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Caring and advocating for school children


When we think about RN staffing issues, most of us immediately think about these issues in the context of hospitals or long-term care facilities. There is another, less obvious setting that we need to focus on as well—our schools.
On any weekday from September through part of June, almost the entire population of the nation’s children is in school. Think about it. Our children spend a large portion of their time in school settings, where they bring all of their health problems and run into others—where they can fall and break an arm on the playground, or have an allergic reaction to peanut butter in the cafeteria.
The Journal of School Nursing and the American School Board Journal have each published studies that show a correlation between facilities with a full-time nurse and better school performance and attendance. For some children, contact with the school nurse may be their only contact with a healthcare provider.
There are approximately 20 million children with chronic health problems, and these children have a right to have the same access to education that other children do. As a result, the school systems must have healthcare support available in the schools, and this support should be an RN. No exceptions. Anything else would be inappropriate and unacceptable.
ANA co-published a position statement with the National Association of School Nurses regarding school nurses. We adopted a minimum nurse-to-student ratio of 1 nurse to every 750 students. This is just the starting point—a realistic goal that will bring about huge improvements if achieved. For example, in California, the current ratio is approximately 1 nurse to 2,700 students! This type of ratio is unsafe for the students, and puts the school nurse in the impossible position of trying to properly oversee and support healthcare needs in the schools.
In California, the ANA filed a lawsuit against the state Department of Education because it has attempted to bypass safe nurse-staffing levels by having unlicensed personnel take over healthcare delivery. In particular, the California schools settled a lawsuit brought by diabetic children and their families about the schools’ failure to provide the proper level of health care that the children are entitled to under the Americans with Disabilities Act and the Individuals With Disabilities Education Act. With ratios like 1 to 2,700, it’s not surprising that the Department of Education settled the lawsuit. The problem is the department settled the discrimination claims by agreeing to have volunteer, unlicensed school personnel administer insulin.
ANA, along with ANA/California and the California School Nurses Organization, contended that the Nursing Practice Act prohibits the administration of insulin by unlicensed personnel in the absence of an “emergency” that is very narrowly defined in California law. In addition, our lawsuit claims that California issued what is, in effect, a new regulation affecting the administration of insulin without going through the required notice and comment process for new regulations. When ANA’s former affiliate, the California Nurses Association, asked to join the case, ANA welcomed them, because the unity of our voices in California carries the message that the nursing profession will come together to advocate for safe staffing and safe patient care.
California, and other states and school districts, must not be permitted to claim that the nursing shortage or budgetary woes make proper RN staffing impossible. Good public policy requires proper funding of education, and with proper funding and decent salaries, nurses will be found.
ANA highlights safe staffing as a key component to health system reform, and safe staffing in the schools is included. Our school nurses and the students deserve better than they have at this point, and we all need to keep them in mind as we debate the merits of various health plans that are discussed. Kids should not come last. As RNs, we know what they need, and we are prepared to care for them.

Rebecca M. Patton, MSN, RN, CNOR
American Nurses Association

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