Cristian Reyes relies on his mother, Teresa Reyes, to help him manage his diabetes. But when his mom works and he’s at school, Cristian depends on Esperanza Garcia Mendez, the nurse for Milwaukee’s Fratney and Pierce elementary schools.
Mendez helps Cristian monitor his blood sugar and count carbs every day. Without that support, Reyes says she’d often have to leave work to deal with Cristian’s diabetes.
University of Wisconsin-Milwaukee Assistant Professor of Nursing Mary Jo Baisch says nurses like Mendez are a valuable resource in schools, giving teachers, administrators and staff more time to focus on instruction and learning.
13: a number nurses can handle
Baisch and two co-authors researched the school-nurse program in Milwaukee Public Schools between 2006-07, and recently published their results in the Journal of School Health. During the study, researchers, administrators and staff reported spending an average of 13 hours a day dealing with students’ health issues.
Based on 2006-07 average wages/benefits for teachers, staff and school administrators, those 13 hours were the equivalent of spending more than $133,000 annually per school. During the 2006-07 school year, average wages/benefits for a school nurse totaled $72,450, indicating that nurses provide significant added value in improving the school’s health environment and allowing administrators, staff and teachers to focus on education, according to the study.
Despite the demonstrated value of school nurses, there will be fewer of them in MPS for the 2011-12 school year. The school district is looking to slash expenses in response to a proposed $82 million cut in state aid next year.
“The data have implications for school funding,” Baisch says, “but politics often supersede the data.”
Currently, MPS has 70 school nurses across the district, with funding for 64 positions expected in the 2011-12 school-year budget.
Asthma, allergies, diabetes top nurses’ to-do lists
School nurses are particularly important in urban school districts, where children are more likely to be affected by chronic health issues, says M. Kathleen Murphy, coordinator of health services for MPS and co-author of the study. Approximately 85 percent of MPS students live in poverty, Murphy says.
That means most schools have a majority of students living in poverty. In addition, many children in these schools deal with chronic health conditions: asthma, diabetes, allergies.
A few years ago, MPS had one nurse for every 8,500 students, far above the nationally recommended 1:750 ratio. With help from Title 1 and other funding sources, MPS brought the ratio down to 1:750 in Title I schools and 1:1088 across all 200 schools.
While the nurse to student ratio was improving, Murphy says: “It should be even lower for districts with a great number of special-needs students.”
“Most of the parents find it reassuring to have a nurse in the school,” adds Marchell Bass-Wilson, a nurse at Congress Year-Round School.
In addition to managing chronic medical conditions and giving teachers and staff more time to focus on education, the UWM study showed that schools with nurses had significantly more complete student health and immunization records than schools without nurses. Other studies have shown medication errors are common when untrained school workers administer medications.
The findings are “things that we all thought we knew about nurses, but it’s always nice to see those ideas have been validated with scientific rigor,” says Murphy.
Nurses treat so teachers can teach
While the study authors – including co-author and College of Nursing Dean Sally Lundeen – didn’t look at attendance issues, other research shows that students in schools with nurses have better attendance rates, focus better on their schoolwork and do better academically.
The MPS nurses agree that their presence and medical support helps keep students focused on school. “I’d estimate that about 90 percent of the students I see are able to go back to their classrooms,” says Marchell Bass-Wilson.
In the first part of the study, Baisch and her research team surveyed principals, assistant principals, clerical staff and teachers from high, middle and elementary schools.
Survey responses showed that principals and assistant principals estimated they spent 57 minutes less a day dealing with health-care issues after a school nurse became part of their team. “They were spending almost an hour a day dealing with children’s health problems,” Baisch says.
At schools with a nurse, clerical staff reported saving about 46 minutes a day, and teachers reported saving about 20 minutes per day due to not dealing with children’s health issues.
According to the same surveys, school nurses were able to build relationships with parents or guardians that were helpful, particularly in managing the chronic health problems.
In the second part of the research, Baisch and her team looked at electronic health records at Title 1 schools with nurses and compared them to records at similar schools without nurses, finding emergency records of students in schools with nurses were significantly more complete. Schools with a nurse also tended to have higher immunization rates than those without a nurse, the study found.
In future research Baisch plans to look at the links between school nurses, better management of health conditions and attendance and learning. “When student health conditions are better managed, students’ attendance often improves.”