PORTLAND, Ore. (PORTLAND TRIBUNE) — When a crisis happens, most people reflexively shrink back. Nurses rush forward.
But now, some say, it’s the nurses themselves who are in crisis.
Oregon school nurses are operating at staffing ratios far above national recommendations of one for every 750 students. The average Oregon ratio is one school nurse to 4,667 students — one of the highest in the country, according to the Oregon Health Authority.
School nurses also are expected to manage increasingly complex needs, and have few resources at their disposal.
“I think the data and the research definitely shows the complexity of health needs that are entering the school doors are increasing over the last several years,” says Jamie Leon Smith, the state’s new school nursing consultant. Smith’s position, and the new school nursing task force he helps manage, are creations of Senate Bill 698, passed by the 2015 Legislature.
The task force met May 6, largely to look at new ways to fund school nurses, who are now paid almost exclusively through state education dollars.
“In Oregon, as we look at reshaping the health care delivery system, I believe a school nurse can be an integral part of that,” Smith says, noting their unique access to underserved populations.
In light of the new depth and breadth of health conditions school nurses are expected to manage, Oregon needs “stable, sustainable funding, specifically for health care services, because we know those needs are there,” he says. He hopes that means funding that doesn’t take away from limited education budgets.
Task force chairwoman Nina Fekaris says that could mean applying for public health grants, using Medicaid and Medicare reimbursements or even billing private insurance companies.
If the task force can navigate the pitfalls of those approaches, it could open up a path to millions of dollars of new funding for school nurses.
“Honestly, I don’t think many states have thought of it before,” says Fekaris, president-elect of the National School Nurses Association and a Beaverton School District nurse. “I think Oregon is kind of pushing the envelope a little bit.”
Health vs. education
Grant High School nurse Lue Ann Beck has seen children’s needs grow and a lot of other changes over the course of her 25-year nursing career.
Beck thinks people don’t really understand the full range of what school nurses do on a daily basis.
“In the early days, I think the thought was, you know, all we deal with is head lice. And that’s so untrue,” she says.
“Mental health issues with students are increasing dramatically,” adds Beck, who also is the nurse for Winterhaven (K-8) School. “I think that’s really big, in my career. Boy, I tell ya, I even see it in the elementary level.”
In addition to high caseloads, school nurses often are stretched over six or more school campuses.
“I think that we do a lot more than people really realize. I think we work so hard and we don’t beat our drums enough about what we do,” Beck says.
Asked what is needed to help the situation, Beck is very clear.
“Money. I think it’s money,” she says. “How do you fund school nurses, you know? School districts are strapped, too. If it comes down to a teacher, a social worker or a nurse, it’s probably going to come down (on the side of) education.”
Full hands, full heart
A nurse since 1986, Lorie Coe has been a Multnomah Eduation Service District school nurse in Reynolds School District in eastern Multnomah County for the past eight years.
Coe says the patients and families she sees seem increasingly desperate.
“In East County, it’s really tough,” she says. “The need is so great.”
Coe spends a lot of her time on wrap-around services, such as making sure families have transportation, health insurance or flexibility to make her recommendations for follow-up care a reality.
“The need has changed,” she says. “That would have been more of an atypical situation (before) and it just seems that our families are dealing with more complex situations day in and day out.”
Coe’s day is incredibly busy. With six schools to manage, she is constantly triaging requests and managing emergencies and health care choices in young and vulnerable populations.
But, she says, she wouldn’t have it any other way.
“It’s immeasurably rewarding,” Coe says. “It is an amazing opportunity to be able to come alongside and celebrate with successes and things that are going well with families and then also be part of a process that’s helping somebody move forward.”