31 Schools Lack Full-Time Nurses

A 5th-grader at Clinton Avenue School got a tummy ache. She was lucky: The school nurse was in.

The student visited nurse Elrose Hall, took a rest in her office for 15 minutes, and went back to class.

If the tummy ache had struck on a Monday or Friday, she might have been sent home instead.

The nurse’s office at the 500-student K‑8 school is closed on Mondays and Fridays. Like most of the New Haven’s 30 public-school nurses, Hall splits her time between schools. As the city faces a shortage of nursing services amid budget constraints, Hall juggles 900 students at two elementary schools.

Of the 45 schools in the district, 31 don’t have a full-time nurse, according to the city health department.

“There is a shortage of nursing services,” said Anne Somsel, the city’s director of public health nursing

Somsel sets a schedule that aims to find the best way to divvy up the 30 nurses’ time between schools. Seventeen school-based health clinics, run by nearby hospitals and community health clinics, supplement the nurses with advanced practice registered nurses and doctors.

Concern about the shortage arose last week during a visit by Gov. Dannel P. Malloy to High School in the Community (HSC), where the state is funding an experiment to help the school rebound from failing test scores and rising truancy and dropout rates.

HSC, which has 240 students, has a school nurse only one and a half days a week, school staff revealed to the team of visiting state officials. One in five students has special needs. The school is receiving $1.5 million in the first year for specified educational reforms, as well as $100,000 for ​“wraparound services,” which tackle kids’ socio-emotional health.

Building leader (aka principal) Erik Good was asked if the school plans to use its infusion of state money to hire a full-time nurse. Good said the staff had that difficult discussion.

“We felt like mental health issues are more emergent on a continued basis,” he said. The school has a social worker two to three days a week. Good said the school decided to use the state money to hire a full-time social worker instead of a full-time nurse.

New Haven state Rep. Pat Dillon, one of several elected officials who attended a roundtable discussion at the HSC library, expressed concern.

“That nurse issue is not closed,” she said. New Haven was home to the first school-based health clinic in the state, she said. Teachers feel health care in the schools is ​“mission-critical,” she said.

“I know the nurses are stressed” given the number of kids they have to tend to, Dillon said. ​“We want to make sure the nurses aren’t thinking of quitting because they are so stressed.”

Triage Scheduling

The National Association of School Nurses recommends one nurse per 750 students well students, and one per 225 in ​“student populations that may require daily professional school nursing services or interventions such as Special Ed inclusions.” With roughly 21,000 students in city schools, the ratio sits around 1:700.

Out of 31 elementary schools, six — Augusta Lewis Troup, Benjamin Jepson, Celentano Museum Academy, East Rock Community Magnet, Fair Haven, John C. Daniels — have full-time nurse coverage every day of the week. Of the nine high schools, three — Wilbur Cross, James Hillhouse, Hill Regional Career — have full-time nurses. The rest have nursing coverage one, two or four days a week. None of the five transitional schools, which are much smaller, has a full-time nurse.

Seventeen schools have school-based health clinics, but not all of those are fully staffed: Clinton Avenue’s, for example, has only a social worker because the nurse practitioner left and has not been replaced.

Click here to see the schedule showing health care coverage in each city school.

The issue flared up last year after the city cut four school nurse jobs in February 2011 to balance the budget. In emotional pleas at budget hearings, nurses decried a staffing shortage they said was short-changing kids. The city cut the number of nurses from 34 to 30 that year, said city health director Mario Garcia. It has since rehired two laid-off nurses and is about to raise the number of nurses to 31, he said.

In an interview last week, Mayor John DeStefano said the city is taking a systematic look at health care in its schools to identify gaps in service and equity across the system. There’s an oddly ​“bifurcated” system, he noted, where some schools have full-fledged health clinics, while others rely on part-time nurses. The clinics popped up in an organic way, not according to a strategic plan, DeStefano said.

Garcia’s department and school staff have formed a task force examining access to primary care in city schools.

So far, ​“the biggest gaps are there are not enough nurses,” said Somsel, the public health nursing director, who sits on the task force.

Somsel called the school nurse staffing level ​“not ideal.”

Ideally, she said, she’d like to see full-time nurses in all K‑8 schools with at least 400 kids.

Since she can’t provide that for every building, Somsel said, she looks at the health needs of each school and schedules staff accordingly. Schools with self-contained special education classrooms, such as Celentano, Cross and East Rock, have a full-time nurse for that reason, she said. Students who need catheterizing, who have to be fed through a tube, or suffer from seizures also need to have a full-time nurse around, she said.

“It Feels Like My Heart Not Beating”

Clinton Avenue, a 500-student neighborhood school in Fair Haven, has a nurse three days a week. Over the course of a visit to the school Tuesday, Nurse Hall saw a steady stream of kids. In the morning, she plucked a splinter with tweezers and tended to several stomach aches.

At about quarter past one, a 5th-grader walked in with a stomach ache.

