Today, a day after the presidential election and two weeks after a council hearing on school nurses, we here in DC know that

–School nurses are vital to the health and well-being of our schoolchildren; and

–School nurses are not vital to the health and well-being of our schoolchildren; and

–The current system of school nurses in DC public schools is working well; and

–The current system of school nurses in DC public schools is not working well.

These–and a whole lot of other–statements were made at the council hearing on October 25 on the new school nurse contract (erm, grants) being proposed to replace the current system of school nurses in schools.

Feeling sick yet?

Earlier this year, the American Academy of Pediatrics called for a full-time nurse at every public school, citing the fact that nurses are on the front lines of health care, particularly for children with chronic illnesses. Right now, according to hearing testimony, the prevalence of asthma in DC kids is 19%, with more than 25% of kids in wards 5, 7 and 8 suffering from the disease.

Seems like a nurse in every school is a good thing, no?

No–at least according to a June 2016 report by DC Action for Children. That organization, led by HyeSook Chung (who also testified and co-authored the report), produced the report at the behest of the DC department of health (DOH), which oversees the school nurse contract/grant system that is being overhauled.

The report concluded that the Whole School, Whole Community, Whole Child (WSCC) model being proposed by DC DOH is superior to what currently exists with nurses in each DC public school. The idea behind WSCC–at least in the proposed DC incarnation–is that DC students have complex health needs, which can be better addressed through a variety of resources, both in and outside schools. Interestingly, the WSCC model as originally proposed by the CDC appears to say nothing about reducing nurse coverage in schools–while it says a lot about healthy living for kids, something that in DC seems to be utterly ignored in its version of WSCC (and elsewhere, as we have seen).

The DC Action for Children report concluded that a nurse in every school is “obsolete” on the basis of rather sketchy evidence: The report noted that “some” data point to the fact that full-time nurses do not result in better health outcomes for children.

The data on which this conclusion was based, however, appears to be limited to an examination of the relationship of DC public school students with individual health plans (IHP) and the presence of a full-time nurse in their schools. That data shows that schools with full-time nurses had lower than expected percentage of students with IHPs.

An IHP is usually sought for children with chronic illnesses or special needs, which may require intervention by a nurse. But as far as I could see, the DC Action for Children researchers made no apparent effort to show how they calculated the percentage of each student body that they thought would qualify for an IHP. Nor did they appear to take into account other factors that could affect whether students who need IHPs have them, including the nurse/student ratio at each school (i.e., an overburdened nurse may not be able to identify students who need IHPs); the fact that student health data is not tracked from school to school; and how high student mobility affects a lack of IHPs (as we know from cross sector task force data, some schools in DC have large proportions of mobile students).

Nor did the DC Action for Children researchers have any actual school health data before coming to the conclusion that a school nurse in every DC public school is “obsolete.” The reason they lacked data was that existing data could not be dis-aggregated, so the researchers had no idea of the relationship of any DC student outcomes to treatment by DC school nurses–or to why DC students had to go to their school nurses in the first place.

It’s not that implementing WSCC is cheap. At $19 million, the city would be funding an entirely new health system for youth and public schools, with a growing number of youth and schools–all for the same price it currently supports most schools having a nurse.

(That would be, for the record: 66 full-time nurses and 47 part-time nurses in DCPS; and 30 full-time and 27 part-time nurses in DC charter schools, four of which lack any nurse at all. Good luck at getting a list of which schools have full-time nurses—the council apparently is still waiting for it, after requesting it from DC DOH during the hearing.)

Defending the proposal to reduce nurse staffing in schools, DC DOH head Dr. LaQuandra Nesbitt during the hearing gave a measured response, noting that our expectations might not be in line with what is either possible or helpful for children. She also observed that DC enjoys one of the nation’s highest per capita number of primary care physicians, which ensures that health care coverage is readily available.

But with less than half of all DC public school students having a completed and current health form on file at their schools, our expectations (and our copious supply of local doctors) appear irrelevant.

That lack of school health forms not merely poses a quandary for school nurses trying to set up IHPs, but it also suggests that despite our being blessed with loads of local docs, children are not seeing those doctors at regular intervals—if at all. Add to that the cost of getting shots and forms for school (I pay about $15/kid/form), it can add up–and that’s not even counting the time parents spend taking their kids to the doctor.

(NB: The latter might have been eased with a workplace scheduling bill that council members–including members of the education committee—recently tabled.)

In response to calls for full-time nurses in every school and for not implementing this change in January, as originally envisioned, the council passed emergency legislation to keep current nursing coverage through the end of this school year.

But even assuming the mayor’s signature and Congressional approval (no, I am not even going there), the legislation is at best a temporary fix until June at the latest. The DC School Nurses Association plans a lobbying day at the city council on Monday November 14, starting at 10 am. Sign up is here.

Methinks we all have some work to do.