Lawmaker: Time to restore support for school nurses

Lawmaker: Time to restore support for school nurses

(Calif.) A student with a severely fractured arm would be lucky in this state to have access to a school nurse who could provide proper intervention and care.

So would a student with a severe hearing loss who might otherwise be placed in special education, or the district where a recent dental screening showed that half of all kindergartners had cavities.

But after years of budget cuts, California has one of the highest student-to-nurse ratios in the nation at 2,700 to one. A fact that diminishes student health – and with it academic performance – as over-burdened teachers and untrained office staff attempt to patch things up as best they can.

Now, with economic conditions improving and revenue on the rise, a California lawmaker wants every school district receiving extra cash for disadvantaged students under the state’s new funding system to hire a nurse.

In addition, Sen. Lois Wolk’s SB 1239 would create a system of cost reimbursement by allowing school nurses to bill a student’s private health plan or Medi-Cal for services.

 “Fifty-seven percent of California’s public school districts do not have even one school nurse, and there is a distinct connection between health and academic difficulty – failure,” Wolk said during a recent hearing on her bill before the Senate Education Committee. “Poor health results in poor attendance, which affects a student’s ability to concentrate and to learn.”

The issue is not unique to California. Nationwide, just an estimated 45 percent of public schools have a full-time on-site school nurse. Another 30 percent, according to the National Association of School Nurses, have a part-time nurse, typically responsible for multiple schools.

Suffering through years of budget cuts, school nurses have faced widespread layoffs in recent years as districts across the nation have dealt with funding shortfalls and deficits. Add to that the fact that more and more six to 17-year-olds – about one in five, according to recent statistics from the Lucile Packard Foundation for Children’s Health – have some type of above-average health care need.

Responding to what some say is a crisis in terms of school health care, state legislatures have passed special laws allowing teachers and other non-medical staff to administer life-saving treatments such as Epipens for anaphylactic shock and diazepam for epileptic seizures.

Laura Olivo, a school nurse with the Marin County Office of Education as well as a member of the California School Nurses Association’s governmental relations team, just happened to be working when the parents of a young boy with a broken arm called to tell the school they were leaving the area because they couldn’t get help for their son. He’d already gone several hours with a severe upper arm fracture but Olivo was able to get him the after-hours care that he needed, including emergency surgery to set the arm and save nerve function.

Same with the hearing-impaired student, who had transferred to her district having been identified as having learning problems.

“Once we tested his hearing, we discovered he had profound hearing loss, and he was found to be quite bright,” Olivo said. “Without that intervention that child would’ve been channeled as special needs for years.”

Wolk’s bill is an attempt to begin aiming for a more reasonable nurse-to-student ratio – the national nurses association recommends 1:750. California’s 1:2,700 ratio ranks it 45th in the nation in terms of nurse-to-student coverage, the lawmaker said.

But SB 1239 would appear to have an uphill battle ahead, as it would require some 501 of the state’s school districts to hire a nurse using money intended to improve the academic achievement of disadvantaged students – English learners, poor and foster students. The accountability demands under Gov. Jerry Brown’s Local Control Funding Formula on these districts are broad, and schools are already concerned that the state expects more than what the money can buy.

Additionally, the plan to bill students’ private health plans is opposed by an association of insurers who argue that the schools aren’t covered under contracted plans and that the entire process, from collecting co-pays to determining reimbursement rates and handling billing, is fraught with uncertainties.

However, Sheri Coburn, director of health at the San Joaquin County Office of Education, said that several mental health clinicians working through her office brought in $689,000 by billing Medi-Cal – a federal health insurance program – for services provided to its students.

“I think school nurses could do the same thing for school districts,” Coburn said while testifying on behalf of Wolk’s bill at the Senate hearing. “It is through that reimbursement process that we could bring down federal funding to support school nurses. We provide services for asthma, diabetes, seizures, teen pregnancy, suicide, depression – school nurses are on the front lines to capture these healthcare issues.”

Wolk, meanwhile, said she believes the concerns over the funding formula can be worked out prior to the bill’s next hearing on May 23.

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