland School Board member Marilyn Reed said.
Change is needed, said Kathleen Halkins, a nurse at Liberty High School, Bethlehem, Northampton County, and the president of the Pennsylvania Association of School Nurses and Practitioners.
“Students in this state are underserved — there is no way you can provide care to all those students,” said Halkins, who has been a school nurse for 20 years.
School nurses, meanwhile, soldier on.
By 10 a.m. recently at Hampton High School, more than 20 students had filed into Thomas’ office.
One student wanted a Motrin. Another wanted something to relieve the pain from a case of pinkeye. A third came in complaining of a fever.
“You can never really predict who comes in or what they will need,” said Thomas, who has been a school nurse for 33 years, 17 of them in the Hampton School District.
Some parents know how difficult the job can be.
Both of Wendy Ridgeway’s children were on medication while at Hampton’s Central Elementary School and made daily trips to see school nurse Mary Jane Rozek.
“I adore Mrs. Rozek — she’s very good with the kids,” Ridgeway said. “It’s a demanding job.”