The health of children in San Diego city schools could suffer if the district approves a proposal to replace 50% of the professional school nurses with lesser-trained nurses and aides, medical officials have warned.
The proposal, to be considered by the district board Tuesday, would save the district up to $900,000 a year by eliminating half the 112 registered nurses and replacing them with lesser-trained nurses and aides. But at the same time it would lead to poorer-quality physical screenings of pupils and an increase in health-related problems within the district, opponents say.
In addition, the move would harm one of the top school district nursing programs in the nation, Dr. Philip R. Nader, professor of pediatrics at the UC San Diego Medical School and a district consultant, said Friday.
Nader has written to the five board members, asking that they take no precipitous action Tuesday.
Nader, who has worked with school health services around the country for 15 years, said that professional nurses are better able not only to identify health problems, but also to make certain that problems are treated properly.
"School health services are usually not a high priority in many schools districts and often are a target for cutbacks," Nader said. "But it's shortsighted, a false economy."
The proposal results from a massive study by the accounting firm of Deloitte, Haskins and Sells to identify ways for the district to save money. It calls for replacing the professional nurses with licensed vocational nurses and health aides who could be trained to perform state-mandated services at lesser salaries. The plan could save as much as $900,000 a year, according to the consultants.
Professional nurses, also known as registered nurses, take four years of specialized education at a nursing school leading to a bachelor's degree, and an additional year for a school nurse credential. By contrast, licensed vocational nurses require two years or less training at a community college.
But any cost savings from using lesser-trained people will prove illusory in the long run, Judith M. Beck, supervisor of nurses for the school district, said Friday.
"They are more than offset by the long-range benefits to keeping kids healthy and in school," said Beck. She hopes that the board will either turn down the proposal or vote to experiment with lesser-educated health personnel in a small pilot program involving only a few of the more than one hundred schools districtwide.
"It's a little disturbing for an outside group of accountants to come in and say that while we run a high-quality program, we can get by with considerably less," Beck said. "I am more than willing to explore different ways of staffing, but I hope the board realizes that health is not a luxury."
Beck said that while health aides and vocational nurses can be trained for technical nursing under careful supervision, school health involves a variety of independent judgments vital to the well-being of students, including home visits by nurses to explain the importance of preventive medicine to parents.
"I'm not sure I want someone making a critical decision about my child's health without a sound base of knowledge," Beck said.
The president of the region's school nurse association is marshaling statistics to present at Tuesday's meeting to show the value of professional nurses.
"At one small elementary school so far this year, a nurse has made more than 275 medical referrals for health defects during her two-day-a-week visits," Edie Gold said. "Of those referrals, 273 required medical treatment by doctors. Forty-five kids were sent to emergency rooms because of injuries. The nurse screened 314 kids for vision problems that resulted in 12 prescriptions for glasses. She screened 450 for dental problems and referred 178 for serious problems."
While certain screenings for vision and hearing problems are mandated by state law, the San Diego program includes dental screenings and free physicals for first graders that are not required under state law. In addition, San Diego conducts tests for curvature of the spine among elementary school students, rather than waiting until they enter junior high, when the test must be performed under state law.
"In that way, we can get potential problems taken care of earlier at perhaps less cost to the family," Gold said.
UCSD's Nader pointed out that a professional nurse can provide specific information to parents about their child's health problems.
"Unlike (an aide or vocational nurse), a professional has the knowledge that an earache may at times be not just an earache, but a sign of a hearing problem requiring prompt treatment," Nader said. "That raises the importance of having the professional around to do the screenings."
In addition, Nader said that the San Diego system has many professional nurses trained at a higher level as nurse practitioners without having to pay extra, a situation "that's a pretty good deal."
For professional nurse Mary Magnuson, the problem of her colleagues' future comes from the failure of people to view nurses as educators. "We don't just sit in an office and wait for kids to come in with a scrape," Magnuson said, adding that new programs beginning next year will involve nurses in child abuse awareness programs.
In fact, the Sweetwater School District in the South Bay restored its full nursing program this year after having cut the number in half, from 17 to 8, the previous two years.
"It cost us $128,000 to restore it, but the feeling was that with the services we wanted to provide, it was necessary to be done," Mary Anne Stro, director of instructional operations at Sweetwater, said.
"We were having difficulty in getting state-mandated screenings done and in expanding the scope of services," Stro said. "We now make our nurses a total part of our school staff and have them provide leadership in health areas."