Despite Layoffs, Dallas ISD Values School Nurses
Monday February 9, 2009
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"No nurses were cut," says Suzanne Kubelka, RN, MSN, SNP, FNP, director of health services for the DISD. "We're considered a critical care need."
In October, the DISD eliminated more than 1,000 positions, including laying off more than 415 teachers, assistant principals, and counselors, as a result of budgeting and accounting errors over the past several years leading to an $84 million deficit.
However, right now the ISD is hiring school nurses, Kubelka says.
"We had four nurses leave voluntarily and we are looking to fill those positions," she says.
Although the district supported the importance of nurses in its schools, Kubelka is far from reaching her goal of a low student-to-nurse ratio. Currently, Dallas public schools have a 1,000-to-1 ratio of students to a school nurse, depending on the campus. Kubelka says she has a goal to lower that ratio to 500 to 1, but does not have the funding for it.
Such budget constraints are felt across the state. Texas averages one nurse for every 870 students, ranking the state 17th in the nation, according to data from the National Association of School Nurses.
But, the NASN is pushing Congress and state legislatures across the country to require all school districts to have one registered school nurse for every 750 students, and a much lower ratio in student population high in chronic illnesses or developmental difficulties.
Texas does not have a state-required student/nurse ratio, but does require the school nurse position be filled by a registered nurse, says Cathy Harris, RN, BSN, president of the Texas School Nurses Organization and a school health specialist in Midland. An LVN can be hired to work at a school, but only under the supervision of an RN or doctor, she adds.
While Texas appears to be close to the NASN student/nurse ratio recommendations, Harris says the numbers don't tell the whole story in the state.
"There are some counties in the state with no hospital, nurse or doctor," she says."One school in Big Bend has 28 kids in the whole school, while in Midland we may have one nurse for every 2,300 students."
Harris says the TSNO worked several years to get the Texas legislature to require a student/nurse ratio, but was never able to get a bill passed.
Last June, the first federal bill addressing the school nurse/student ratio was presented to Congress. H.R. 6201 authorizes the Secretary of Health and Human Services to make grants to eligible states for the purpose of reducing the student-to-nurse ratio in public schools. An updated support letter for the bill from the NASN will be sent to the new Congress in January, according to a spokeswoman.
Harris says it is difficult for school districts to compete on salary with hospitals and others who hire nurses.
"The pay scale in a school setting can be much lower than a hospital setting," she says. "But if you divide it out by a daily rate, it's pretty competitive."
Still, nurses tell her they can work in a hospital for four days for the same amount as they would earn in a month as a school nurse, Harris says.
The Dallas ISD hires nurses at the same pay scale as its teachers, and is one of the few districts in the state that can hire new nursing school graduates, Kubelka says.
"Most districts must hire their nurses with experience, but we have a school nurse clinical development program that allows us to mentor nurses coming in," she says.
Working as a school nurse has become more challenging than many potential candidates recognize, Harris says.
As many as one in four students receive no other form of medical care than a school nurse. Also, as counselors are cut or focus on helping students with college choices, many of the mental health issues of students end up being treated by a school nurse, Harris says.
"As a school nurse you have to be a jack of all trades and a master of all trades," she says. "A lot of people think all we deal with is Band-Aids and throw up and that it's a cushy job — but it's usually not."
One large part of school nurses' job today is to create a care plan for students with chronic diseases, including Type I and II diabetes and asthma, says Harris, who has 4,000 children with asthma in her district alone.
While there are challenges to a school nurse job, one favorable aspect of the job is what keeps many candidates coming forward: a schedule that works for nurses who are parents.
"We get a lot of nurses who are tired of working long hours in a hospital," Kubelka says. "As a school nurse you work only daytime hours and you get the same days off as your kids. It's nice for parents."
Teresa McUsic is a freelance writer.
To comment on this article e-mail editorSC@nurseweek.com.
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