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School nurses key to reopening schools, but new research shows equity gaps in Washington
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School nurses key to reopening schools, but new research shows equity gaps in Washington

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Just as a slew of Washington school districts are planning to bring more students back into buildings this year, a new study from University of Washington researchers suggests that many districts are short of school nurses, who will play a critical role in developing pandemic-related health and safety plans and will care for sick students.

Statewide, schools employed an estimated 978 full-time equivalent nurses in 2019-20, up from 625 two years ago, the researchers found. But Washington has more than 2,000 public schools, suggesting that many buildings still don’t employ a nurse full time.

The findings also suggest vast gaps, like in the health care system at large, in who has access to medical care at school.

Districts in rural corners of the state, and those with more low-income children, have fewer school nurses per student, the researchers found. Conversely, districts with more Black, Native Hawaiian, other Pacific Islander or multiracial students have more nurses per capita. This might be because students of color have a higher prevalence of certain chronic illnesses, according to some research, and districts choose to hire more nurses to meet this need.

School nurses and other school-based medical staff constitute what many researchers call a “hidden health care system.” Students don’t need appointments, insurance or transportation. The result: School nurses help ease racial and income-based disparities common in other health care settings by providing basic care to students who might not otherwise receive it.

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In pandemic times, on top of their regular duties, these critical medical staff members are charged with screening or testing staff and students for COVID-19 symptoms, contact tracing when cases crop up and tending to students who fall ill at school.

“There’s going to be a lot more COVID-related stuff that schools are going to have to do, right? And who is going to do that?” said Mayumi Willgerodt, who was involved in the research and is associate professor of child, family and population health nursing at UW. School nurses “are trained to do the assessments and make those judgments that I’m not so sure others can do.”

The researchers also found that in many rural places in Washington, the school nursing shortfall overlaps with areas that are poorly supplied with primary medical care for the community at large.

According to the UW research, on average, each Washington school nurse serves 1,173 students. That ratio has declined from 1,605-to-1 in the 2000-01 school year. For comparison, the American Academy of Pediatrics recommends one nurse per school. In Washington, that would work out to a ratio of one full-time nurse per 482 students, the researchers say.

The researchers calculated nurse-to-student ratios using 20 years of data from the state Office of Superintendent of Public Instruction and the state Department of Health.

The role of the school nurses has expanded over the past 20 years, the researchers say. The percentage of children with chronic health conditions is rising, and state and federal laws have increasingly reinforced the role of schools in keeping children healthy.

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