MMS Physician Focus: January 2010
By Linda Grant, M.D., and Kathy Hassey,
B.S.N.
Children spend more time in school than any place except home,
and success in school is directly linked to a child's health. Those
two facts alone should mark the importance of health in our
schools.
But the topic becomes more significant when you consider the
wide range of risks and conditions facing our youngsters. Obesity,
bullying and violence, allergies, and chronic illnesses like asthma
and diabetes have risen dramatically in recent years and show few
signs of declining. Consider that more than 20 percent of the 1.2
million children in Massachusetts schools have some kind of medical
condition.
Add to that continuing concerns about H1N1 and seasonal flu and
a severe shortage of school nurses, and you have a situation that
should cause deep concern among parents, teachers, and school and
public officials alike.
The scarcity of school nurses is a nationwide problem.
Massachusetts has only 2,100 nurses for its school children, and
nationally, only 45 percent of public schools have a full-time
nurse. Another 30 percent have a part-time nurse, and 25 percent
don't have any nurse at all. The preferred ratio is one nurse for
every 250 to 500 children, but in some locations in the country, a
single nurse may be responsible for as many as 2,000 children.
The poor economy, causing budget cuts at the federal, state, and
local levels, is making the challenge even bigger. Recent state
cuts, for example, have caused 13 of 80 school districts across the
state to lose their essential school health services grants, funds
that support a range of services, including administration, basic
and emergency care, substance abuse prevention, and nursing
positions.
Despite that, as a physician and nurse who have worked on school
health matters at the national, state, and municipal levels, we can
tell you that good news and bright spots do exist.
To start, Massachusetts is one of the best states in the nation
for school health, particularly with regard to school nurse
leadership. Further, the caliber of our school nurses is higher
than it's ever been. Each must be a registered nurse, have a
bachelor's degree, and engage in continuing education. Each must
also be licensed by both the Board of Registration in Nursing and
the Department of Elementary and Secondary Education and have at
least two years of experience before becoming a school nurse. Most
have 10 to 15 years of experience in such areas as emergency or
intensive care, pediatrics, and mental health.
That experience translates into solid performance. School nurses
in Massachusetts have an enviable 92 percent return-to-class rate -
demonstrating an ability to keep children in school and able to
learn. And each school year, nurses save upwards of 175 children by
administering Epinephrine in response to life-threatening allergic
reactions.
Finally, the state Department of Public Health has taken an
active and thorough approach to school health. Its two-volume,
1,300-page Comprehensive School Health
Manual provides detailed policies and practices for school
health, addressing such topics as infectious disease control;
mental, nutritional, and oral health; injury and violence
prevention, and substance abuse and addictive behavior, among
others.
But challenges remain. The biggest is funding, to provide more
nurses and resources for our students. Another constant test is
trying to meet the expectation that schools can handle it all -
education, discipline, guidance, counseling, safety, health, and
even substitute parenting.
It's important to remember, however, that school health is more
than having a nurse on site. School health entails all the
services, activities, policies, and programs in schools designed to
remove barriers to teaching and learning. It includes a healthy
building, a healthy environment, healthy foods, physical fitness,
staff who are role models, and a dedicated administration.
And that's where parents, teachers, administrators, and public
officials can work together to play a critical role. We encourage
everyone to get involved, ask about school nurses and the health
care available, and advocate for improvements if needed. It bears
repeating: Success in school is directly linked to a child's
health. Good school health programs contribute to a safe
environment and create a sound structure for children to learn. To
learn more, visit the National Association of School Nurses at www.nasn.org or the American
Academy of Pediatrics Council on School Health at http://www.aap.org/sections/schoolhealth.
Linda Grant, M.D., M.P.H. is Medical Director of the Boston
Public Schools. Kathy Hassey, B.S.N., M.Ed., is Director of the
School Health Institute at Northeastern University. Physician Focus
is a public service of the Massachusetts Medical Society. Readers
should use their own judgment when seeking medical care and consult
with their physician for treatment. Send comments toPhysicianFocus@mms.org
