Minnesota school nurses and pandemics: the first line of defense

While some Minnesota students wait for their schools to reopen in the wake of H1N1 Swine Flu cases, officials wonder if the school health network is strong enough to protect students from such outbreaks.

The school closures show again that the officials at the junction of public health and schools are the school nurses. They are charged with not only keeping students well and promoting healthy lifestyles, but also with mitigating outbreaks and planning for emergencies that are both small and catastrophic.

Sadly for Minnesota students and their parents, epic underfunding by state government has forced school districts to cut the number of school nurses. All major school health organizations — the Center for Disease Control and Prevention, the National Center for Health Statistics and the National Association of School Nurses — recommend a school nurse-to-student ratio of 750 to one. Minnesota’s school nurse-to-student ratio is 1,404 to one, which is 30th in the nation.

Even without the threat of a global pandemic, the need for a well-funded corps of health professionals in the schools is great. Anne Hoxie, a school nurse and the president of the School Nurse Organization of Minnesota, said that even though their numbers are small, school nurses are ready to handle any emergency that might arise. In fact, they already handle many highly contagious diseases and viruses that emerge in schools.

“We’re used to identifying cases of communicable diseases such as pertussis, or whooping cough, tracking them and contacting public health officials,” she said. The nurses that remain in the schools are fully prepared to handle an outbreak of the Swine Flu, she said.

Are there are enough nurses to handle student health needs? In a survey conducted last year by Minnesota 2020 and SNOM, most nurses said districts don’t have enough money to adequately staff schools. More than 60 percent said current staffing is inadequate to meet some student needs, and 14 percent said poor staffing is inadequate to meet most student needs.

They said students are suffering because of this staffing shortage: Students with depression or other mental health needs are undetected; uninsured students aren’t getting referrals to health care programs and clinics; students with chronic health conditions such as asthma don’t get care at the level to meet their needs; and emergency planning doesn’t get the attention it deserves, according to 90 percent of school nurses surveyed.

Hoxie said the extreme shortage of nurses means many school nurse duties devolve onto school secretaries, teachers, aides, and even coaches.

“This situation means there is no consistency of service,” she said. “A sick student may be seen by a nurse or a teacher or an aide or a secretary or a principal or a paraprofessional.”

State funding for education has dropped 13 percent since 2003.

Some districts have been able to make up that difference by asking voters to raise their property taxes; some have not. For those districts that face budget deficits, school nurses are among the first to go.

“This is an example of how we need a strong public health system in Minnesota that has continuous investment that is not threatened by these continuous deficits,” Hoxie said.

School nurses are one of the first lines of defense in our public health system. Now, more than ever, the decision to shortchange Minnesota schools looks shortsighted and careless.