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Vincent Iannelli, M.D.

School Nurse-to-Student Ratios

By January 10, 2012

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Should schools stock "general use" epinephrine pens? That seems to be the big question that many people are asking after first grade student Ammaria Johnson died after suffering a severe allergic reaction last week.

With a general stock, an EpiPen could be used for any student who was having a severe allergic reaction, even if they hadn't left their own prescription medication at the school.

While increasing access to epinephrine seems like a great idea, we should likely all be talking about something else that might affect access to life-saving treatment - limited availability of school nurses to help care for medical issues in school. For example, in the Chesterfield County Public Schools, where Ammaria was a student, there are only 28 nurses for about 58,578 students in 62 schools, including 38 elementary schools, 12 middle schools, 11 high schools, and 1 technical school. That is one nurse for 2.2 schools or just over 2,000 students.

The Chesterfield County Public Schools ratio is well below the nurse-to-students ratio recommended by the National Association of School Nurses and Healthy People 2010 guidelines of about 1:750 (well students) or 1:225 (student population that may require some daily school nursing services) or 1:125 (students with complex health care needs).

Does your child's school have a nurse? If you live in Vermont, Connecticut, New Hampshire, Delaware, or Washington, D.C., then they likely do. According to the latest 2010 Student-to-School Nurse Ratios from the National Association of School Nurses, they led all states with the best ratios.

The worst nurse-to-students ratios were in Oklahoma, Florida, Utah, North Dakota, and Michigan. These states, and unfortunately many others, have nurse-to-student ratios that make it unlikely that your child's school has their own nurse. It is more likely that they have to share a school nurse with two or three other schools, which makes it harder to help manage kids with specific conditions or special needs, do screening for obesity, vision, and hearing, etc., and help figure out when sick kids need to go home.

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January 17, 2012 at 11:25 am
(1) Annette Lemma says:

Great article that underscores the real reason for certified school nurses – safety of the students. I am fortunate to work in a school district in PA that permits and stocks general use Epi Pens and, more importantly, provides a certified school nurse for each of our 7 buildings. I have 2 students Type 1 Diabetes, students with active seizure disorders and at least 10 food allergies that are life threatening. It is important to note that the general public is often not aware of, nor in favor of such low nurse:student ratios as noted in your article.

January 17, 2012 at 12:14 pm
(2) Kris says:

As a school nurse I totally support that all schools should have an Epi-pen and standing orders especially with so many students presenting now a days with the unknown severe allergy. My previous school system had epinephrine but you had to draw it up during an emergency and feel that an Epi-Pen should be stocked. With that being said I am a school nurse at a high school in CT with a student body just shy of 1200. I am the only nurse and on most days it is like running an ER on your own. I have close to 40 students with Epi-pen orders, 6 diabetics, along with asthmatics and numerours other physical and emotional issues. The role of a school nurse is no longer putting on the bandaid. I feel very strongly that each school should have at least one nurse and more for the bigger schools. A child cannot learn if they are not healthy and many times we may be the only health care person a child sees. We are a necessity not an extravagance and something the every child deserves to have in there schools.

January 17, 2012 at 7:15 pm
(3) Tami Tucker RN says:

I am a DNP graduate student and was a school nurse for ten years. We had three buildings, 900 students and two nurses, and were able to accomplish a lot in terms of student safety and student/staff wellness. We had a wellness policy in place and vending machines upgraded before it was a federal mandate. We also had epipen stock at each building as well as pulse oximeters, standing orders for OTC meds and emergency O2/epipen use. How we accomplished this is through: a supportive, knowledable superintendent; an RN on the School Board; an active community/faculty health advisory board. I am in grad school now with the intent of finding ways to help school nurses find better support to meet the needs of their individual schools, especially in view of financial windfall. It starts with ground level education of your superintendents, school boards, and communities – I encourage school nurses to step onto the front lines to make your case at the grass roots level.

January 17, 2012 at 8:48 pm
(4) Rita Molloy, R. N. says:

Epinephrine standing orders can and do save lives

January 17, 2012 at 9:07 pm
(5) Rita Molloy, R. N. says:

Standing orders for stock epinephrine can and does save lives. I applaud the author for raising anither serious saftey question…aren’t children entitled to the services of school nurses to keep them safe, healthy and ready to learn at school? The cost to a school district to staff adequate coverage of school nursing staff yields a return that is both tangible and intangible. Keeping students healthy leads to improved financial returns in state reimbursement rates for schools, and improved academic scores for children.The life long health management skills taught to students with chronic health conditions by their school nurses leads to more healthy and productive individuals who move forward as successful contributing members of our society. Properly managed, most health conditions should not be a barrier to attending school and achieving academic success. As the parent of a son with anaphylaxis to peanuts, I quickly learned just how valuable a school nurse is to the academic success and saftey of students with food allergies. Having the co-morbidity of asthma, I knew it was most imprtant for the assessment of my son’s symptoms to be accurate, and treated appropriately in a timely fashion.I invite the parents of children with any health concerns to support your childs academic success by letting your school district know that adequate staffing of school nurses is not a luxury but a necessity that your child is entitled to.

May 5, 2012 at 7:53 am
(6) Fran RN says:

Hi all, first time on this blog…

Are we all set in CT, do we have a standing order in all school systems for EpiPen? Does this mean that all schools have a blank prescription EpiPen to administer to any child that presents with Anaphylaxis?

Does CT state law cover that a child be allowed to carry their EpiPen on the bus to and from school? Is this determined district to district?

What can nurses do in general to fight for more nurses in our schools?
I worked in a middle school 1200 kids about 5 years ago… I left after 6 weeks. I feared for my license and the children. I didn’t feel I could keep them safe. I applaud school nurses,but we all need to make this a fight for ourselves and all children.

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