More Students with Serious Medical Needs -- But Few School Nurses

By Jane Meredith Adams, EdSource

Five-year-old Gabriella Dominguez spends 20 minutes every hour in the back of her transitional kindergarten classroom consuming mini-meals she finds dreadfully unappetizing: no water, no sugar, no fat, the occasional cracker and lots of bland liquid nutritional supplements.

Born with Hirschsprung’s disease, an intestinal disorder, Gabriella is one of four medically fragile students at Willow Glen Elementary School in San Jose and part of a growing number of students who come to school with chronic and often serious health conditions.

The medical oversight that students like Gabriella receive at school is part of a “hidden health care system” that intertwines school nurses, educators and community health providers according to a statewide report released Friday. That system could be run a lot more efficiently and effectively, according to the report's authors at the School of Nursing at California State University, Sacramento.

Medical advances and federal and state laws have opened the door for more chronically ill children to attend general education classrooms, the report said. School nurses, already carrying large case loads because of budget cuts, are now suctioning breathing tubes, inserting urinary catheters, testing blood sugar levels and monitoring ventilators.

And they’re scrambling. Some 57 percent of public school districts report having no school nurse personnel, according to the report, which researchers said relied on an analysis of 2011-2012 state education data, interviews and a large-scale survey of certified school nurses who are members of the California School Nurses Association. These districts serve about 1.2 million students -- about 20 percent of all public school students in the state.

At Willow Glen Elementary, school nurse Kelly Shepherd oversees Gabriella’s care as well as the needs of a kindergartener with spina bifida, another kindergartener with pulmonary disease, and a fourth-grader with diabetes. They come to school not only with chronic medical conditions, but a host of technological tools, including a ventilator in case of emergencies, an iPod to track nutritional intake and output, a catheter, and an insulin pump whose battery died recently and set off a persistent alarm. “These kids with the technology, they stand out,” Shepherd said. “They are acute.”

Among the report’s recommendations are the creation of systematic data collection and reporting systems in school districts to identify and serve children with special health care needs and to monitor their health and educational outcomes. The report also recommends mandatory training for all personnel delivering health services in schools, including first aid, CPR and procedures needed to serve specific children in each school. It states that funds generated through Medi-Cal claims should be earmarked to support school health services.

California provides little data or guidance to ensure that children with special health care needs are being identified and served, said the report’s lead author, Dian Baker, a pediatric nurse practitioner and associate professor of nursing at California State University, Sacramento. “We can do better.”

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