Khyrie Brown, a seventh-grade student at L.P. Hill School in Strawberry Mansion, had an asthma attack at school in September. Unfortunately, the school nurse, who splits time between Hill and other school postings, didn’t happen to be in that day. “The secretary didn’t know how to give Khyrie his asthma pump,” says his mother, Dawn Hawkins. “I had to end up calling an ambulance to take him to the emergency ward, due to him not having a school nurse.”
Brown is only one player in the Philadelphia School District’s ongoing game of school-nurse roulette. In 2011, the district cut 101 school nurses. As of this school year, only 84 of 363 district schools have a full-time nurse; the other 103 nurses split their time between two, three or even four schools. The city’s student-to-nurse ratio is pushing the state limit of 1,500:1. Nurses say some schools are falling out of compliance with state-mandated record-keeping on required immunizations and physicals as a result.
It’s a crisis in the making, according to parents and nurses, who protested each Wednesday for 22 weeks outside School District headquarters last year. Efforts in Harrisburg and Philadelphia to moderate the cuts’ impact have focused on transferring duties to schools’ non-nursing staff or emphasizing preventive care outside the school — proposals nurses describe as ranging from ineffective to outright harmful. Now, with all eyes on the progress of a plan to close one out of six district schools, how and whether the school-nurse shortage will be addressed remains even less certain.
Near-calamities like Brown’s have hit medically vulnerable students across the city. Cathy Roccia Meier’s son is a special-needs student at the Science Leadership Academy, a magnet school in Center City that has a nurse two days a week. On a day the nurse was present, her son was taken out of school for a infection and hospitalized. If not for the nurse, she says, “we might not have been able to save his leg.”
Maureen Fratantoni is the president of the Home and School Council at the Nebinger School in Bella Vista. More than 30 of Nebinger’s 275 students have autism-spectrum disorders, but a nurse is there only one day a week. On one occasion, Fratantoni’s son, who is on the autism spectrum and has ADHD, had to be treated by an instructional aide for a nosebleed. “She said he wouldn’t let [her] stop the bleeding,” she says. “What if it was bleeding profusely?”
Part-time nurses face the challenge of coordinating medications and care with principals, teachers and secretaries. In one case, says a nurse who didn’t want to be named, a principal simply sends kids home if they’re sick.
Keeping in contact with parents has also become more challenging. “The telephone numbers are ever-changing,” says Ann Keenan, who works at two schools in South Philly and a third in Manayunk. For unreachable parents, “there is no plan for illness.”
Some schools are falling behind on state-mandated health-care requirements, says one nurse. She says fewer than half of the sixth-graders under her watch have had physicals, which the state requires on entrance to grade school and again in sixth and ninth grades. “You may have children in your midst who have severe chronic illness that you don’t know about,” she says. What’s more, records for required immunizations are incomplete.
Legislative responses from Harrisburg have raised more concerns. The state Senate in 2011 toyed with allowing noncertified nurses to serve in schools; following protests by nurses, the bill died in committee. Nancy Kaminski, legislative director for the Pennsylvania Association of School Nurses and Practitioners, expects a separate bill, which would allow nonmedical staff to administer insulin and glycogen to diabetic students, to re-emerge this year.
City Councilwoman Jannie Blackwell, who heads Council’s Education Committee, has been looking to hospitals, community health centers and universities to help mitigate the impact. “We can try to make available what the city has, the different health centers,” she says. She has worked with the Children’s Hospital of Philadelphia to procure a six-figure grant. “I don’t know how we’re going to use it yet,” she says — but likely not to rehire laid-off nurses.
District spokesperson Fernando Gallard, like Blackwell, says students will need to look to primary-care providers or city health clinics as a first resort for tests and screenings. But he doesn’t anticipate further cuts to the nursing staff. “We have cut to the bone,” he says.
Some nurses, though, say the district is not taking them seriously. Peg Devine, the nursing representative on the Philadelphia Federation of Teachers executive board, points out that School District health director Tracey Williams isn’t trained as a nurse.
The plan to turn around Philly schools drawn up by the Boston Consulting Group purports to streamline nursing services under a shared-service organization that “would manage both contracts of specialists and allocation across schools.” Such a structure typically removes employees from site-specific posts and deploys them according to the needs of “consumers,” in this case students. Gallard couldn’t speak to the possibility of subcontracting or shared-service reorganization, or to what might happen to nursing positions if dozens of schools are closed next year.
Superintendent William Hite’s more recent Action Plan 1.0 makes no mention whatsoever of nurses — or guidance counselors or psychologists, for that matter.
One group that is calling for more access to nurses, social workers, guidance counselors and psychologists is the community- and parent-run Philadelphia Coalition Advocating for Public Schools. Those parents, after all, have already seen the impacts of the nursing shortage — consequences that have little to do with the School District’s bottom line, but a great deal to do with the children it’s supposed to be protecting.