Parents in Charlotte, N.C., celebrated last week when their county commissioners approved a budget that includes $1.8 million to make sure every public school has a full-time nurse.
The agreement capped two years of work by a parents advocacy group started by Teri Saurer, the mother of daughters who just finished first and third grades.
Saurer got involved with the nurse issue in the Charlotte-Mecklenburg Schools because her younger daughter, Hannah, has a history of seizures and serious food allergies. But she said nurses made schools safer for all students. Other parent advocates joined the effort because their children suffered concussions at school. One had a child who experienced a first-time food allergy.
"You want to know that if something happened to your child _ they're at school so many hours of the day _ that there's going to be somebody with medical training who can attend to them," Saurer said.
Several hundred parents wrote to the Mecklenburg County commissioners urging them to approve the money for school nurses, Saurer said. A sample letter on her group's website argued that nurses should be part of every school's safety plan.
Members of the group attended the county commission meetings wearing bright orange T-shirts emblazoned with the message, "Healthy children learn better. School nurses make it happen."
Many other parts of the country don't have nurses in every school. The situation varies state by state, and often county by county.
Some places, such as Pennsylvania, have had school nurse positions reduced because of budget cuts. But the bigger problem has been that tight budgets in many places have meant that full-time registered nurse positions aren't being added to keep up with population growth, or school RNs who retire are replaced with aides or nurses with less training, said Erin Maughan, director of research at the Robert Wood Johnson Foundation, a public health philanthropy, and an executive nurse fellow at the National Association of School Nurses.
"Much of the country does not have sufficient coverage of school nurses," she said. "This means that school nurses are covering multiple schools, so they rely on secretaries and unlicensed personnel, even teachers and principals, to step in and do the daily duties a school nurse would do."
Sometimes that works. But some decisions require the trained assessment that only a school nurse can make, she said.
In Philadelphia last year, sixth-grader Laporshia Massey died from asthma complications that started at school, where no nurse was on duty. Last month, 7-year-old Sebastian Gerena died after he collapsed in another Philadelphia school when _ again _ no nurse was on duty. A retired nurse who was volunteering at the school that day helped perform CPR on him before medics arrived. A coroner said Sebastian's death was due to a heart defect.
Advocates for more education funding in Philadelphia are calling for enough money to restore nurses, teachers and other school staffers whose positions have been cut.
Nurses help children manage chronic conditions such as asthma, diabetes and seizures so they don't miss school. They also treat injuries and counsel students about physical and emotional issues.
It's difficult to know just how many schools have full-time nurses. The nurses association's last survey was in 2007, when it found that 45 percent of public schools have a full-time school nurse every day, and an additional 30 percent have nurses who work part time in one or more schools.
U.S. school staffing surveys from the Department of Education show 81,410 full-time and part-time nurses in all U.S. schools in 2011-12, the latest year available. That's down from 90,910 in 2007-08. The nation has about 132,000 public and private schools.
Last month, a report in JAMA Pediatrics, a publication of the Journal of the American Medical Association, said many schools district in recent years have cut or reduced nursing services in schools. Looking at school nurses in Massachusetts, it found that for every dollar spent for the school health program, society got back $2.20. The savings resulted from less work time lost by parents and teachers and fewer outside medical services needed by students.
The National Association of School Nurses says that having a nurse at school saves teachers an average of 20 minutes per day.
In North Carolina, the state Senate's proposed budget called for cutting 70 of the 260 school nurses hired with state funds. State lawmakers are still working to hammer out an agreement between the House and Senate versions of the budget.
The state has about 1,200 school nurses. Most are paid by local districts, and most take care of more than one school. The numbers have held fairly steady in recent years and are an improvement over a decade ago, but more nurses are needed, said Cheryl Blake, president of the School Nurse Association of North Carolina.
"The students have more medically complex conditions and chronic illnesses in schools," she said. "We're dealing with huge numbers of asthma and diabetes, and food allergies."
Saurer, who founded N.C. Parents Advocating for School Health, said the additional county money to pay for more school nurses will mean Charlotte-Mecklenburg Schools will have one nurse for every 900 students. The county commission approved the budget this month .
"Sometimes a school nurse is a child's only health provider," said Tina Gordon, CEO of the North Carolina Nurses Association. "They can catch things early and perhaps treat them in the school. That's much less expensive than the emergency room."
By Renee Schoof
McClatchy Washington Bureau