The nurse’s station at Slater Elementary School in Atlanta consists of two plastic chairs and a filing cabinet behind a folding screen in the assistant principal’s office.
There is no cot. No computer. When the air conditioning fails, nurse Rethia Nickerson cracks open a window to help a 7-year-old with asthma breathe.
Nickerson is at the school only one day a week, and young patients line up well before the school day starts.
The situation highlights a nationwide shortage of nurses that is afflicting schools as well as hospitals and nursing homes.
Some nurses and others say sick children often are sent to school because both parents are working, and families sometimes rely on school nurses to be the family doctor because they lack insurance or have limited coverage.
Add to that the growing number of children who take prescription drugs during the day–up to 10 percent in some schools–and school nursing can be overwhelming.
“I would not encourage anybody to be a school nurse now,” said Jayketa Shingleton, head of nursing for Atlanta Public Schools.
A University of Iowa survey published last fall found the average ratio of children to nurses is almost twice the National Association of School Nurses’ recommendation of one for every 750 children.
Nurses say school boards are slow to dole out scarce education money for people they consider Band-Aid and aspirin suppliers.
“People are clamoring for those test scores to come up, so that’s where the resources go,” said Brenda Z. Greene, director of school health programs for the National School Boards Association. “There’s never enough money for everything schools would like to do.”
But school nurses are far from mere Band-Aid suppliers these days.
Many find themselves responsible for thousands of children, performing medical procedures such as insulin injections, tube feedings and even catheterizations for less money than they’d make at a hospital.
“Kids who didn’t even leave the hospital when I got out of nursing school in the 1970s are living at home now and getting on a school bus every day,” said Martha Bergren, a nursing instructor at the University of Minnesota.
“Back then, you needed first aid and office nursing skills,” Bergen said. “Today, I don’t see how you can operate without high-level skills.”
The stress leads to burnout, said Judith Robinson, director of the school nurses association.
“We get nurses who come right out of ICUs and they’re in the school job less than a month before they say, ‘I had no idea it was this tough!'” she said.
Many schools rely on secretaries or health aides, not licensed nurses, and call 911 if there’s an emergency. Children with serious health needs are bused to schools with a full-time nurse.
Often nurses can do no more than drop in once a week to teach healthy habits and advise teachers on what to do if a child becomes sick. Even some of Atlanta’s wealthiest counties have only a handful of registered nurses for more than 100,000 students.
“I’ve seen school secretaries open their drawers and say ‘Here you go, kids. Now go ahead and take your medicine,'” said Joyce Allers, who runs a school health outreach program for Children’s Healthcare of Atlanta. “And some of these schools have 100 bottles of Ritalin and thousands and thousands of doses.”
Also worrisome is the chance a child will get the wrong medicine or miss doses completely. Almost half of school nurses reported errors when dispensing medication, most often missing a dosage, said Ann Marie McCarthy, who led the University of Iowa study.
“The trouble is there’s no single answer to this,” McCarthy said. “You have to hand it to these school nurses … They’re trying very hard, and they’re asking for help. It can be overwhelming, all the things they do.”
The key to ending the shortage is pressuring elected school officials to increase pay and reduce workloads, Robinson said. Nurses’ groups and some parent-teacher associations are teaming up to lobby school boards, saying school nurses improve academic performance.
“We need to say to school boards, you put a nurse in every school, and you’ll see attendance improve, you’ll see kids doing better in class, you’ll see healthier kids,” Bergren said.