An apple a day might be what’s keeping the doctor away, but at the Guilford County Board of Commissioners’ Thursday, Sept. 15 meeting, some county commissioners wanted to know what’s been keeping Guilford County away from having a greater number of school nurses in the county’s schools.
When it comes to the ratio of school nurses to students in schools statewide, Guilford County is nearly at the bottom of the barrel, and now some commissioners – both Democrats and Republicans – are calling for a serious look into the issue in hopes of finding affordable ways to address the problem.
The school nurse dearth wasn’t on the agenda for the board’s Sept. 15 meeting, however, it became the main focus of a lively discussion during a presentation by Guilford County Health Director Merle Green, who was there to speak on other matters such as the Zika virus threat and the county’s new health guidelines.
Guilford County Commissioner Carolyn Coleman said she had been getting calls from school nurses who say they’re spread way too thin to be as effective as they should be.
Guilford County currently has 33 school nurses and, on average, a nurse covers about three schools each.
Green, when asked about the number of nurses the schools should have, said, “The recommended ratio nationwide is one for every 750 students – Guilford is around 1 to 2,000 students.”
Commissioner Ray Trapp, a Democrat like Coleman, jumped in.
“I know that exact number – I can help you out here,” Trapp said. “It’s one to every 2,217.”
He threw out another eye-opening statistic as well: “There are 115 identified school systems in North Carolina,” he said. “We’re number 111 on that list.”
Trapp said that, by comparison, Mecklenburg County has one nurse per school.
He also told a personal story. He said that recently when his own child required daily medication at a Guilford County school, Trapp and his wife needed a school nurse to sign off on it, but no nurse was available to do so for about a week, which caused complications in getting that medicine administered.
“It has an impact on families,” Trapp said of the county’s school nurse shortage.
He said that, in his case, the consequences were merely an inconvenience. But he added that it could create major issues when someone has “a horrible case of diabetes and needs their blood sugar monitored” and there’s no nurse available.
One thing that made the lively discussion even livelier is when Coleman attempted to blame the nurse shortage on the Republican-driven tax cuts of recent years.
Coleman said she was astonished that the board hadn’t provided more nurses to the school system in the 2016-2017 budget adopted in June.
“It’s good to cut taxes, but we want to keep our children healthy,” Coleman said. “I am hoping we will reconsider what we’ve done in that budget. It’s not providing the money that you need; 2,200 students is just too many for any one person.”
At the Sept. 15 meeting, she commented that for many years Guilford County didn’t put enough money into the school system for either buildings or personnel, and she said that’s why the county is now having to build so many new schools.
“I just think that it has to stop at some point. And no one wants to pay for someone else’s mistake but I think that’s the position we find ourselves in,” she said.
In the 2016-2017 Guilford County budget – the current one adopted in June – the Board of Commissioners added three certified nursing assistant positions, but no additional registered nurses. Green and other county health officials were requesting one additional registered nurse at that time, but the commissioners felt that, for only slightly more money, the county’s school children would be better served by adding three less costly health workers rather than one registered nurse.
Chairman of the Board of Commissioners Jeff Phillips and Commissioner Justin Conrad both took umbrage at Coleman’s suggestion at the meeting that it was the Republican tax cuts in recent years that had brought about the school nurse shortage.
“It didn’t happen overnight,” Phillips said, “certainly not in the last four years.”
The chairman said the board had spent a good deal of time correcting things left undone by the boards of commissioners that ran the county before the Republicans took power in late 2012. He said that, like those other matters, the current board could address this issue, but he emphasized that Coleman’s remarks didn’t reflect reality.
“It minimizes the issue to suggest that cutting the tax rate is the reason why,” Phillips said, adding that this is another “area of opportunity” for the board and stating that the commissioners and staff need to work together and “think out of the box” to find a good solution.
Conrad also said the shortage wasn’t caused by the tax cuts of the last four years.
“I’m a Guilford County resident,” Conrad said. “And I remember, growing up, we certainly had this well covered. When did that go away? When did we stop funding those positions?”
Green told the board she’d been with the Guilford County health department for 19 years and that, for all that time, the county had been very low on school nurses. Green said all the money the county puts toward school nurses goes to school nurses and that she’s in the process of hiring the three new nursing assistant positions that the commissioners funded in June.
Green said the alarming ratio of students to nurses was a real problem.
“Children now are sicker than ever,” Green told the commissioners. “They are coming in with major conditions.”
She added that the national school system trend in recent years was to “mainstream” more students with health issues of all sorts who previously may have been in more specialized learning environments and that increases the demand for school nurses.
”Everything you can find in the total population generally, you can find in the schools,” Green said of health problems.
According to Green, a subcommittee of the Guilford County Health and Human Services Advisory Committee is looking at “strategic ways to identify more funding for school nurses.”
After the meeting, Green said that in order to get the county up to a respectable level, it would need about 40 additional nurses. At a price tag of about $60,000 each, that would be an extra $2.4 million for school nurses annually. Green added that even that amount wouldn’t provide a nurse for every school.
She stressed this was a serious need and that the schools are seeing an alarming number of diabetes and asthma cases.
“They’re not getting better – they’re getting sicker,” Green said.
This week, in response to some of the comments at the meeting, Phillips pointed out that, despite tax cuts by the Republican majority in recent years, Guilford County has increased rather than cut school spending. He also said that, like Trapp, Coleman and others, he was disturbed by the high number of students for each nurse.
“Absolutely it’s a concern,” Phillips said. “It’s added to the long list of concerns that we continue to address.”
Phillips pointed out that the addition of three nursing assistants in the most recent budget is a move that the county can build on as it addresses the problem going forward.
Conrad said he agrees with Coleman that this is a problem that certainly needs attention.
We have to take that first step,” he said, adding that if the county “chipped away” at the current shortage it could eventually get that number where it needs to be.