---

E-mail to a friend | Print This | Select Text Size:

A recent study by The Commonwealth Fund, which averaged and compared children's health performance indicators for each state and the District of Columbia, placed Florida 50th, barely above bottom-ranked Oklahoma. Researchers analyzed 13 indicators of child health, grouped into five dimensions: access, quality, costs, equity, and potential to lead long, healthy lives.

"I'm appalled for Florida, but it's a good report that points to trends and needs," says Judi Vitucci, ARNP, PhD, executive director of Healthy Start Coalition of Pinellas Inc., Clearwater, Fla., and community outreach committee chair for the Florida Gulf Coast Chapter of the National Association of Pediatric Nurse Practitioners. "It looks like what's driving low scores are access and equity. Disparity is going up instead of down."

Florida is the only state that mandates prenatal and infant risk screening, and it originated the Healthy Start private/public coalitions to provide services for those at-risk during pregnancy and children through age 3, but funding is a problem. "Based on funding, we can only meet 47% of identified needs," says Vitucci. Florida KidCare is also failing to serve needy children, she says, because of inadequate funding and excessive bureaucracy, and parents can't afford the $20 monthly fee.

Florida's highest score was for the 65.7% who had both medical and dental preventive care in the past year, which earned a 10th-place ranking. Its second highest score was a 15th-place ranking for the 61% who got follow-up from their primary nurse or doctor after specialty care.

Many parents, those with and without health insurance, consider and even list school nurses as their child's primary healthcare provider, says Kathleen Rose, RN, MHA, NCSN, president of the Florida Association of School Nurses and school nurse for four Lee County Schools.

School Nurse Role

"[Parents] may care deeply for their children, but when they have to make hard financial decisions about what they can afford, they send sick kids to school and tell them to see the nurse," says Rose.

At Nursing Spectrum's request Rose reviewed the emergency contact cards at an elementary school she covers; 231 of the 633 students lacked a medical provider, and 18% of the remainder listed a clinic. But she's not always available or even on-site: her total practice encompasses three other schools and 4,000 students.

In Florida, the ratio of school nurses to children is three times lower than the recommended number. (Florida has one school nurse for every 2,471 students; the recommended ratio is 1:750.)

There's a tremendous need for services to handle dental and mental health issues, even for the insured, says Rose, because they affect school success like other health issues. "Dental problems are the leading cause of school absences, due to pain and infection," she says. Untreated cavities can also cause abscesses and subsequent, expensive ED visits.

Access Barriers

Other pediatric providers are in short supply. "It's hard even for people with private health insurance," says Melissa Kelly, ARNP, CPNP, at Silver Lake Pediatrics, Leesburg, Fla. "Some patients travel an hour because we're the closest pediatric practice, and they may have to travel another 90 minutes or more to Orlando or another city since many counties, like ours, don't have pediatric specialists."

Further, "the number of providers who take Medicaid is skin-thin," says Janel Saunders, CPNP at Altamonte (Fla.) Pediatric Associates and president of the Florida Chapter of NAPNAP. "Although our six MDs and five NPs accept almost all Medicaid programs and interact with them daily, it's difficult even for providers to understand the regulations. Getting access is such a complicated process, especially for the less educated, that people give up, especially after an initial rejection or if they're dropped without notice."

The four nurses agree that both the private and public sector are fumbling their responsibilities to patients.

"Some families are turned away from medical appointments unless they bring an interpreter, which violates the Civil Rights Act," says Vitucci, reeling off examples. "Medicaid letters are in English, so some women who get 45 days of Medicaid coverage think they get 45 visits and hoard them, missing prenatal care. Despite our high infant mortality, families that reapply for programs are automatically denied if they don't try to re-enroll every child, including the deceased. Try to get answers, and the information line has two options; press one for an application, press two if it's complete, with no opportunity to ask questions."

Other stumbles and cutbacks have confused and alienated potential clients most in need of services. "Florida has had to return federal dollars because the state was inappropriate in matching funds, and two Florida pediatricians associations have sued to improve Medicaid eligibility," says Saunders. Florida's income eligibility cutoff for prenatal care is more stringent than federal requirements.

How can nurses help low-income parents — whether in their practices or communities — access healthcare? "They may not know they can get vaccinations and other free services at the health department and elsewhere, even if they're not eligible for Medicaid programs," says Saunders. "And we need more community outreach to teach how to access and also maintain coverage."

School nurses have application forms and help parents complete and file them by mail or online, says Rose. Applications are available by calling 888-540-5437 and by logging onto www.healthykids.org.

Wendy Bonifazi, RN, CLS, APR, is a senior staff writer with Nursing Spectrum.

---

To comment, e-mail editorFL@nursingspectrum.com.