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Schools, parents: Nurses are vital to student health
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North Hall Middle School nurse Jennifer Smallwood takes the blood pressure of student Natalie Ledford. Smallwood checks Natalie’s blood pressure every day to determine if she needs medication for a heart problem. - photo by Tom Reed

If you’re older than 40, you probably didn’t have school nurses when you were growing up.

When you got sick at school, the secretary would call your mom, and you’d sit in the office waiting for her to come pick you up.

Though having a nurse might have been a nice amenity, most schools got along without one.

But that was a simpler time. Things have changed, drastically. And that’s why so many people are upset about Gov. Sonny Perdue’s proposal to eliminate funding for school nurses.

“The days are gone when a front-office secretary could take care of the medical needs of students,” said Mamie Coker, health services coordinator for the Hall County school system.

But Perdue apparently disagrees. His 2010 budget would take the $30 million allotted for nurses in Georgia’s schools and redirect the money to other programs.

The assumption is that teachers or other school employees would take over whatever duties now are being performed by nurses.

But Coker said there are a lot of misconceptions about what the nurses actually do and how much their services cost.

“Everybody’s talking about $30 million, but in most years the school nurse program got far less than that. Thirty million was the maximum amount that could be spent,” she said.

Coker said that in 2000, then-Gov. Roy Barnes earmarked an annual $30 million from Georgia’s portion of the federal tobacco settlement to be spent on school nurses. But because there are no restrictions on how the tobacco money can be spent, states often “borrow” the funds for programs unrelated to health care.

Perdue spokesman Bert Brantley said though the funding for school nurses originally came from the tobacco settlement, “it’s bounced around among departments, and some years it came mostly out of the general fund.”

However, this year Perdue decided education should be a higher priority.

“We felt we should put as much money as possible into direct classroom instruction,” Brantley said. “If local school systems deem (nurses) a priority, they will find a way to come up with the extra money.”

The Hall County school system spends about $850,000 a year for 29 clinic nurses, including one in every elementary and middle school, as well as two special education nurses and two supervisory nurses who travel to all schools.

About 30 percent of the funding comes from the state. The rest comes from the Hall school system’s general budget. For a few years, a grant from the Medical Center Foundation helped pay for nurses, but since then the system has been trying to keep the program going without a grant.

With school boards struggling to make ends meet, Coker said they would not be able to make up the difference if state funding disappeared. “Finding that extra 30 percent locally would be tough,” she said.

Coker said she can’t cut the nurses’ salaries. As it is, their pay grade is the same as a paraprofessional, or teacher’s aide. That’s about half of what they could make working at a hospital.

Jennifer Smallwood, the nurse at North Hall Middle School, has been writing letters to the governor and state legislators urging them not to cut funding for the school nurse program.

“It’s not because I’m trying to keep my job,” she said. “It’s because I’m worried about what’s going to happen to these kids.”

Smallwood said anyone who thinks school nurses are nonessential should spend a day with her and see what really goes on.

“We had life-threatening emergencies last year that would have resulted in death had a nurse not been here,” she said.

Smallwood said of the 865 students at North Hall Middle, 10 have diabetes and are dependent on insulin.

Eight students have severe allergies that can cause them to go into anaphylactic shock. Another has a condition that can cause her heart to stop without warning. There’s a child who has a feeding tube, and another who is being treated for a brain tumor.

“I never know what’s going to walk through that (clinic) door,” she said. “Since school started on Aug. 7, there have been more than 2,200 diabetic visits to my clinic (to check blood sugars or give medications).”
In addition to treating sick students, Smallwood also is responsible for keeping them well.

“I do the immunization checks, the screenings for vision, hearing and scoliosis,” she said. “Those are all mandated by the state. Who’s going to do them if there are no nurses?”

Jo Dinnan, principal of Wauka Mountain Elementary, said anyone who thinks the nurses do nothing but take temperatures and dole out aspirin hasn’t visited a school lately.

“It’s unbelievable how hard these nurses work,” she said. “At our school, we have many students with special needs, and our staff does not have the expertise to handle that. We rely on the nurses on an almost daily basis.”

It’s true that in the old days, schools got along fine without nurses. But that’s because students with severe medical problems simply didn’t attend school.

Now federal law guarantees every child a free and appropriate education, regardless of their disability. But what if skilled nursing care is necessary in order for a child to be able to attend school? Would eliminating school nurses be a violation of that child’s rights?

“Having nurses on campus allows some of our students to be here,” Dinnan said. “Otherwise, they might have to have homebound schooling, because they are so medically fragile.”

Jill Haack, parent of a seventh-grader at North Hall Middle, is worried that she might have to make a tough decision. Her 12-year-old daughter, Anastasia, has type 1 diabetes and wears an insulin pump. Despite being vigilant about checking her glucose level, last year a sudden drop in blood sugar caused Anastasia to suffer a near-fatal seizure.

“It took probably 30 minutes for the ambulance to get there,” Haack said. “I don’t know what would have happened if the school nurse had not been there to inject glucagon.”

Haack said she cried when she heard about Perdue’s proposed budget.

“My daughter loves school. She would be devastated if I didn’t let her go,” Haack said. “But if there were no nurses, I would probably have to home-school my child.”

She believes life-threatening illnesses should be handled by medical professionals, not by teachers or other school employees.

At some Hall schools, students, parents and nurses have all been writing letters to state officials, pleading with them to preserve funding for nurses.

“I know that economic times are bad, but I don’t think we should risk kids’ health,” Smallwood said. “It’s sad when our kids are having to write letters to the governor, begging to keep the school nurses.”

But Brantley said it’s not up to Perdue now. “The governor has submitted his budget to the legislators for their consideration,” he said.

Rep. Doug Collins, R-Gainesville, said lawmakers have been hearing from plenty of their constituents on this issue.

“I think the governor’s proposal caught a lot of people off guard,” he said. “My main concern is that a lot of special-needs students are being mainstreamed into regular classrooms, and you have to be able to provide services for them.”

Collins said he’s in favor of keeping the program intact.

“I’m hopeful that we’ll be able to find the money to retain the school nurses,” he said. “It provides an extra measure of assurance to families.”

Lt. Gov. Casey Cagle also has voiced opposition to Perdue’s proposal. “Our children’s well-being has to remain a top priority,” he said.

Brantley suggests that school systems should form partnerships with local businesses and medical providers to help pay their school nurses’ salaries.

“If school systems can’t fund nurses, they have to figure out what they want to do,” he said. “I know it’s not an ideal situation, and I understand their concerns.”

Coker said some local school principals already have approached her about doing fundraisers so the nurses’ salaries will continue to be paid.

But in a recession, businesses that are struggling to survive may not have anything to give.

Coker thinks it’s unrealistic to expect the private sector to take responsibility for the school nurse program. As the number of children with serious medical problems continues to grow, Coker believes the state needs to be involved in supporting the nurses.

“All of these health issues are not going to go away,” she said. “They’ll still be there, even if the nurses aren’t. Then what do we do?”

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