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Children spend more time in school than any place except home. That
situation puts an intense spotlight – and a huge responsibility – on
those in charge of school health.
The importance
of school health takes on even greater significance when one looks at the
health of our young people. Obesity, bullying and violence, allergies, and
chronic illnesses such as asthma and diabetes are rising, some
dramatically. These conditions have raised alarms among parents, health
providers, and school professionals. Of the 1.1 million children in
Massachusetts schools, between 20 and 24 percent have some kind of medical
condition.
Finances, or lack of finances, have made the
challenges bigger. Municipal and state budgets have dwindled,
affecting the supply of the all-important front-line provider: the school
nurse. Schools across the state – and the nation – don’t have
enough school nurses.
Those are the main messages on school health conveyed
by two health care professionals in the field – a physician and a nurse
– in the January 2010 edition of the Massachusetts Medical
Society’s Physician Focus television program hosted by Lynda Young,
M.D., a Worcester pediatrician and vice president of the medical society.
According
to Kathy Hassey, B.S.N., Director of the School Health Institute at
Northeastern University and immediate past president of the Massachusetts
School Nurses Organization, the preferred ratio is one school nurse for
every 250 to 500 children. But in some locations, a single school nurse
may be responsible for as many as 2,000 children.
Ms. Hassey
suggests that the skills, education, and experience of today’s school
nurses are more expansive than many people know. All school nurses must be
registered nurses and have a bachelor’s degree and engage in continuing
education. They must be licensed by the Board of Registration in Nursing
and the Department of Elementary and Secondary Education. And they must
have at least two years of experience before becoming a school nurse.
“Most of our
nurses,” says Ms. Hassey, “are seasoned health providers with at least
ten to twenty years of nursing. This experience gives them the assessment
skills and independent practice to deal with children and faculty. It’s
important to be able to determine if that child’s belly ache is a clue
to a major health condition or just nerves before a math test.” She
also notes that school health and nurses are guided by a Department of
Public Health manual – 1,300 pages long in two large volumes-- detailing
all aspects of school health from handling chronic conditions to
coordinating care.
But school
health isn’t just about having a nurse on site.
“Nurses are the foundation of school health,” says Linda Grant,
M.D., Medical Director for the Boston Public Schools, “but school health
is much more. It’s about all
the services, activities, policies, and programs in schools designed to
remove barriers to teaching and learning. It includes a healthy building,
a healthy environment, healthy foods, fitness, staff who are role models,
and more.” And the faculty
and administration are critical, as well, to set the tone for a healthy,
nurturing environment, she says.
Both Ms. Hassey
and Dr. Grant agree that Massachusetts is one of the best states for
school health and particularly nurse leadership. But both also agree that
challenges remain. “Funding
is a major weak link, particularly in a down economy,” says Ms. Hassey.
“It’s the most difficult thing we deal with. If funding wasn’t an
issue, we would have the correct number of nurses.” She
also notes that budget cuts occur on different levels – federal, state,
and municipal - and affect other resources as well.
Dr. Grant, while
agreeing that funding is a challenge, adds another: “It’s
the expectation in society that schools can handle it all. It’s as
though schools are a single parent who says I don’t want to do it all,
but what choice do I have? It’s my responsibility.
I find that a lot of health work that can be done out in the
community is given to the schools.”
But both Ms.
Hassey and Dr. Grant say there’s a silver lining. “Massachusetts is
one of the best states in nurse leadership,” says Dr. Grant. “We
don’t have enough, but the nurses we have and the leadership we have
stands out among the states.”
Their final message to parents,
teachers, administrators, and all those concerned about school health?
Get involved and advocate – at all levels - for improvements,
because success in school is directly linked to a child’s health. And
school health contributes to a safe environment and creates a sound
structure for children to learn.
Text by MMS/Richard Gulla
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