“Come, sweetheart, let me talk to you right here,” said Hall. Originally from Jamaica, she started working in New Haven Public Schools in February, landing her first U.S. job. She speaks with a warm Jamaican lilt, calling students ​“sweetheart” or ​“baby.”

Hall interviewed the student and determined she would benefit from lying down. She set up a folding privacy curtain and rolled out a sanitary paper sheet to cover a bed.

While the student was lying down, Hall brought ice to a 2nd-grader who had bumped his leg in his classroom. She took the temperature of a student who complained of an ear ache.

A boy and a girl burst into the nurse’s office breathing heavily.

“We forgot to take our pumps!” announced the girl.

The students, who suffer from asthma, were supposed to see Hall for an albuterol pump before heading to gym class. Hall helped them pump their inhalers and inhale through a large tube that covers the nose and mouth.

“Remember to shake it up before you put it in,” Hall advised.

“It feels like my heart not beating,” said the little boy. Hall checked him with a stethoscope and pronounced him OK. She let him rest on a bed before going back to class.

Hall spends Tuesday, Wednesday and Thursday at Clinton Avenue. On Monday and Friday, she reports to Wexler/Grant School, a city ​“turnaround” school with about 400 kids.

Hall said she sees 20 to 29 students a day at Clinton Avenue. She sees up to 20 at Wexler/Grant on the days that she’s there. Her duties include checking immunization duties for all pre‑K, K and 7th grade students; helping diabetic kids manage blood sugar levels; helping students manage daily meds for asthma and seizures; and tending to the many bumps, trips, and falls that come with being a kid. She said most of her visits come from kids with acute problems such as a scraped elbow or a bloody nose.

On days that she’s not in the office, the nursing room sits closed, she said. Kids can’t go in to take a nap. In her absence, the principal and assistant principal manage daily medications. The gym teacher comes in to grab ice. Teachers handle health problems as they arise, contactl parents to take kids home, or call 911.

Hall said when nurses are on staff, they allow teachers to focus on teaching, administrators to focus on leading the building, and students to deal with medical problems so they can hit the books again.

As Hall and Somsel were talking, the 5th-grader with the stomach ache emerged from the privacy curtain.

“Better now?” Hall asked.

“Yes,” the girl replied as she headed out to class. ​“Thank you.”

“Just a little lie-down sometimes helps,” said Hall.

Somsel, who’s also a registered nurse, said the girl is an example of a kid who probably would’ve been sent home if the nurse hadn’t been on duty.

Hall said if she worked full-time at Clinton Avenue, she could better keep up with how her kids are doing. Teachers could pick up the phone to tell her about a kid with a chronic illness any day instead of waiting until she’s in the office.

When nurses work full-time in schools, Somsel said, they can spend more time educating kids and parents about their health. They become a part of the team of school staff. And they can serve as a constant presence in the building.

“It would be of a great advantage to be around five days” a week in a single school, Hall agreed. ​“Kids tend to love constant” support, knowing the nurse is ​“always there.”

“I Know Everybody”

The constancy was on display across the city at James Hillhouse High School last week. There, nurse Carol Braga (pictured) works five days a week to keep up with the roughly 1,000 students. Last Thursday, several kids popped by the school to say hi or check their look in her mirror. Braga is in her 8th year at Hillhouse.

“Being here, I know these kids. I know everybody.” When she reports to work at 8 a.m., she said, ​“they’re waiting at the doors for me.”

On Thursday, she tended to a student who complained of a sore throat. Braga checked her temperature and let her lie down for a while.

A few minutes later, she tended to a girl who complained of trouble breathing.

Braga took out a stethoscope.

“Sit up straight, hon, and take a nice, deep breath,” Braga directed.

She discovered the student’s breathing was fine, but she suffered a different problem: The student had been attacked by four girls during a mugging five days prior. Her side was bruised; she hadn’t told the school. Braga called mom and arranged for the student to go to the doctor’s office that afternoon.

Hillhouse also has a health clinic run by Yale-New Haven Hospital offering an APRN and a social worker.

While Clinton Avenue is missing its nurse practitioner and clerk, schools spokeswoman Abbe Smith said, none of the school based health centers (SBHC) are ​“closed.”

“There has been some turnover in nurse practitioners to staff some of the centers and the district is working to place nurse practitioners at any SBHC that does not have a full-time person. Most of the centers also have a clerk and a social worker available at least part time,” she wrote in an email.

“Ensuring student health and wellness is a top priority,” Smith said. To supplement school nurses and health clinics, the schools have school wellness committees, work with Community Alliance for Research and Engagement (CARE) on programs like Health Heroes, and run a program called PAW (Physical Activity and Wellness) in 18 schools. At certain schools, the Boost! initiative helps ​“coordinate health and wellness services,” Smith added.

“During a time of limited resources for the district,” Smith wrote, ​“we are working with the city and others to come up with a broad plan on how to expand health services for our students and their families.”