For several years now, West Virginia’s public schools have had to contend with the challenge of sharing school nurses between multiple locations. In Greenbrier County, which has approximately 4,800 students enrolled for the 2020/2021 school year, nurses are responsible for covering three, four and sometimes as many as five different schools. This creates a scenario where a nurse is not in the school building each day that students are present. Under the best of circumstances, this situation would undoubtedly have nurses severely overworked. Once the current realities of the COVID-19 pandemic are taken into account, the job of a school nurse certainly becomes exponentially more challenging.
According to the West Virginia Department of Education, “School nursing, a specialized practice of nursing, protects and promotes student health, facilitates optimal development and advances academic success. School nurses, grounded in ethical and evidence-based practice, are the leaders who bridge health care and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that allow individuals and communities to develop their full potential.
School nurses devote time providing health information to students that promote physical, emotional, social and mental health needs and develop prevention programs that today have an influence on school-age children. Additional roles performed by the school nurses in the school setting are; training school personnel to provide basic and specialized health care procedures, develop individualized Health Care Plans for students, administering daily medications, developing 504 plans for students in the academic process.”
Under current W.Va. law, each county Board of Education is required to employ a minimum of one school nurse/RN for every 1,500 students in kindergarten through grade-seven. There are approximately 260,000 students currently enrolled in West Virginia public schools (261,633 as of the start of the 2019/2020 school year).
According to W.Va. Superintendent of Schools W. Clayton Burch, there are 450 school nurses employed across the state. Burch describes these nurses as a mixture of “RNs, LPNs and folks that meet a variety of categories.” However, no explanation was given as to what those “categories” are.
The W.Va. Department of Education does state that, “School nurses are required to have or obtain a Bachelor’s Degree in Nursing (BSN) and a Certification in School Nursing. (CSN)”
Based on Superintendent Burch’s estimate of 450 school nurses, and the 2019/2020 number of 261,633 enrolled students, each school nurse is responsible for the care of approximately 581 children; well below the 1,500-student limit. However, 581 children is still a very large amount. To put that number in perspective, on the average, the W.Va. public elementary-school student:teacher ratio is 14:1, according to research compiled by Public School Review. Granted, a school nurse typically does not interact with 581 students every day. But they could, so they must always be prepared to. And in light of the current COVID-19 pandemic, preparedness has taken on a whole new meaning.
In a statement made on Friday, September 25, Superintendent Burch referenced W.Va. House Bill 206 which was passed on June 17, 2019. Burch stated that the bill has provided between $24 and $30-million to be used for the hiring of additional support staff. This would allow the state to increase its total number of school support staff, including school nurses, to 1,300 employees.
On Monday, September 28, Burch was asked by the WV Daily news if those funds were currently available, and if the sourcing of new support staff was yet underway. The Superintendent responded by stating, “Those (the funds made available through HB 206) are in state-aid funding right now, they’re available for this year to increase support staff,” Burch said. “And as I indicated it allows for over 500 additional support staff. That can be counselors, social workers, school nurses, anything in the support staff realm, it allows for that. So those funds this year did total nearly $25 million.”
This would seem to indicate that the additional funds have been made available to county school-systems, and that the hiring process had begun. However, that does not yet seem to be the case for several counties. Pocahontas County Superintendent of Schools Terrence Beam perhaps said it best. “Sometimes with these bills that they pass, you hear about them, but they can take a while.”
Pocahontas County currently has 975 students throughout five county schools. Up until December 2019, the county employed one school nurse. However, the Pocahontas Board of Education took matters into their own hands by hiring an additional three LPNs since January 2020. The resources used for these hirings were from the county’s own budget, and not provided by HB 206. In light of the current pandemic, the Board’s decision to hire the additional support staff members could not have come at a better time.
“We felt like it was a need we had for our students,” Superintendent Beam said of the hirings.
In addition to HB 206, HB 2870 has been introduced to the state legislature for consideration. The bill seeks to reduce the amount of students and school locations that a nurse be required to serve. Under the guidelines of the bill, a school nurse would be responsible to care for a maximum of 500 students, and be required to service no more than two separate school locations. Delegate Cindy Lavender-Bowe, one of the architects of HB 2870, believes this is a necessary step towards improving the state’s education system.
“There are a lot of kids in the state who are special-needs, and who have medical conditions such as diabetes, among other things,” Lavender-Bowe said. “As a state, we need to be able to provide them with the type of care they need to be successful in school.”
House Bill 2870 was introduced during the legislature’s regular session on January 8, 2020. It has since been adjourned sine die, meaning no future date has been scheduled for legislature’s review of the proposal.
While speaking at his coronavirus media-briefing on Wednesday, September 30, W, Va. Governor Jim Justice seemed to sum up the urgency of the situation perfectly.
“From the standpoint of our school (COVID-19) outbreaks, we now have 17 active outbreaks, with 40 confirmed cases in the public schools. Now let’s just talk one second about this,” Justice said. “We’ve all been told, over and over, we all know that really and truly as we go back to school, we’re going to have more cases arise and we’re going to have to address those situations.”
When asked by the WV Daily News if he could explain the process by which county schools could gain access to their portion of the funds made available by HB 206, Governor Justice declined to answer, rather deferred to Superintendent Burch who was not present at the briefing.
As much as doctors and first-responders, nurses, teachers and school personnel are the first line of defense for West Virginia’s school-children. It remains to be seen just how soon the funds provided by House Bill 206 will be able to be put to use by county schools.