Three additional nurses needed to approach meeting state standard

School nurses needed in Macon County, but with high demand for nurses and lower pay in public health service, that need has been challenging to fill.

In all, Macon County Schools are allotted up to five nurses, whose positions are supplied through the county health department. Only two of those slots are currently filled after two nurses left in August and a third position became vacant in November.

“We lost a third position last month, but with a shortage of nurses and the salary of nurses, we haven’t been able to fill those positions as quickly as we would like,” said Anne Hyder with Macon County Public Health Department. “Public health nurse salaries just aren’t competitive.”

According to payscale.com, a registered nurse in North Carolina makes on average $24.22 per hour. On a 40-hour work week, that equates to just over $50,000 annually. A public health nurse, level II, in Franklin makes closer to $36,000 a year, according to salary comparison Web site indeed.com. The site further indicates that salary is 20 percent lower than the national average.

“About 10 years ago the county gave us funding for the first two positions,” Hyder said, adding that the county was ahead of the game at that time. “Simultaneously, the state began legislative efforts to assist with school nurses. They did not factor in what the counties were already doing.” Macon County hired its first school nurse in January 2001.

Over the years, the state has supplemented that funding and now supports an additional three positions here in the county.

It wasn’t until 2004 that the State Board of Education targeted the goal of one nurse per 750 students. That same year, the North Carolina General Assembly approved the addition of 145 new school nurse positions to the 100-county statewide system.

The new legislation helped, but fell short of the state board’s recommendations.

In 2000, only seven North Carolina counties (including two city school systems) had school nurse to student ratios better than 1:999 (Kannapolis City Schools in Cabarrus County, Mt. Airy Schools in Surry County, Camden, Currituck, Dare, Davie, Graham, Hyde and Tyrrell).

By 2005, about 15 percent of all school children were reporting chronic illnesses that would benefit from a school nurse’s care, according to an October 2005 report from the State Department of Health and Human Services. Thirty-three school districts were still reporting ratios of more than 1 nurse per 2,000 students.

Right now, with two nurses on board in Macon County, nurses are operating on a 1 to 2,250 ratio. With a student population of 4,509, according to the 2008-09 10th day of school attendance standard, six nurses should support the school system. With the five paid positions available, Macon County would operate closer to a ration of one nurse per 900 students.

“Right now, on a daily basis, we each have five schools,” said Jennifer Garrett, head school nurse. “Basically, we visit one school each day of the week on rotation.”

She said the state standard of one to 750 is a good standartd, but hard to meet —especially here in Macon County where new school construction is in process and continued growth takes place each year.

“What they don’t tell us, is that they [the state] may be able to fix us for this year,” she said. But, in terms of funding, “with the economy being what it is, who knows what we will be able to expect from them.”

In addition to the low pay-scale, the isolated location of the county and the shortened work year can be negatives when trying to fill the position.

“Some people can see that as a carrot to have two months off, but that really affects pay, too,” Hyder said. “School nursing is very autonomous and they have to make a lot of independent decisions.”

Because of that, nurses are required to carry a BSN certification – a four-year degree in nursing and pass a state test for registered nurse certification.

Hyder said school nurses are critical as the number of special needs children is on the rise. Nurses are needed to assist diabetic and asthmatics and work to facilitate medical communication between parents, teacher and students.

“It’s very much a liaison position,” she said.

The state department of health and human services continues to work towards its goal of 1:750 nurses to student ratio by 2010. The 2008 Annual Report for North Carolina Public Health reported in the 2007-08 school year, 237,000 of the state’s children were living and coping with chronic disease. Thirty-nine of the 115 local education agencies have met the national standard of 1:750. Today, statewide the ratio stands at an average of one nurse per 1,226 students.

In 2007, the state allocated $4 million to hire additional nurses with another $4 million allotted for 2008. This amount would fund an additional 80 nurses statewide.

Funding is still reliant, however, on local taxes, LEAs and community support to supplement what the state is lacking in supporting this initiative.

Only two school nurses provide healthcare to more than 4,500 students in the school system. Each nurse is responsible for five schools and visits each school one day per week on a rotating basis. Above, head nurse Jennifer Garrett performs a routine lice inspection.