Do Chatham County’s public schools have enough nurses?

BY ZACHARY HORNER, News + Record Staff
Posted 12/19/18

In the last academic year, school nurse Melissa Lassen estimated she saw more than 3,000 Northwood High School students at come through her small office.

Based on a school calendar that ran just …

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Do Chatham County’s public schools have enough nurses?

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In the last academic year, school nurse Melissa Lassen estimated she saw more than 3,000 Northwood High School students at come through her small office.

Based on a school calendar that ran just more than 170 days, that’s an average of at least 17 students a day for issues ranging from headaches to a chronic health condition requiring 30 minutes or more of attention.

And she does it all by herself.

“If I was walking in here and had not ever been the nurse at this school,” Lassen said, “I would feel very overwhelmed.”

A 12-year veteran of school nursing currently in her seventh year at Northwood and Chatham County Schools’ head nurse, Lassen is one of eight working for the district. The nurses help care for 8,835 students across 18 schools.

The U.S. Department of Health and Human Services and American Academy of Pediatricians recommend that school districts have one nurse per every 750 students, and the AAP says having a full-time nurse in each school is “the best means of ensuring a strong connection with each student’s medical home.”

As of September 2018, Chatham County’s ratio is just more than 1,104 students per nurse, and Lassen is the only nurse that works at one school full-time.

Chatham isn’t alone. A 2015 report from the National Association of School Nurses said that around two in five schools had a full-time nurse, and a quarter of schools did not employ a nurse at all. According to the N.C. Department of Health and Human Services, North Carolina school nurses serve an average of 1,112 students. Lassen, who recently attended a North Carolina school nurse conference, said she learned that just 11 of the nearly 120 school districts in the state have a nurse at each of its institutions.

It’s a problem that has been growing. A 2016 article from the U.S. News & World Report said school districts nationwide “have steadily shed school nurse staff since the early 2000s as budgets tightened heading into the Great Recession. But since then, most districts haven’t made a concerted effort to rehire and instead have opted to rotate nurses among schools.”

In a way, Chatham County Schools reflects that pattern. According to Tracy Fowler, the district’s director of student services, Lassen is the only nurse to serve just one school — Northwood has 1,404 students — and the other seven rotate among Chatham’s 17 other schools.

Chatham County is not even an outlier in the central North Carolina region in regards to a shortage of school nurses, nor is it the only one that has to rotate nurses. Wake County currently has a 1,572:1 school nurse ratio, while Randolph County’s is 1,517:1. Lee County has 1,019 students per nurse, and six of its 10 nurses split time between schools. Moore County rotates half of its 14 nurses and has a 904:1 ratio.

Some districts do meet the ratio. Chapel Hill-Carrboro City Schools has 19 nurses for a student population of nearly 12,000, creating a proportion of 630 students per nurse, and Orange County has 12 nurses for a 623:1 ratio in a smaller student population than Chatham.

Fowler said she feels a nurse at every school would be “wonderful,” but wouldn’t work because of the disparity of student populations at these schools. Anywhere between 20 (at SAGE Academy in Siler City) and 799 (at Perry Harrison Elementary School in Pittsboro) students attend the other 17 institutions.

“The way that our schools are configured, it wouldn’t be equitable,” Fowler said. “The job of being a nurse in a school that has 1,400 kids is different than the job of a nurse in a school that has 200 kids. That would look really different. There’s more kids that take medication that they would be managing. There would just be more issues in general.”

Lassen said that, despite the ratio, Chatham’s nurses handle the job well.

“There are districts that are maybe staffed better than us, but there are districts that are not where we are at this point,” she said. "You can look at it county-by-county and see what their ratio is. Yes, I want more school nurses. But I also feel like we do a really good job with what we have.”

In a position paper on its website, NASN does not give a recommended ratio, saying a one-size-fits-all approach doesn’t incorporate special health situations that require one-on-one care. But the organization, citing several studies, says that “appropriate school nurse staffing is related to better school attendance and academic success” and “when there is a school nurse present, a principal gains nearly an hour per day and teachers an extra 20 minutes per day to focus on education instead of student health issues.”

Lassen said her experience — she used to cover “three-and-a-half schools” during a week, she said — backs that up.

“It sure would be nice to know that a nurse would be at that school more than one day a week,” she said. “When you’re there at a school, no matter how big it is, one day a week, you’re getting a snapshot of what’s going on. You’re not getting the whole picture of what’s going on. That can make it difficult for the nurse.”

In the absence of that, Lassen and Fowler said, nurses do a lot of educating, like helping teachers know what medications their students take or awareness of warning signs for potential health issues.

“I can’t be everywhere at one time,” Lassen said, “so teachers have to know how to manage these chronic health conditions and know when to call for help.”

Fowler said the Chatham County Boards of Education and Commissioners have been “very supportive” in increasing the number of nurses and support personnel in recent years, pointing in particular to the most recent nurse addition.

Lassen said she’s keeping her fingers crossed for another one soon, particularly with Chatham Grove Elementary School scheduled to open in August 2020 and Seaforth High School slated to begin operation 12 months later.

“We can hope for another one in the upcoming year, or at least by the time we open the new school,” she said. “That would be awesome.”


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