FeaturesOct/Nov 2014 Issue

Gluten-Free Kid Concerns: An Rx for School Health

These 4 steps can help bring a full-time nurse into your child’s school.


The lack of a full-time nurse rattled Teri Saurer’s nerves while her youngest daughter, Hannah, attended elementary school in Charlotte, North Carolina. Now in second grade, Hannah has multiple life-threatening food allergies and a history of epileptic seizures, which she has outgrown. Emergency medication for her seizures and epinephrine auto-injectors for her anaphylaxis are kept at school—but the nurse wasn’t there two and a half days a week.

“I was nervous whenever the nurse wasn’t in the school,” Saurer says. “What if Hannah ate something by accident? Would a teacher or staff member recognize the signs? Would they get to the epinephrine quickly enough? With 20-plus kids in the class, would they be able to handle that while dealing with everything else?”

Many parents throughout the country ask the same questions as their children attend schools without full-time nurses. Only about 45 percent of U.S. public schools have a school nurse all day, every day. Another 30 percent have a part-time nurse who works in one or more schools, according to a 2007 study by the National Association of School Nurses (NASN).

The fact that a majority of schools in the United States do not have a full-time nurse “is stunning,” says Charlotte Collins, JD, senior vice president of policy and programs for the Asthma and Allergy Foundation of America (AAFA).

Without a nurse, the daily management of students with chronic illnesses and medical emergencies is shouldered by non-medical staff, usually a school secretary or teacher. These staff members have less experience, less exposure and may be positioned in the school in a way that’s less effective than the school nurse, says Michael Pistiner, MD, MMSc, a pediatric allergist at Harvard Vanguard Medical Associates.

“The framework of the school secretary keeping pills is simply not adequate,” Collins says. “There is risk. What happens if something goes wrong?”

The ramifications are significant, especially for students with chronic illnesses like asthma and those with food allergies and anaphylaxis, says Carolyn L. Duff, RN, NCSN, president of NASN.

School nurses assess the needs of students with chronic health issues, plan for effective management, and help students learn to self-manage their illness, allowing them to spend more time in class. They also identify students who might not have been previously diagnosed with a chronic illness, Duff says.

“School administrators can’t expect to achieve their goals of increased graduation rates, reduced absences and higher levels of academic performance without providing quality health services by a team led by a school nurse,” she says.

first aid wooden box

Igor terekhov/hemera/thinkstock

Taking Action

When her daughter Hannah started kindergarten in 2012, Terri Saurer was so concerned about the lack of a full-time school nurse she created N.C. Parents Advocating for School Health. The group’s hard work and persistence paid off two years later when county commissioners voted to fund 33 more school nurse positions. Today, every school in the Charlotte-Mecklenburg school district has a full-time nurse.

“You have to persevere,” Saurer says. “I truly don’t feel it would have happened were it not for the parents’ group.”

Like Saurer, you can take steps to ensure that your child has access to a full-time nurse in school. Here’s how to do it.

Step 1: Determine the Funding

Find out who is responsible for hiring school nurses in your area. Who are the decision-makers?

The funding and structure for school nurses varies in each state and district. While state budgets or grant programs might specifically slate funds for school nurses, the amount of money often isn’t adequate to employ the number of school nurses needed. For example, North Carolina pays for one school nurse in the Charlotte-Mecklenburg school district, which has more than 140,000 students.

In many areas, school districts foot the bill. In other places, like Charlotte, North Carolina, the county health department picks up some of the tab.

Some districts have other funding models, Duff says. For example, in a pilot program in Portland, Oregon, school nurses can bill Medicaid for the qualified services they provide. In Austin, Texas, a school district contracts with a private provider to employ the nurses.

Step  2: Gather the Facts

Pull together the information that shows the need for more nurses.

No one can argue with the facts. The prevalence of chronic health conditions in U.S. children jumped from almost 13 percent in 1994 to almost 27 percent in 2006, according to a study published in The Journal of the American Medical Association. Food allergies increased about 50 percent between 1997 and 2011 among children, according to a study released in 2013 by the Centers for Disease Control and Prevention. Asthma, a leading cause of school absenteeism, accounts for about 14 million missed school days, according to the American Lung Association.

The rise in chronic conditions strengthens the case for a full-time nurse, not only to provide proper health care but to keep costs down.

“The impact can be a real fiscal one where the schools are concerned because their funding is largely dependent on kids who show up for class every day,” Collins says.

It’s economically beneficial to hire a full-time nurse because it allows teachers to do their jobs, says Anne Sheetz, RN, NEA-BC, former director of the Massachusetts Department of Public Health, School Health Services Unit, and co-author of a study of a Massachusetts program that put full-time registered nurses in schools. Published in May 2014 in JAMA Pediatrics, the study found that each dollar invested in the nurse program saved $2.20 in medical costs and lost productivity for teachers and parents.

The findings related to teacher time could have a big impact, says Sheetz, a school nurse consultant for Massachusetts. Results from a 2011 study in Journal of School Health showed that without a school nurse, every teacher spends an average of 26 minutes a day on health issues. With a school nurse, that number drops to 6 minutes a day. Sheetz used this data to calculate teacher savings.

“It’s a really salient argument that school nurses aren’t just important to student health, they actually make good economic sense,” says Pistiner, co-founder and content creator of AllergyHome.org.

Step 3: Get the Word Out

With facts in hand, the next step is to alert the community and grow the ranks. To enlist parents to join the cause, Saurer held a community meeting and invited the media. She raised awareness and solicited help through parent-teacher associations, social media and the local support group of Parents of Allergic Kids (PAK).

She made it easy for busy parents to get involved, providing a sample letter and sharing key email addresses so they could advocate. Her group sent hundreds of emails containing data, personal stories and relevant information to county commissioners. She also made community connections that helped underline the credibility of the cause: Local doctors wrote letters in support of the issue.

Saurer initially garnered the most help from parents of other children with chronic illnesses but she consistently made it clear that school nurses serve all students.

“This issue affects all children, not just those with medical issues,” she says.

Step 4: Make Your Case

Once you’ve done your research and gathered fellow advocates, it’s time to convince decision-makers that full-time nurses are essential.

Saurer did this by attending key public events and meeting personally with decision-makers. She gained the support of a newly elected commissioner who then raised the priority of school nurse funding. Saurer ultimately became part of a new school health county task force.

“Understand that you’re competing with other interests,” Collins says. “You have to continue the message that this has got to be a strong priority. You have to make the case for why your cause is important.”

Let your state legislators know how important it is for students to have full-time access to a school nurse. Follow up with them and bring a group of concerned parents to the state legislature when they’re considering the budget, she says.

“Many decision-makers are still in the mindset where the school nurse tests your eyes and checks your immunizations,” Sheetz says. “What they’ve completely missed is that there are kids in really critical health situations that need careful monitoring and treatment.”

In Massachusetts, nurses invited legislators to their school health rooms to enlighten them about the wide range of duties the school nurse performs, Sheetz says.

On the national level, parents can support NASN and its efforts to pass the Student-to-School Nurse Ratio Improvement Act of 2013. The bill would use a formula-based approach to make grants available to school districts with the lowest ratios of students to school nurses, Duff says. (The CDC recommends a ratio of at least 1 nurse for every 750 students.)

“If we’re committed as a society to not just improving the health of our children but to protecting their health while they’re in school, there’s no more common-sense investment than having a full-time nurse available at all times when kids are in school,” Collins says.

Contributor Wendy Mondello (wmondello@GlutenFreeAndMore.com) has a child with severe multiple food allergies and asthma. She lives in New York City.


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