School Nurses: We Have Been Here All Along

In honor of National School Nurse Day, guest author Dr. Thomas Stinson, a school nurse and AFT member, talks about the vital role of school nurses which has been amplified during the COVID-19 pandemic.

How many people actually know what school nurses do? Probably not many. This is undoubtedly why, as National School Nurse Day approached, one of my mentors asked if I was willing to write a blog. As a practicing school nurse in an urban public school since November of 1997, I thought this was a great opportunity to share my perspective on the important role school nurses play within society which has been amplified during the COVID-19 pandemic. 

Performance Measurement In Healthcare And Education

A recent story in the New York Times reports that, according to an Obama Administration-commissioned panel, the measures being used to evaluate the performance of healthcare providers are unfairly penalizing those that serve larger proportions of disadvantaged patients (thanks to Mike Petrilli for sending me the article). For example, if you’re grading hospitals based on simple, unadjusted re-admittance rates, it might appear as if hospitals serving high poverty populations are doing worse -- even if the quality of their service is excellent -- since readmissions are more likely for patients who can’t afford medication, or aren’t able to take off from work, or don’t have home support systems.

The panel recommended adjusting the performance measures, which, for instance, are used for Medicare reimbursement, using variables such as patient income and education, as this would provide a more fair accountability system – one that does not penalize healthcare institutions and their personnel for factors that are out of their control.

There are of course very strong, very obvious parallels here to education accountability policy, in which schools are judged in part based on raw proficiency rates that make no attempt to account for differences in the populations of students in different schools. The comparison also reveals an important feature of formal accountability systems in other policy fields.

How Many Schools Don't Have Nurses?

In 2006, the National Association of School Nurses (NASN) commissioned the largest and, to my knowledge, most recent national survey on the availability of nursing services in U.S. public schools. It was administered to a sample of over 1,000 schools in all 50 states and D.C.

The primary purpose was to gather basic information on the health staff in these schools, as well as a few core characteristics, such as school size and student demographics.

I must confess that I was a little surprised by the results. Here is the distribution of schools by nursing availability, summarized very briefly (these proportions vary by school size, type and other characteristics):

An Uncertain Time For One In Five Female Workers

It’s well-known that patterns of occupational sex segregation in the labor market – the degree to which men and women are concentrated in certain occupations – have changed quite a bit over the past few decades, along with the rise of female labor force participation.

Nevertheless, this phenomenon is still a persistent feature of the U.S. labor market (and those in other nations as well). There are many reasons for this, institutional, cultural and historical. But it’s interesting to take a quick look at a few specific groups, as there are implications in our current policy environment.

The simple graph below presents the proportion of all working men and women that fall into three different occupational groups. The data are from the Bureau of Labor Statistics, and they apply to 2011.

AMA To Nurses: Teamwork Means 'Just Follow Our Lead'

Why are some doctors so threatened by nurses?  One recent example of such physician angst can be found in the American Medical Association’s (AMA’s) response to a recent report on the future of nursing by the highly respected Institute of Medicine (IOM). Among the IOM’s recommendations are that “nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States."

Being a “full partner”, the IOM report notes, “transcends all levels of the nursing profession and requires leadership skills and competencies that must be applied within the profession and in collaboration with other health professionals. It includes “care environments” (hospitals and medical offices) and the policy area. Nurses must “have a voice in health policy decision-making and be engaged in implementation efforts related to health care reform”, the report argues.  They must be “leaders throughout the system”. 

What? Full partners?  The AMA was quick on the trigger: “A physician-led team approach to care —with each member of the team playing the role they are educated and trained to play—helps ensure patients get the high quality care and value…”

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