By Susan Abram, Staff Writer | LA Daily News
School nurse Evangeline Arafiles checks on student Emily... (Michael Owen Baker/Staff Photographer)
August 8, 2008 - NORTH HOLLYWOOD -- The backpack Evangeline Arafiles slings across her shoulder each morning holds the tools of her trade: a lilac-color stethoscope, thermometer, oximeter, penlight and stopwatch.
There isn't a Band-Aid in sight.
As a school nurse at Lowman Special Education Center, Arafiles oversees about 150 students, and there often is another registered nurse with her on site.
And despite having to insert catheters, inject insulin, treat seizures and monitor asthma, because she only has to look after 150 kids, she's one of the lucky ones.
"If you were to compare a school nurse from 40 years ago, she was someone who usually waited for a student who needed a Band-Aid," said Nancy Spradling, executive director of the California School Nurses Association.
Once known as "Band-Aid Queens," Arafiles and other school nurses have increasingly become a safety net for thousands of children.
But as their roles have changed, the nurse-to-student ratios haven't, a concern among industry groups who say complacency, budget cuts, a personnel shortage within the profession and an overall misperception of what school nurses do all collide to place children at risk.
Federal guidelines require one nurse for every 750 students. But California ranks 44th in the nation, with a ratio of 1:2,300. Of the nearly 1,000 school districts statewide, half have no school nurses at all, Spradling said.
Within the Los Angeles Unified School District, the second-largest in the nation, there are 600 registered nurses for nearly 700,000 students - or a ratio of 1:1,167, school officials said.
But in some parts of the city, that ratio can swell to 1:4,000.
The shortage comes at a time when children's health issues are grabbing more headlines:
The leading cause of absenteeism among LAUSD students with chronic diseases is asthma, which afflicts some 63,000 students.
Of children born in 2000, about one-third of the boys and 39 percent of the girls will develop type 2 diabetes, according to the California Center for Public Health Advocacy analysts' estimate.
Less than 21 percent of LAUSD students met all the criteria considered to comprise a healthy lifestyle, according to California's statewide fitness exam.
A school nurse's job already was challenging because of a federal mandate in 1975 that required schools to accommodate disabled students.
"We welcome those kids. We want them to come to school and they have that right," Spradling said. "But today, school nurses are managing kids who need pharmaceuticals, children with cardiac problems, cancer, kidney treatments."
Burden of care
The lack of nurses has placed a burden on teachers, office workers and other staffers, but many don't want to be in a position to give first aid, said A.J. Duffy, president of United Teachers Los Angeles.
"The ratios are too high," he said. "Teachers have been told in the past that they would have to do certain things. At one point, the district wanted teachers to give shots. Our nurses were up in arms."
The California chapter of the American Nurses Association filed a lawsuit last week against the state's Department of Education, which is calling on unlicensed volunteer school employees to administer insulin to students with diabetes.
"Not only is the California Department of Education breaking state law with this directive by violating the established scope of nursing practice, but by negating the need for licensed nurses to administer insulin, they are placing the children at risk," Rebecca Patton, president of the ANA, said in a prepared statement.
Duffy said even though the nurses could train teachers, the district training would likely fall short of what teachers need to know in a medical emergency.
"We have a certain degree of student population that are at risk and they have a right to have a medical professional to be there for their needs," Duffy said.
Last year, the LAUSD was ordered to pay $7.6 million to the family of an epileptic boy who suffered a seizure at a North Hollywood elementary school, according to published reports.
The boy's family said the response to his seizure in 2005 was inadequate because several minutes passed before CPR was administered by a playground supervisor. There was no nurse on campus that day. The district argued that adults responded as best they could.
Grants are sought
Federal legislation was introduced again in June by Rep. Carolyn McCarthy of New York and Rep. Lois Capps, D-Santa Barbara, once a school nurse herself. They are asking the secretary of health and human services to make grants available to eligible states to help reduce the nurse-to-student ratio.
"We're all very concerned about access to health care in the federal government," Capps said. "When kids come to school and they've never had a checkup, they come with a lot of health problems and it's a real challenge."
Still, in its most recent budget, the LAUSD cut funding for nurses to early childhood education classes or preschool.
"That, to me, is a challenge because how do we meet those needs of those in early education?" said Connie Moore, the district's director of nursing services.
"Through early detection, we can see if a child needs a pair of glasses or has an ear infection. If we just had a nurse in every school, we would be available to follow up with these children."
The district is now filling a dozen vacancies and has been able to hire 100 nurses in the past two years, especially for schools near downtown.
But there is competition for registered nurses from hospitals, and other health settings also are facing shortages.
Meanwhile, Arafiles considers herself lucky. She remains on campus all day. There is a second school nurse on staff. And she oversees fewer students than most of her peers.
Still, the job can be challenging.
"The work is rewarding," she said, "but we are stretched to the limit."
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