As children around the United States returned to school this autumn, many districts were looking to cut costs by curbing or eliminating school nursing programs.
Some states, such as Texas, do not require school campuses to have nurses on site. But even without nurses, many Texas schools still want to be sure students stay healthy and out of the emergency room.
The Austin Independent School District has been outsourcing its school health services to Seton Family of Hospitals for about fifteen years. The $5 million annual contract, funded predominantly by local tax money, ensures that the AISD has some 73 registered nurses and 55 school health assistants that work in teams to provide healthcare coverage to students at all levels of education in 112 schools.
Middle and high schools receive full-time teams while younger children have access to services based upon the needs of each school.
"School nurses (these days) handle medical emergencies, manage chronic conditions, track communicable diseases, identify health problems that impact learning, and address students' emotional and mental health needs," said Susan B. Hassmiller, RN, the Robert Wood Johnson Foundation's senior adviser for Nursing. "Investing in school nurses who can address problems before they become severe has the potential to improve students' health and reduce the overall cost of healthcare. It also frees up teachers and administrators to focus on what they do best: education."
For many student patients, school nurses provide care they might not otherwise receive.
"Seton provides a hospital model of care in an educational setting," said Tracy Diggs Lunoff, coordinator of School Health for the AISD and liaison between the school district and the Seton contract. "It works well."
The AISD receives $300,000 annually in in-kind donations from Seton to run some of its health programs, such as mobile health units that are available 24-hours a day to care for students in the community.
"We wouldn't be able to do some of the things we do without that donation," said Lunoff.
The school health services were particularly helpful when the H1N1 virus broke out a few years ago, she said. Having the latest and greatest technology and information from Seton at the school's fingertips helped experts to determine the danger of an outbreak in the schools. None had to be closed.
In a majority of states, there are no healthcare entities that have taken on the responsibilities to fund school nursing, so the costs fall to the education systems.
All states provide money to school municipalities according to a formula based upon student attendance, but this is usually not sufficient. Federal funding doesn't close the gap, either. The largest chunk of funding comes from local taxes.
"We're bearing some of the cost of this - in emergency departments," said Nicole Fauteux, lead author of "Unlocking the potential of school nursing: Keeping children healthy, in school, and ready to learn," published in the August 2010 issue of RWJF's Charting Nursing's Future.
"We see poorly managed chronic disease and children struggling in school because of poor eye sight or poor hearing because no one recognizes it in the early stages," she said.
Fauteux's brief suggests that policy-makers have an important role to play in ensuring access to school nurses and highlights a number of potential policy approaches that are gaining traction at the federal level.