WEST NEWBURY — Just how many nurses are needed to keep students and staff safe and healthy in a regional school district? The Pentucket school board examines that question at a meeting tonight in the high school cafeteria. The discussion is slated to begin at 7:30 p.m., prior to a scheduled public hearing on the 2011-2012 Pentucket budget.
President Maria Gray of the Pentucket Association of Teachers told the committee last week that she first brought a concern about understaffing in the nursing department to the administration last November.
But in a memo to the school board dated Feb. 11, Superintendent Paul Livingston states that Gray's concern was not brought to him by any of the building principals or by the lead nurse, Kim Kelly, of Donaghue School, or the other nurses. The district, which has 3,129 students, employs a full-time nurse for each of its six schools.
However, in early 2010 the nurse at the district's regional middle school went on an extended medical leave. No long-term substitute has been hired to fill the spot, and the 15 registered nurses who are listed as potential substitutes are frequently not available, according to Gray.
Gray said there's no excuse for risking the well-being of students and staff by having fewer than one nurse for every school, every day. Livingston argued that the district is actually pretty close to meeting state guidelines, which are, after all, just recommendations, not requirements.
Instead, other Pentucket nurses — primarily high school nurse Lois Pencinger and Bagnall Elementary School nurse Jayne McNulty — are required to leave their buildings in order to provide services elsewhere in the district. Since October, there have been at least 15 times when one school building has been left without a full-time nurse on site. The union has filed a grievance, but the problem remains unresolved.
"We have dozens and dozens of medical conditions, some of which could be potentially life-threatening if prompt medical attention were not available," Gray said.
According to Pencinger, medical concerns at the high school include several cases of Type 1 diabetes, two wheelchair-bound students, one with cerebral palsy, four with seizure disorders, a Down syndrome student who has difficulty swallowing, 25 with allergies who require Epi-pens, one student with an implanted defibrillator to control heart issues and more than 50 with asthma.
Between October 2010 and January 2011, Pencinger was required to leave the high school 15 times to provide nursing care at the middle school — often called when she was in the middle of treating a student. At those times, she would leave the older teen in the care of an administrator until she could return. Why are the health care needs of one school taking precedence over another, Pencinger asked.
Livingston, School Board Chairman Rich Perrotti, and high school Principal Jonathan Seymour declined to speak on record for this article.
However, in an e-mail to Gray made public because she said doing so would not compromise the grievance process, Livingston acknowledged that substitutes are not always available, but insisted that it is the district's intention to provide coverage when a nurse is out. Given the current law, Pentucket is actually fortunate to have two registered nursing positions on staff at the secondary school campus, he wrote.
The state Department of Public Health recommends one full-time equivalent (FTE) licensed school nurse for each building of 250 to 500 students; another 0.1 FTE for each additional 50 students in buildings with more than 500 students; and 0.1 FTE for every 25 students in buildings with fewer than 250 students.
The recommendation stipulates that other factors to consider include "the number of students with special health care needs, the number of buildings and the distance and/or travel time between buildings."
However, the National Association of Nurses recommends one full-time registered nurse for every 750 students in the regular education program, with significantly smaller ratios for special needs populations or students with complex heath issues.
While the NASN states that districts should "provide a full-time registered nurse all day, every day, for each school," Massachusetts General Law is less definitive, indicating only that a district "may employ one or more" school physicians and registered nurses. It leaves it up to the district to decide on the amount of service rendered per district town by each nurse.
In his memo, Livingston pointed out that when he was hired in 2006, Pentucket had no comprehensive districtwide nursing guidelines, a liability risk that he addressed within his first two years by creating the School Health Services Policy and Procedures Manual.
As a registered nurse, Pencinger is required to uphold the Nurses Practice Act, which stipulates that although nursing activities can be delegated to other nurses or health care professionals, the ultimate responsibility for patient care remains with the primary nurse, who is legally responsible for all delegated activities whether she is in the school building at the time they are performed or not.
Some medications can only be administered by a registered nurse, Pencinger said.
"If a layperson were to give this medication, it would be viewed as the person practicing medicine without a license," she said.
No one would be OK with administrators pulling out a third-grade teacher from one school in the district to fill in at another school if it meant a classroom would be left without a teacher, Pencinger noted. Medical and mental health issues don't wait until a nurse is back in the building to present themselves, she said.