From the Melrose Free Press
Wednesday, February 26, 2003
School nurses cut as roles expand

No one knew that the girl was allergic to bee stings.

Until she was stung.

"She went from having numbness and tingling in the area where she was stung to having closing of her throat," said Lois Pencinger, who until last Friday was the school nurse at the Horace Mann School, where the incident took place last year.

Pencinger realized that the girl was having a life-threatening allergic reaction and quickly gave her an injection of epinephrine to stop it.

The incident only highlights the varied and serious health issues school nurses face on a routine basis today. No longer is the nurses office just a place to lie down with a tummy ache. Today's school nurses administer prescription medications, deal with asthma, and address other serious health problems, sometimes administering to children who might not have even attended a public school a generation ago.

School nurses provide a safety net for children with major and minor health issues and are sometimes the only health provider a child sees, said Pencinger, who also served as supervisor for all the city's school nurses.

Now some of those nurses are gone.

When Gov. Mitt Romney cut the Enhanced School Health Grant, he eliminated funding for three of the city's seven school nurses. Last week, the state Senate voted down a measure to restore those funds. When children come back from school vacation on Feb. 24, schools will be down three nurses.

Last week, the Board of Health assigned full-time nurses to the Beebe and Roosevelt schools and half-time nurses to the Horace Mann, Hoover, Lincoln, and Winthrop schools.

St. Mary's School will pay for its own nurse through the end of the year.

"There is no good answer to this," said city health director Ruth Clay. "Every school deserves and needs a full-time nurse."

Nurses who are assigned to two schools will carry beepers, Clay said, in case a child becomes ill when they are not in the school. "We will basically go back to where we were five years ago," she said.

In recent years, outside money has allowed the city to place a full-time nurse in every school, but that money has all disappeared in the past year. For three years, Hallmark Health paid the city $175,000 per year, which funded 3.5 nurse positions. When that funding ended, a local resident set up a living trust with his own money to pay for one part-time nurse and Mayor Rob Dolan put the other three positions on the city budget.

"We fought very hard to get a nurse in every school," said Winthrop School nurse Celine Hubbard, who once covered three schools. "To see it go the other way is disheartening."

Since last September, Hubbard has had 2,775 visits from students needing first aid, 2,363 visits for illness, and given 359 doses of medication to students.

More responsibilities

"School nursing has changed a lot," Pencinger said.

Parents may remember the nurse's office as a place to lie down when they had a tummy ache, but on this day, Pencinger was using a nebulizer to pump medication into the lungs of a child with asthma.

"The types of children we have in schools has changed," she said. "We have children with more special health-care needs, children needing medical technology."

The nurses see children with asthma, diabetes, attention deficit disorder, seizure disorders, cardiac conditions, and food allergies.

While some of those children might not have attended public schools in the past, state and federal laws require that children with severe health conditions be educated in regular schools whenever possible.

In addition, some conditions, such as food allergies, are more common now than they were 30 years ago. "In this district, we have 91 children with a life-threatening food allergy," Pencinger said. Principals and teachers are trained to give injections if those children have a severe reaction, but if a child has not previously had an allergic reaction — as was the case with the girl with the bee sting — they may not realize what is happening.

The nurses also screen children, as they always have, for vision and hearing problems. They provide health care for children whose parents have lost their jobs and cannot afford insurance. "The school nurse keeps those healthy and in school so they can learn," Pencinger said. "Sometimes we even provide breakfast."

And there is one thing more: in case of a bio-terror attack, the school nurses would treat students and faculty, Hubbard said.

The remaining nurses will do the best they can to meet those needs, Pencinger said, but she is worried about the students. "This is not a good situation," she said. "Those nursing positions should not have been cut."

What school nurses face

Winthrop School nurse Celine Hubbard case load since last September:

Melrose schools also have 91 children with life-threatening food allergies.