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Underfunding for School Nurses May Have Link to Chronic Absenteeism

Katie Riordan

A third-grader at Riverview K-8 Schoolin South Memphis has come to see Rachel Norris, or Nurse Rachel, as the students call her. Through sniffles, the young girl tells Norris that she’s been coughing and sneezing for two days.

“I’m going to call mom and let her know,” Norris says. “We’ll just try and get you some cold medicine.”

Norris’ clinic fills up throughout the morning; she has daily meds to dispense and state-mandated health screenings to complete. Not to mention she must tend to a bumped head, scraped knee and a 5th grader who's been throwing up.

Credit Katie Riordan
Norris is in charge of completing state-mandated health screenings.

Prior to this year, dealing with these aches and pains mostly fell to teachers and administrators, because a nurse was only in the building once a week.

Limited state funding has meant there are far more schools in Tennessee than school nurses. But Norris is part of an ongoing study that places full-time nurses in five Memphis-area schools.

The Urban Child Institute, Le Bonheur Children’s Hospital and Shelby County Schools are collaborating on the program to examine the local impact of nurses on health-related absenteeism and in turn academics.

“Before we had a school nurse, it was if you’re sick, if you don’t feel well, if you hurt yourself, just call your parents and go home,” Norris says.

Healthcare and education advocates say more full-time, registered nurses are needed across the state, not just to stave off minor medical problems, but also to help students manage chronic conditions like asthma, high blood pressure or ADHD. They say unmanaged health issues feed absenteeism.

Credit Katie Riordan
Nurse Practitioner Lanetra Wiley visits the study's schools once a week to check on students.

The state defines a chronic absentee as a student who misses more than 18 days a school year. In Shelby County Schools, one in five students fit that criteria, which is higher than the state average.

Nurses are typically the only school staff members who parents can trust for qualified medical assessments, Norris says.

“I can tell the parents exactly what happened... how severe it is, if they are contagious, if they need to see a doctor or if they are okay to return to class,” she says.

So far, students who have regular access to a nurse appear far less likely to be taken out of school by parents. Charnece Brown, a supervisor for the nursing program, says that at the five schools in the study, 90 percent of students who saw the nurse last semester returned to class.

“It takes a load off [teachers’] shoulders,” she says. “They can focus on teaching, and we can focus on health.”

Credit Katie Riordan
Norris has built a rapport with students at Riverview K-8.

Currently, Tennessee funds one nursing position for every 3,000 students, which means nurses in some districts juggle duties in up to five different schools. The nationally-recommended ratio is at least one nurse for every 750 students, a formula advocates want the state to adopt.

“Everyone feels like 'sure, that would be great to have more nurses in the schools',” says Mike Carpenter, the head of Tennesseans for Quality Early Education. “The issue is cost."

Lowering the nurse-to-student ratio would require about 1,000 new nursing positions in the state,at a cost of roughly $39 million. Some districts, like Shelby County Schools, would also need to provide additional funding.

“Like with many good issues [and] policies, is that is the rub,” Carpenter says. “Where do we find...$39 million to meet that ratio in addition to all the other things that we need to address?”

In its most recent report, a committee that studies the state’s education budgetrecommends nurse funding as a priority. But the priority list is long.

“The nursing ratio is just the tip of the iceberg in terms of what we need to do,” says Republican State Representative David Hawk, who adds that past priorities have included school safety and the need for more resource officers.

But given the growing number of students with special medical needs and children who lack access to healthcare at home, Hawk is reintroducing legislation this session that could fund roughly one nurse for every school.

Credit Katie Riordan
Charnece Brown supervises the nursing program.

“Seeing a school nurse may be the only healthcare that these individuals get,” Hawk says.

Since Norris arrived at Riverview, teacher Andrea Dandridge says students and faculty have become more health conscious.

“You see more washing of hands and you see more, ‘Okay, I’m going to put my scarf on,’” she says.

But bigger than scrapes and colds is thegrowing number of chronic conditions in children that need close monitoring. Patrica Bafford, a former school nurse who now manages health service programs for Shelby County Schools, says nurses are a line of defense against illnesses like asthma and diabetes.

Credit Katie Riordan
Norris weighs a student for a health screening.

They can keep symptoms from spiraling out of control.

"If you are a part of that family in that building, you know your children,” she says. “You [recognize] what they look like when they are wheezing—what... they look like when their blood sugar is high.”

Norris says she’s become a part of her school’s community. Some staff say it’s hard to imagine how they got by before her.


“There’s just a lot more than band-aids and boo-boos,” Norris says.