Mitzie O’Rourke places a calm hand on the trembling student’s shoulder, explaining that everything is going to be all right. She coaxes the scared girl into the room and places a stuffed animal in her arms. Within seconds, O’Rourke has convinced the first-grader that the vaccination won’t hurt for long.
Assisting with daylong clinics for the swine flu vaccine was just one of the recent roles that O’Rourke juggled as a school nurse in Atascadero. She also does vision and hearing screenings, supervises daily insulin injections for diabetic students and assists with an extensive educational campaign targeted at students and their parents to help prevent a large outbreak of influenza.
Like her colleagues countywide, O’Rourke is always on-call and always busy.
The nurse-to-student ratio at most school districts in San Luis Obispo County is low — mimicking what is considered by some officials as a dangerous trend in many California schools. School secretaries and yard-duty staff are often left to take care of bloody noses, skinned knees and other minor medical issues while nurses dedicate their time to more immediate needs.
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The recommended ratio in California — set by the National Association of School Nurses — is one nurse to 750 students. At the county’s largest school district — South County’s Lucia Mar — the ratio is one nurse to 1,464 students. In Atascadero, there is one nurse to 2,446 students.
While county schools are nowhere close to meeting the recommendation, they are not alone. According to a survey conducted by the nurses association in 2009, California ranked 40th nationwide with an average of one nurse to 2,240 students.
Some school administrators say the existing shortage of school nurses, coupled with the growing health needs of students, makes every day a juggling act.
“School districts are struggling to get the type of help they need,” said Kathy Hannemann, assistant superintendent of student services for Atascadero Unified. “There are fewer and fewer hours available, and everyone is pulling double duty. Are we struggling? Yes, we are.”
No law in California
With swine flu cases rising and the likelihood that more students will fall ill with flulike symptoms, school nurses are likely to become even busier.
It is law in some states that each school have a school nurse — but not in California. And officials say ongoing budget constraints make it difficult to increase nursing staff at schools.
In 2008, during budget cutting, Paso Robles Public Schools replaced a school nurse position with a part-time health specialist. The district only has one full-time nurse for 6,884 students. Assisting is a part-time nurse, who only works three months a year, and two health aides, but it is not nearly enough to meet students’ growing needs.
“Unfortunately, the days of having adequate nursing support for schools has diminished greatly with the ongoing budget issues happening in our state,” said Greig Welch, assistant superintendent of personnel services in Paso Robles. “The potential rise in student illnesses does not allow us the possibility of increasing our nursing staff due to the fiscal restraints.”
The school district will rely on the county Public Health Department for more help if needed, officials say.
“If the district had a large number of students that became ill, and if it was to overwhelm the nursing staff, it would be likely that the health department would close the school to prevent any further spread of the flu,” said Jason Taylor, a safety officer.
Deborah Sowerby, who has two daughters in the Paso Robles district, said she is concerned about not having adequate nursing staff at schools given the flu’s potential to spread.
In October, she lobbied fellow parents to help with a campaign to put hand sanitizers and other hygiene supplies in classrooms.
“This flu has ... the means to spread, is more severe, can kill and might possibly mutate,” Sowerby said. “I don’t think they (students) have gotten the message of this flu’s severity and how important it is to sanitize, no matter how many bottles of hand sanitizer we place in the classroom.”
Nursing staff has been cut too thin, she said.
“With the threat of this flu and students in every school with special needs and injuries that occur on a regular basis, I believe shorting our nursing staff in our district down to basically one nurse is a risk to both students and staff,” Sowerby said.
Needs on the rise
In addition to the current flu pandemic, the health needs of students are expected to continue increasing.
“The number of children who come to school every day with chronic disease, whether asthma, diabetes, severe allergies, adrenal insufficiency or children with cancer, is growing,” said Linda Davis-Alldritt, president-elect of the California Association of School Nurses.
Alldritt said advances in medical care have changed schooling for children with chronic illness — allowing them to live regular lives and attend school daily. However, those advances in medical care bring rigid treatment plans, which become the responsibility of a school nurse during school hours.
“There are all sorts of situations that really demand a licensed professional’s time in our schools now,” said Davis-Alldritt. “California school nurses are stretched very thin and extremely challenged — they are doing yeoman’s work.”
Behind the scenes, all school staff are feeling the added pressure.
Teachers are constantly reminded that if children appear ill, send them home.
School office clerks now handle tasks such as record-keeping to help maintain the day-to-day flow of health operations at each school.
And in most school districts, secretaries and administrative staff are trained in first aid and CPR.
“School secretaries now do things like track immunizations and make sure the sick room is stocked with needed supplies,” said Hannemann, assistant superintendent in Atascadero. “But fewer and fewer hours are available, and they too are stretched thin.”
Reach AnnMarie Cornejo at 781-7939.