Courting Disaster

As a nation we have become adept at going to extremes to prevent the last disaster or near-disaster from occurring again. Isn't that why we must take off our shoes in airport security lines and can't carry more than a single one-quart baggie holding 3.4-ounce containers of liquid onto a plane?

It's easier to be reactive than proactive, I guess. It takes imagination and foresight to anticipate what might happen next.

Sometimes, though, a disaster in waiting stares us in the face and we continue to ignore it. That's the case with the alarming and growing shortage of nurses in schools. The decrease in school nurses occurs at a time when more kids with serious medical issues like asthma and diabetes are requiring regular assistance during school hours.

In many schools unqualified secretaries, teachers and administrators are helping kids with insulin monitoring and injections, blood draws and even feeding tubes.

"People used to chuckle at school nursing and say 'oh, that's just Band-aids and Tylenol,'" Kathy Patrick, the Colorado Department of Education's principal consultant for school health services said during an Education News Colorado podcast interview last week. "Not anymore."

It's only a matter of time before some awful and preventable tragedy occurs. Then the finger-pointing and hand-wringing will begin and we will all ask ourselves how did we ever let this happen?

"We think about this all the time as school nurses," Patrick said. "The potential is there for someone to act incorrectly or not act at all and have a child end up severely injured or dead."

Patrick said some states require districts to have nurses in all schools. Short of that, she said, districts could offer training programs for people who would like to become health aides in schools. Those people would need to be trained and supervised by a registered nurse, "but at least there would be someone in the building who has a little more expertise than the average staff person."

This way, someone with minimal training would be helping kids with what can be tricky and delicate procedures. As Patrick told me, you wouldn't want to be in the hospital and have the person who changes your bed performing medical procedures on you. Yet we seem comfortable, or at least blissfully unaware, that the equivalent is taking place in schools across the country every day.

The U.S. Department of Health and Human Services' Healthy People 2020 initiative recommends one school nurse for every 750 "relatively healthy" students, Patrick said. Given nursing shortages and school budget realities, that's probably not a realistic figure, she acknowledged. What the state would like to see is somewhere in the neighborhood of one nurse for every 1,200 students.

But look at these ratios, reported in last week's
story by Rebecca Jones:
  • Adams 12 - 1 nurse per 4,936 students
  • Aurora - 1 nurse per 1,754 students
  • Boulder - 1 nurse per 3,500 students
  • Cherry Creek - 1 nurse per 735 students
  • Greeley - 1 nurse per 3,271 students
The high ratios slap you in the face. But what about Cherry Creek? How has that suburban district, strapped by budget realities and shifting student demographics like other districts, managed to keep a ratio even lower than what the federal government recommends? What can Cherry Creek teach other districts about prioritizing?

District Spokeswoman Tustin Amole credits a successful $18 million mill levy election in 2008 for keeping cuts from being as deep in Cherry Creek as in some Denver area districts. For the most parting, staffing at schools, other than secretaries, have been protected, though some jobs are lost to attrition.

But even before the mill levy, Cherry Creek placed a high value on nursing services in schools. "I've been here a dozen years and this is the way it was even before I got here," she said.

The district averages one 911 call per day because of seizures, asthma, allergic reactions or playground accidents, Amole said. When you factor in all adults and children, "there are about 60,000 people coming in and out of our buildings every day." About the size of Grand Junction, in other words. So nurses in schools "is something we have wanted to protect."

What happens next is unclear. Additional budget cuts are certain, in Cherry Creek as well as all other school districts as the state ties to weather an ongoing fiscal crisis. There is no guarantee nursing services will be spared the axe in the next round of reductions, in Cherry Creek or in districts that have already pared nursing to the bone.

And so it goes until something awful happens. Then somehow the money will materialize.