COOS COUNTY – School nurses are being stretched thin making student health care more difficult to provide.
Medicaid cuts in 2007 prevented schools from being able to keep a nurse in every building. Some districts lost all of their nurses.
In September, the Graham-Cassidy bill was proposed by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) that would have not only dismantled Medicaid expansion and system subsidies to help people afford health insurance, but it would have impacted education’s ability to keep nurses onsite.
"Over and over, Republicans in Congress have tried to pass a plan to rip health care from millions, and the American people keep rising up to stop it,” U.S. Sen. Jeff Merkley of Oregon wrote in an email to The World. “When Senate Republicans geared up for one last attempt to slip a repeal bill through, teachers' unions, students, and countless other Oregonians took a stand against eviscerating Medicaid; gutting protections for people with preexisting conditions; and devastating school health systems. It was thanks to grassroots America that once again, we were able to rise up and defeat this diabolical scheme before it was too late.”
Part of the grassroots effort to stop the bill was Teri Jones, the Zone 4 Director for the Oregon School Employee Association (OSEA) and the library media clerk for the Coos Bay School District. When she went to Washington D.C. in September to lobby against the bill, she found chaos on the Congress and House floors. Where one bill fails, she said, it’s never really gone.
“When we got there to lobby, the Graham-Cassidy bill was being put forth to make major cuts to health care and education, so it became what we were speaking about,” Jones said. “Of course, we didn’t know for sure what we were going to lobby for until we arrived because it is just so chaotic over there. The health care act is gone and then is back and then is gone again all in the same day. When I spoke with Sen. Jeff Merkley he said, ‘Don’t ever think anything is gone.’”
School nurse crisis
Jones and the other OSEA representatives chose to lobby against the Graham-Cassidy bill because of its impact on school nursing. When a nurse isn’t in a building to help a student, the responsibility falls onto school secretaries.
“At the Coos Bay School District, we have amazing secretarial staff but even so, having insulin injections become part of my job duties would make me uncomfortable because I don’t have medical training,” Jones said.
“It’s not a good situation,” Lindsay Reeves, nurse coordinator for the Coos Bay School District, said. “Secretaries are handling their duties and tasks and then are expected to do nursing tasks on top of it, which they do under the license of a registered nurse, so my license, which isn’t fair to them either.”
Jones posed a hypothetical situation where a student at Madison Elementary discovers he or she is diabetic. As a child, “you don’t know when there is a trigger and they need to be monitored carefully.”
There is no nurse in the Madison building, so giving insulin to students with diabetes is a daily routine. Reeves pointed out that insulin is a potentially deadly drug that if administered in the wrong dose could prove fatal.
“If they are trying to manage the phone and then administer insulin safely, that is a difficult thing,” Reeves said.
Blossom Gulch Elementary School secretary, Taryn Kirk, is one of the people who fills in for Reeves when she isn’t in the building. Kirk explained that the extra nursing duties add more work to her day but most importantly, “It’s detrimental to all the students in the school.”
Not only that, but school nurses help keep watch over medically fragile students, connect them to community resources if a student doesn’t have health insurance or if they are homeless, or help them find resources for health needs such as a new pair of eyeglasses. Nurses also help students who find themselves in a mental crisis.
“Without nurses, all of this would slip through the cracks,” Reeves said.
Though the National Association for School Nurses recommends one full time nurse per 750 students, it is not a requirement.
Before the last recession hit, the Coos Bay School District had one nurse in every building. After the recession, the district was faced with either cutting nurse positions funded through Medicaid, or having to pay for those positions themselves.
“We decided nurses are important and we wanted to keep them,” Coos Bay School District Superintendent Bryan Trendell said.
When Medicaid funds began to dry up, the district moved away from relying on that money to pay for school nurses.
“Currently we receive a small chunk out of this budget from Medicaid, which is about $10,000,” Trendell said. “At one point it had grown high in our district and became a sizable chunk of $80,000, but this was over five years ago when the superintendent at the time and our business manager decided to use that money to pay for a part time nurse.”
Right now, the district employs two full-time nurses and one part-time nurse. If the Medicaid account builds up again the next two years, the district can beef nursing up.
“If more cuts to Medicaid were made, it depends on what they would cut if it impacts us,” Trendell said. “Right now we’re not sure because everyone is unsure what is coming out of the federal government. Any type of cut in Medicaid at this point wouldn’t affect us because we’ve separated ourselves from it, but it would impact our future ability to build the account up to fund more nurses because we don’t have enough. What we’re doing now is filling the gaps.”
Though Coos Bay Schools separated itself from relying on Medicaid funding for nurses, smaller districts weren’t able to do the same. Some local districts either purchase nursing services through the Education Service District (ESD), while others can’t find any nursing services.
The Central Curry School District isn’t close enough to ESD offices to contract with them. According to Trendell, Central Curry Schools have tried working with their local hospital but are having trouble getting cooperation.
“There’s frustration because they have needs and are scrambling to figure it out to make sure their kids are getting what they need,” Trendell said.
The World reached out to the Central Curry School District for comment but received no response.
“Medicaid certainly concerns us,” Trendell said. “We want a clear picture so we can plan. If reduction in funding impacts us, we need to build our budget.”
“Preaching to the choir”
OSEA's Jones has seen unending cuts to education funding since the recession and while other parts of the economy began to recover, education never did.
“The problem with education is when a program like art and music gets cut, they don’t come back,” Jones said. “Education isn’t playing catch up, it’s just hanging on. I think federally they would like to say schools are a state’s responsibility, but when you put it on a state budget, where are you taking it from? Mental health? Fire and police?”
Jones lobbied during the Oregon state legislative session to find a better funding source for education rather than “steal from each other.”
While Jones lobbied in D.C., she met with Merkley, U.S. Sen. Ron Wyden and Rep. Peter DeFazio. However, she didn’t get to see Rep. Greg Walden or any local Republican representatives.
“We try to see people overseeing committees important to our issues,” Jones said. “Usually we will speak to them, but we didn’t get those appointments this time. Either they were too busy with the chaos, but no one said they couldn’t speak to us because . . . well, they had no excuse. I didn’t see a single Republican and that bothers me. All we did was preach to the choir. Were we heard? Yes, but everyone said they wished they could help but again, they were part of the choir.”
Jones urged the public to watch what is being done for Medicaid and education in D.C. because “this isn’t a time to have your head in the sand.”
As the library media clerk at Madison Elementary, Jones recently picked a book to read to students called “The elephant in the dark.”
“It’s about how people in the story are so busy arguing that what they are touching is a snake or a tree trunk that they aren’t listening to each other,” she said. “I picked it for a reason. It’s time we all start listening to each other.”