School Nurses Alarmed Over Shrinking Staff, Rising Needs

By MARILYN BROWN The Tampa Tribune

Published: Aug 30, 2007

TAMPA - Hillsborough's school nurses are warning that student health is in jeopardy because of district personnel cuts.

Over the past year, the district lost more than 66 of the 316 nurses and health assistants who oversee about 191,000 students. A hiring freeze kept those jobs vacant. Nine of the remaining 70 registered nurses met with the superintendent Monday night to sound the alarm.

"Every one of us told her we're in fear of children not receiving the right treatment," said Karen Tanski, a registered nurse with 21 years of experience. "It's not safe out there in the schools."

The nurses are seeing more students with greater health problems, including asthma, diabetes and allergies. At the same time, the Hillsborough County school district this year ended its program to dispense over-the-counter drugs that kept children in class.

And more students with disabilities and the severest health problems have been placed back in regular public schools, nurses said, requiring more, not less, trained staff.

A registered nurse with 16 years of experience in Hillsborough said she has never seen it worse.

"That first day of school was absolutely horrendous," said Paula Wootten, who has spent seven years at Lopez Exceptional Center, where dozens of tube feedings and other procedures are required every day for the severely and profoundly handicapped students. "I called my supervisor that day and said: 'I'm not staying here if there is no help. It is not safe.'"

A health assistant was assigned this week to help Wootten and the licensed practical nurse at the center, but she remains concerned the district is cutting back as health needs increase. She also supervises a health assistant at nearby Lopez Elementary but said, "I haven't even gotten over there yet."

The district ended its Healthy Student program when school started last week. Parents can no longer sign up to have the district dispense over-the-counter drugs such as Tylenol or Motrin when needed. Students must sign out and go home instead, unless they have a doctor's note. Students aren't allowed to bring any drug to school. Even cough drops are prohibited.

The program was important because "it kept children in school," said Sandy Gallogly, supervisor of school health services. But the district could not afford the registered or licensed practical nurse required at each school with the program.

List Of Nurses Turns Up 'Placeholders'

Despite the cutbacks, Nelson Luis, who oversees health services, said he is confident children are safe and schools are covered.

"No child's going to go without care," Luis said. "I'm convinced we are doing what we need to be doing - with less people, with cutbacks."

Luis, the district's general director for student support and federal programs, said Monday morning that there is a health professional at every school. On Tuesday morning, he produced a list showing at least one person's name beside each school. Luis said the list was valid as of last week, although subject to change.

The first name The Tampa Tribune checked out was Tanski. The list shows her as the sole health care provider assigned to the South County Career Center.

"I don't even know where that is," Tanski said Tuesday. Her assigned schools are Dowdell Middle and Clair-Mel and Palm River elementary schools, with Summerfield Elementary added this year, she said.

Gallogly said late Wednesday that the list remains "fluid" and is being revised. Tanski's name was listed next to the career center as a "placeholder." There is a nurse at the school, Gallogly said, but she teaches there and is not employed by her department.

The health assistant listed for Riverview High School is Shelly Olsson, who Gallogly confirmed has been doing paperwork and compiling records in her office until this week. She has worked as a health assistant and will work in that capacity to fill in where needed, Gallogly said.

"They're placeholders," Gallogly said of the assignments that don't match what nurses said is reality. "The list is probably 96 percent accurate."

Nurses describe daily challenges of monitoring children on chemotherapy, students with transplants who must be observed for swelling, and sleep apnea patients who could die if they fall asleep in class.

In addition, they supervise and train health assistants and other staff, conduct mandated vision, height, weight and scoliosis screenings, make home visits and alert parents of possible problems. They also assist teachers and other staff, although the district's employee wellness program was scrapped when its grant funding ran out.

"Last year a teacher came in not feeling well and I assessed her and was sure she was going to have a heart attack," said Gayle Oord, a registered nurse assigned to Newsome High. "I administered an aspirin and called 911. The doctor told me she would have had a heart attack if I hadn't given her an aspirin. She tells everybody I saved her life."

Hillsborough schools now have at least one defibrillator each. They are just one of the technological advances that make health care better, but more complex, nurses said.

"It's more complicated than it seems,' said Wootten. "Every [feeding] pump is different. It may take you 15 or 20 minutes to figure out how to fix it. That's 15 minutes I'm late being someplace."

Wooten knows the risks: "Last year I was reported to Child Protective Services because I fed a child late. I had to tell them, 'I'm doing two jobs.' That was the truth." She said no action was taken against her.

Worried About Care Guidelines

Nurses who requested the meeting with Schools Superintendent MaryEllen Elia this week are concerned about whether they are complying with the state Nurse Practice Act, which specifies requirements for medications and procedures.

School board attorney Tom Gonzalez, who also met with the nurses Monday, said Wednesday, "These nurses aren't going to be left out there." State law gives the district the liability for school staff administering to medical needs, he said.

Nurses train and supervise the 105 health assistants who may be the sole health care worker assigned to a school. Health assistants must hold nursing assistant certification and receive 80 hours of district training, Gallogly said.

"They don't have the experience or the education to anticipate and assess problems," said Barbara Ross, a registered nurse for 32 years, 12 in Hillsborough. "Basically we're teaching them first aid and some other basic things."

She said she has sent letters to the district outlining her concerns. "If I had a child in school, I would be concerned."

Dealing with the growing needs in student health has been a chronic problem. For years, student health needs were handled as often by clerical workers as they were by trained medical professionals.

In 2005, the district put a trained health care professional at every school, a first for the district. Since then, the district lost flexibility with federal funding that was used to help pay for nurses. Last year, health professionals were funded by more than $6 million from the district's general fund plus $1.6 million from federal money for students with disabilities. The Hillsborough County Health Department pays for 13 nurses.

Elia said Wednesday night that the current numbers are enough as long as there is a health professional at every school.

She said some solutions were worked out with nurses Monday, which included hiring retired nurses to review student health records at the beginning of the school year.

"This is a national issue," Elia said, noting that Hillsborough has had model programs for health. "It would not be my intention to cut. We're near the level we should be."

Reporter Marilyn Brown can be reached at mbrown@tampatrib.com or (813) 259-8069.