During a typical school day, it’s not unusual for Sue Barrie, RN, head nurse for the Mountain View (Calif.) Whisman School District and her staff to work with multiple students at 12 different school sites. The children they work with need medical services as varied as insulin administration, catheterization and treatment for injuries and traumas.

"Gone are the days when a school nurse would put a Band-Aid on a student’s skinned knee," said Barrie, who works with a group of seven nurses funded by grants from the El Camino Hospital District in Mountain View.

Although nurses play a critical role in schools, budget cuts have made them a scarce commodity. In 2010, the National Association of School Nurses ranked California 45th in the ratio of school nurses to children. According to those figures, one California school nurse is responsible for 2,187 students. In Vermont, the state with the lowest ratio, one nurse looked after 396 students.

"State funding for essential services like school nurses has been cut by approximately 15% over the past four years," Barrie said. "This has occurred at a time when there are significantly increasing demands placed upon school nurses for direct services, compliance monitoring and record keeping."

Barrie said the El Camino-MVWSD partnership was formed four years ago after the school district’s superintendent had conversations with members of the community, including community benefit staff from the El Camino Hospital District.

"Many discussions followed, and we were asked to provide a proposal," Barrie said. "Our superintendent strongly felt that a healthy child is able to come to school and learn. If a child was not well and not in school, then that child was not learning."

Before receiving the grant from the El Camino Hospital District’s Community Benefit program, the MVWSD’s student-to-nurse ratio had increased from 1,000:1 to 4,400:1. With the El Camino Hospital District grant, their student-to-nurse ratio is 1,650:1.

"We are seeing more medically involved students coming to school who require more specialized medical care while at school," Barrie said. "We provide care to both acute and chronic conditions at school."

The nurses MVWSD hired have years of experience but were new to school nursing. They were mentored by Barrie and required to take classes toward their state school nurse credential.

"As nurses, we have been fortunate that our county has made medical insurance coverage available to nearly all our children, which El Camino Hospital District also funds," Barrie said. "We are able to refer our students who come without insurance to the appropriate agencies where they can apply for medical insurance. With this coverage ... we are able to send many students to their primary care providers and not send them to the emergency room when they are sick or have minor injuries at school."

Director of Community Benefit for El Camino Hospital Barbara Avery said she would encourage other hospitals to partner with local school districts based on the success of their program.

"This process has worked extremely well for our community and has allowed us to establish deep, meaningful and long-term relationships with organizations that are helping the most vulnerable and at-risk populations," Avery said. "We also have found it very valuable to bring nurses and administrators together several times a year from the districts we fund to share best practices and areas of concern in youth health."

The partnership also goes beyond simply providing schools with funding. "We do a lot of research and consult with the school district directly in advance of awarding the grants to make sure we understand what their needs are and what resources are required to meet those needs," Avery said. "When the school district applies for a grant, they are asked to outline their goals and the metrics they will use to achieve them."