AISD must retain its registered nurse staff

Austin American-Statesman, June 6, 1996

Registered nurses are needed in the schools now more than ever. Today’s schools encounter increasing medical complexity – child abuse, students needing daily medicine such as Ritalin (a controlled substance), pregnancy, depression disguised as headache, violence, eating disorders, injuries, poor nutrition, infectious illnesses, and chronic conditions such as asthma, diabetes, and cancer.

On the heels of a stunning victory for Austin schoolchildren – the citizen vote approving $370 million in bonds for school improvements – comes an equally stunning threat to the health and safety of our schoolchildren:  a budget proposal by Austin Independent School District Superintendent Dr. James Fox to eliminate registered nurses from our schools.

In a misguided effort to “expand services” and cut costs, Dr. Fox has proposed replacing all 30 professionally prepared licensed, registered nurses working in our schools with 47 health aides within two years.

Granted, the addition of numerous health aides or licensed vocational nurses in the schools would relieve current elementary school staff of health-related interruptions.  These personnel could perform routine functions such as providing minor first aid, checking for head lice, and taking temperatures.  But the elimination of registered nurses to finance more numerous lesser trained workers would come at a great cost to our community.

Registered nurses are needed in the schools now more than ever.  Today’s schools encounter increasing medical complexity – child abuse, students needing daily medicine such as Ritalin (a controlled substance), pregnancy, depression disguised as headache, violence, eating disorders, injuries, poor nutrition, infectious illnesses, and chronic conditions such as asthma, diabetes, and cancer.

The American Academy of Pediatrics as well as the Texas Board of Nurse Examiners strongly recommend professionally prepared registered nurses in the schools.  The Academy recommends registered nurses with a baccalaureate degree.  Since the 1970s, AISD has enjoyed a tradition of maintaining a high-quality staff of RNs with baccalaureate degrees.

Only registered nurses are prepared to provide the high-level skills of expert medical triage, assessment, and judgment with subsequent appropriate and necessary referrals to area physicians and community-based health care organizations.  Moreover, parents depend heavily on the judgment of the registered nurse to determine if a child is able to attend class or in need of medical attention.

In medically underserved areas such as south and east Austin, the school nurse is the only door to health care for many families.  Nurses from schools in these areas may see as many as 40 students per day – some very sick, some needing hospitalization.  Schools in these areas clearly need a full-time registered nurse on site.

The national average ratio of students to RN is 1,200 to one, itself lower than the recommended ratio of 750 to one.  AISD, on the other hand, has a student-to-RN ratio of 2,560 to one.  This understaffing is of particular concern given the fact that AISD now mainstreams into the classroom a growing number of “medically fragile” children with severe mental and physical disabilities as well as chronic diseases.

AISD’s student-to-RN ratio calls for additional staff support – not replacement – of registered nurses with assistive personnel, such as health aides or LVNs.  Surely the citizenry of our state capitol – and many would say the “oasis” of Texas – would not tolerate a student-to-RN ratio of 76,800 to ZERO.

The taxpayers of AISD and the City of Austin will not enjoy a cost savings with the replacement of RNs by health aides or LVNs.  What on the surface might appear to be a cost-effective move by AISD will in reality result in increased costs by requiring more complicated and expensive care through our City clinics, the Brackenridge Emergency Room, and admissions to Children’s Hospital.

As an analogy, replacing professional teachers with more numerous teacher aides might seem to reduce costs as well as improve the student-to-teacher ratio, but the high cost of a diminished quality of education for our children would clearly be unacceptable.  Replaceing either registered nurses or professional teachers with lesser trained aides would represent a serious disservice to children and their families.

Additionally, consideration of a major program policy change of this magnitude should be part of a careful, deliberate planning process with effective community input – not as part of a unilateral budget proposal from AISD staff.

If Austin children are truly valued, and if their health and safety are important in their learning, the proposal to remove registered nurses from our schools is decidedly unsound and must be declined.

Toni Inglis, MSN, RN CNS (retired), FAAN, a lifelong Austin resident and retired neonatal intensive care nurse and editor of NursingNews, writes a monthly opinion column for the Austin American-Statesman editorial page.