Some school nurses in Utah are assigned to six or seven different elementaries. Others are instructing office staff how to give insulin shots because they don’t have enough time to administer them. In one district, the only nurse there is responsible for 34 times the recommended number of students she should have under her care.
The shortage is serious.
“These are just not good numbers,” said BettySue Hinkson, school nurse consultant for the state. “We are nowhere near where we need to be.”
An annual report on school nursing released Thursday by the Utah Department of Health chronicles the state’s continued struggles to staff enough nurses at its public K-12 institutions. And as the student population in Utah continues to grow, it warns, the problem could potentially become catastrophic with kids not receiving care when they need it most.
Currently, there is one nurse for every 3,773 students statewide. While that’s slightly better than last year — which had one for every 4,136 students — it’s likely not enough to make a noticeable difference, Hinkson said. It’s still more than fives times the national recommendation of one nurse per 750 students, preferred by the federal health department.
And, because that new ratio is just an average, it’s much worse in some school districts.
Kane County School District in southern Utah has just one part-time nurse for its 1,269 students. She’s contracted through the county health department, which helps pay her salary.
“We don’t have enough revenues to pay for a full-time nurse,” said Ben Dalton, district superintendent.
For those with registered nurses on staff, that puts Kane County School District at the highest ratio for nurse to students in the state — with more than 30 times the recommended workload. But Logan and Tintic school districts have no registered nurses at all.
The biggest part of the problem is cost, Hinkson said, in a state that consistently has the lowest per pupil spending in the nation. Many districts — like Kane — don’t have enough money to pay for the extra staff. A bill passed in the Legislature this year allocated some funding for new hires, but districts have to choose if they want a nurse, counselor, psychiatrist or social worker. And many are focusing on mental health.
Even to meet a lower threshold than the national recommendation and instead have just one nurse per school in the state would cost at least $78 million a year, and that’s using a low salary estimate, the health report notes.
Only one district in the state is even meeting that, too. Park City School District has one nurse for each of its seven schools, but it sits in a more affluent community and its associate superintendent acknowledged that makes it “super lucky.”
“We’ve really invested in it,” said Ben Belnap. “But we tend to have more funding than other districts.”
Even still, this is the first year Park City School District has had the full staff. Fifteen years ago, Belnap said, they still had seven schools but only one nurse. It currently has one of the lowest ratios for nurse to students in the state, at one to 869.
In Utah, overall, there are nearly 700,000 students in K-12 public schools. There are 220 nurses — not all of which are full time.
Fewer school nurses means fewer trained professionals to deal with everything from playground accidents to the spread of norovirus, which infected people in several schools and counties last fall, or pertussis and chicken pox. It also impacts children with serious medical issues, such as diabetes, asthma, seizures or anaphylaxis.
At least 23,968 students in Utah schools have one of those conditions, according to the report. (The data is somewhat limited because three of the 41 school districts in the state did not respond; but it does include some public charter schools). Those kids often need medicine administered daily by a trained individual. And sometimes they need emergency shots.
“We have a lot of students with health conditions,” Hinkson said.
In the 2018-2019 school year, there were 193,043 documented visits of students to their school health office. Personnel other than a nurse, including teachers and principals, responded to many of those cases, Hinkson added.
In the case of an emergency, not having trained medical staff could create a crisis, particularly if a student is having an allergic reaction.
The Utah Department of Health recommends one nurse per school — more for those with higher needs — or to at least not assign a nurse to more than five schools.
“That allows the nurse to at least go into the school one day a week,” Hinkson said. On average, though, Utah school nurses are currently assigned between five and 10 buildings in a district.
Sally Goodger, the lead nurse for Canyons School District, said many of the nurses that she oversees cover up to six schools. The district, as a whole, has roughly one nurse to every 4,000 students.
Canyons has nine nurses and plans to hire three more in the spring and three more next fall, according to its budget, for a total of 15. At that point, no nurse would be covering more than three schools, Goodger added.
“That’s the goal, to get down to a smaller caseload,” she said. “We’re on a good path.”
Nurses are also responsible for preventive care, such as teaching about hygiene and hosting maturation lessons. Last year, Canyons’ nurses conducted 13,000 eye exams.
“A lot of people think we’re Band-Aids and boo-boos. But we do a lot,” Hinkson said. “We do education about measles and immunizations. We do staff flu shots. We do a whole range of things.”
Hinkson expects to see the numbers for school nurse workloads improve again next year with Canyons adding more staff and Alpine School District, too, planning to hire 11 more nurses. And overall, the ratio is down from the 2016-2017 school year when it was the worst for the state, with one nurse for every 4,543 students.
“We’re doing better,” she said, “but it’s still not good.”