Original article written by Emilie Le Beau Lucchesi for Discover Magazine.
According to a study published in The Journal of School Nursing in 2018, almost 60% of schools in the U.S. don't have a full-time nurse. Of these schools, 35% share a part-time nurse with other schools and 25% do not have a nurse on campus at all. Schools are experiencing a nursing shortage that advocates argue puts children's well-being at risk. It’s a problem that has troubled educators for more than a century, but it's grown worse in recent years, with the COVID-19 pandemic adding to the confusion, and public health officials worry the crisis will only keep compounding in the years to come.
Advocates in the early 1900s pushed for medical professionals in schools, not for the purpose of excluding children as they had in the late 1800s, but to diagnose fixable problems and give more students the opportunity to learn. In some areas, the school nurse provided the only medical attention a child was able to receive.
By the 1950s, school nurses were also given the role of health educator and tasked with teaching fundamentals of good diet and hygiene. But budget cutbacks in the late 1960s and 1970s slashed education programs and diminished school nursing funds. At the same time, both educators and school nurses were learning how to include and care for children with disabilities. Beyond that, the 1980s recession brought even more cuts to school nursing programs.
Today, tightened budgets have meant that most school districts share nurses between campuses. Others offer a lower salary for full-time nurses, which makes recruitment challenging. School nurses make between $10,000 to $20,000 less than their hospital counterparts, according to a 2021 report by the Pew Research Center. For many schools, that means there isn’t a trained medical professional on campus, or the one available is overwhelmed. On top of that, the number of trained professionals who could fill those open positions has continued to shrink: More than 500,000 registered nurses are slated to retire by 2022, creating a need for 1.1 million additional nurses.
The shortage comes at a time when many kids have medical ailments. About 40% of school-aged children have a chronic illness such as allergies, asthma, diabetes, epilepsy, or behavior/learning issues that require daily medicine, according to the Center for Disease Control and Prevention. Without a school nurse on campus, faculty and staff who lack medical training are tasked with giving insulin, administering emergency doses of epinephrine during life-threatening allergy attacks, and in rare instances, having to administer CPR. Plus, the pandemic has added a serious wrinkle to the meaning of medical care at school, pushing already-burnt out professionals to their limits.
School nurses became frontline workers during the pandemic. They had to advise schools on pandemic policies, identify symptoms in sick children and assist with contact tracing. In a survey published in the Journal of School Nursing in 2021, almost all school nurses expressed some type of moral distress about the problems they experienced at work, which included an overwhelming workload and lack of support.
As schools continue to reopen after years of virtual learning, school nurses might be on the frontlines of a different crisis: student mental health. Deteriorating mental health among young people was already a problem before the pandemic; one in three students said they had persisting feelings of sadness and hopelessness in 2019, according to a CDC report. By the end of 2021, the Surgeon General released an advisory warning about adolescents’ soaring mental health needs.
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