The adage "penny-wise and pound-foolish" is being played out nationwide as school districts cut RN positions to make up for funding shortfalls: a school district in Wicomico County, Maryland, plans to replace three RNs with certified nursing assistants, according to the August 30 issue of Delmarva Now; in California, some districts want to allow unlicensed personnel to administer insulin to school children with diabetes (fortunately the legislation was defeated in state supreme court in October).

Figure. School nurse Jill Burgin helps Alyssa Brown check her blood sugar level in the infirmary at Stiles Point Elementary School in Charleston, South Carolina. With current funding shortfalls, some schools want to allow unlicensed personnel to administer insulin to school children with diabetes. Photo (C) Associated Press.

But cutting school nurse positions may be a short-term fix with long-term consequences. Cynthia Tollini, president of the Maryland Association of School Health Nurses, told AJN that she sees both sides of the issue-the value of keeping an RN in every school and the financial challenges school districts face in meeting budgets. However, she cautions, "Acuity is an ever-increasing problem." Martha Dewey Bergren, director of research for the National Association of School Nurses, agrees, pointing out that caring for children with acute needs takes a "very experienced, confident nurse." When a decision has to be made, Bergren says, such as recalculating a child's insulin dosage, and a nurse isn't on premises, miscalculations can have serious consequences.

"Many principals and superintendents understand that school nurses contribute to the educational process, but some don't," Bergren says. She also points out that children in schools with nurses on the premises have better vaccination rates and attendance and are less likely to be sent home early because of a health issue.

"Nurses assess the health concern and try to figure out a way to keep the child in school that day," she says, whereas health assistants may ask only for a parent's phone number so the child can be sent home. This affects not only the child's health and ability to learn, but may cause parents to miss work needlessly. And adding insult to injury, attendance rates are often the basis for state financial aid to schools.

School nurses have achieved gains in healthful-lunch and exercise programs, asthma care plans, and attendance, Bergren notes. School administrators who try to balance the budget by cutting RN positions may not understand the value of the school nurse until some of those gains are lost, she says, "and no one wants to see that happen."-Gail M. Pfeifer, MA, RN, news director