School nurse staffing policy raises concern.(Front) - The Virginian-Pilot (Norfolk, VA)

By Steven G. Vegh | The Virginian-Pilot

NORFOLK

On her son's first day at Granby Elementary , Christine DeHaven was anxious to meet the school nurse .

Her 6-year-old son has autism, asthma and a potentially fatal peanut allergy, so DeHaven wanted to drop off his medications and discuss his condition in person. Instead, she found a part-time medical assistant who told DeHaven she couldn't administer medicine.

DeHaven complained, and a full-time nurse was installed at the school the same week, she said. But the incident left her worried for another reason: Norfolk, unlike other South Hampton Roads school divisions, does not post a full-time registered nurse at each of its schools.

Instead, it cedes responsibility for school nurse staffing to the Norfolk health department, which in some cases relies on medical assistants who aren't licensed and on-call nurses to look after the division's students.

To DeHaven, the practice means that some students might not receive proper medical attention. Given her son's health problems, 'anything can happen' to him on any given day, she said.

Chief Operations Officer Michael Spencer said the city's students have more access to medical attention than the state recommends.

Virginia law encourages, but does not require, local school boards to provide a ratio of one nurse per 1,000 students, with no more than one nurse per school building. There is no directive on the minimum credentials a school nurse must have.

By that standard, Norfolk schools exceed the ratio, Spencer said. The division has about 33,000 students and 47 nurses. It makes practical sense, he said, for there to be on-call nurses at the division's smaller schools, such as the Madison Alternative Center, which currently has only 50 students.

Dwayne Merritt, a spokesman for the Norfolk health department, said that even though there isn't a full-time nurse at every school 'whenever a medical staff person is absent, every attempt is made to provide a substitute.'

In each school, principals and designated school staffers also get trained to administer medication, he said.

Norfolk is one of four of Virginia's 132 school divisions that give responsibility for school nursing to a local health department, said Janet Wright, a school age health specialist for the state health department.

The department has provided Norfolk's nursing services for more than 15 years, said Spencer, who noted that the division is an educational, not a medical, organization.

'I can't imagine we're any better equipped to recruit and hire nurses than the health department,' he said.

But hiring their own nurses is exactly what the Virginia Beach, Chesapeake and Suffolk school divisions do. They provide one registered nurse per school - the same standard endorsed by the Virginia PTA last year.

Norma Bergey, president-elect of the Virginia Association of School Nurses, describes the one nurse per school ratio as 'the gold standard.'

'Can I say to you Norfolk is less safe because they don't have a nurse in every building? They're safer with one, but they're not necessarily unsafe,' Bergey said.

Registered nurses' deep training equips them to assess a student's symptoms more precisely than a medical assistant, she said.

Compared with a nurse, a medical assistant 'cannot assess the lungs if the child has an asthma attack, or assess the heart if the child has a r ising heartbeat. All she can do is check the pulse and call the parent,' Bergey said.

Suffolk Assistant Superintendent Kevin L. Alston wrote in an e-mail that his division has always felt that having a nurse at each of its schools means that students are better cared for.

'They have had the training,' he said. 'Would you want a plumber to wire your home? Better yet, would you want a butcher to remove your appendix?' he wrote.

In Virginia Beach, in addition to a registered nurse at every school, there is also a clinical assistant at schools with more than 800 students.

Frances Gray, a health services supervisor in Portsmouth Public Schools, said her staff works with students who take medication for all kinds of ailments.

'In particular, I cite our diabetic children, our children who require Epipens Only the division's three pre-K sites do not each have registered nurses, she said. Instead, a certified nurse assistant covers one center, while a registered nurse covers the other two, she said.

'Continuity is the main thing - having someone in the building who knows the kids five days a week and can follow through,' Gray said. 'If there's a situation identified where a child needs special medical attention, having the same person providing that, that's good.'

Patricia Crawford, whose son attends Bay View Elementary in Norfolk, said nurses there rotated so often last year that she feared none had a deep knowledge of her child's needs. Her 7-year-old son has serious heart problems.

'We wouldn't accept that kind of turnover if they were teachers,' she said.

Four of Norfolk's seven School Board members said they knew little about the division's nursing arrangements. Linda McCluney and Linda Horsey did not return messages; chairman Kirk Houston was out of town. Spencer said that while the division can't unilaterally dictate how nurses are staffed at its schools, the health department typically listens to its suggestions.

A couple years ago, division leaders were worried that an elementary school needed more nursing staff to cover a surge of students with fragile health conditions, he said. The health department added a part -time nurse position to the full-time nurse already assigned to the school.

'I've never ... ever had a concern about lack of support or responsiveness,' he said.

Steven G. Vegh, (757) 446-2417, steven.vegh@pilotonline.com

CAPTION(S):

Ross Taylor | The Virginian-Pilot

Christine DeHaven requested that Granby Elementary in Norfolk keep a full-time nurse on staff because her son, Dylan, has multiple health issues. The school now does.