Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, December 27, 1993 TAG: 9312270031
SECTION: VIRGINIA PAGE: B-1 EDITION: METRO
SOURCE: LAURA WILLIAMSON STAFF WRITER
DATELINE: LENGTH: Long
At Troutville Elementary School, Principal Sandra Tunnell locks anti-seizure medication in her office for two pre-kindergarten students. She and her secretary hand out the pills each day, along with Bactine for cuts and scrapes and calamine lotion for poison ivy.
In Roanoke County, School Health Coordinator Lavern Baird shows teachers and special education aides how to insert urinary catheters, change the special colostomy bags that collect human waste, and tube-feed children with birth defects.
Baird demonstrates the procedures so the teachers can perform them in her absence. Although she is a registered nurse, she has only one assistant to help her care for the growing health needs of the county's 13,000 schoolchildren.
Tunnell gets even less help - Botetourt County employs no school nurses.
"Our personnel is not trained to give medications, and they're doing it on a daily basis," said Botetourt Superintendent Clarence McClure. "We're concerned about that."
So are others.
Backed by medical, education and parent associations, Del. Linda Puller, D-Mount Vernon, will reintroduce a bill next year directing localities to provide one registered nurse for every 1,000 students. The bill would allow localities to contract with health departments for the service.
The ever-present need for student health care, said Puller, has grown stronger in recent years with the move to include emotionally and physically disabled children in regular classrooms. As a result, teachers, secretaries and principals now find themselves learning to dispense medication, administer shots and wrestle with complicated and sometimes embarrassing medical procedures.
"If parents were really aware of it, they'd probably have a fit," she said.
The school-nurse proposal, studied by the General Assembly since the 1970s, has failed repeatedly to make it into law. It came closest this year, passing the full House of Delegates before stalling in the Senate Committee on Education and Health. Supporters find hope in its recent progress, however, including the bill's referral to the Department of Education for further study.
Last month, the department presented a report to the state Board of Education outlining the number of school nurses employed by each school division and the amount of money each locality spends on student health.
What it failed to report, however, was how much the state pitches in to pay for those services. The Senate committee and the state board want to know how far $5.8 million in state money earmarked for student health goes and whether localities actually are using it for health needs.
John Rickman, an Education Department budget specialist, said he will present that information at the board's Jan. 6 meeting.
"They want to see, division by division, the state's contribution," he said.
School administrators say it isn't much.
McClure called state legislators' assertions that they already provide some money for school nurses "a lot of bull."
"When they say they put the nursing care in [to the formula providing basic aid to schools], I didn't get any additional money," he said.
In fact, McClure said, he got less.
Even taking the $5.8 million into account, educators say, that's only $5 to $6 for each student in Virginia.
That is not enough to hire even one nurse, said Salem Superintendent Wayne Tripp. In Salem, where there are 3,750 students, $5 per child would amount to $18,750. Tripp estimates he'd have to spend between $21,000 and $33,000 per nurse.
"It's not realistic," he said.
Puller hopes the study will show that it is realistic - at least enough to get started. While she hasn't finished writing next year's version of the bill, she said it likely will require localities to provide one registered nurse per 2,500 students the first year. Localities would be expected to use the money now allocated by the state.
She called the bill "more of an incentive" than a mandate, yet admitted it provided as much stick as carrot.
"They won't get the money if they don't spend it on health," she said.
The carrots would follow in subsequent years, Puller said, as localities phased in more nurses to meet the 1-to-1,000 nurse-student ratio.
The number of registered nurses employed by schools ranges from zero in Botetourt and other counties to 82 - one in each school - in Virginia Beach.
How much money the legislation would provide over how long a time remains uncertain. Puller said she still is working that out but may follow this year's version of the bill, which created a four-year phase-in period and cost $14 million.
The local share to provide one nurse per 1,000 students would amount to $11 million across the state, Puller estimated.
Judy Castleman, legislative liaison for the Virginia Association of School Nurses - which is helping to craft the bill - said a registered nurse should cost a locality no more than $24,000 per year, including benefits. School nurses often work for significantly less, she added.
She said the bill should require no new state money for the first two years, relying solely on what is already being provided. It will call for one nurse for every 2,000 students by the end of the second year.
If some localities are spending the money on transportation or other services instead of on health, she said, they're just going to have to change.
Castleman said she would like to see the state provide $3.7 million in the third year for a 1-to-1,500 nurse-student ratio and $8.4 million in the fourth year to bring the ratio down to one nurse for every 1,000 students.
Some localities plan to hire the nurses with or without legislation.
"The state law would help us," said Dick Kelley, executive for business affairs for Roanoke schools.
Roanoke pays for five full-time nurse positions, plus has two more who work at school health clinics under a grant from Carilion Health System. The city plans to phase in up to four nurses per year for each of the next two years, a course that would net the city more than the 1-to-1,000 ratio by the 1995-96 school year.
Kelley said any law providing state matching funds would ease the city's financial burden.
Franklin County already meets the proposed ratio, with more than seven full-time nurse positions for 6,500 students.
"I'd really like to have one at every elementary school," Superintendent Leonard Gereau said. "I'll never get it."
Perhaps not, but Puller is optimistic about the chances of bringing other localities in line with counties such as Franklin. Her next step, she said, is convincing the state board to back her bill. While the endorsement will not guarantee passage, it could make the battle easier.
"It's an important group to have on your side," she said.
James P. Jones of Abingdon, state board chairman, said he was sympathetic to the need for better health care for students but reluctant to force localities into doing something they could not afford.
"I frankly just haven't decided how I'm going to come down on this particular issue," he said.
Other groups have made their feelings clear. Puller has earned the backing of the Virginia Nurses Association, the Medical Society of Virginia and the Virginia Pediatrics Society.
The state Parent-Teacher Association also jumped on board this year; in Roanoke, the PTA Central Council has asked members to lobby legislators to pass the bill.
And there's no question about where the Virginia Education Association stands.
School divisions must hire registered nurses, said VEA President Rob Jones - even if they must be forced to do so by state mandate.
"The bottom line for our organization is: You've got kids in need of the service," he said. "Somebody needs to ante up for the safety of the children."
Keywords:
GENERAL ASSEMBLY 1994
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