‘Never-ending work’

Patty Sagers has been a school nurse in Butte County since 1999. During that time, she has seen workloads increase, both in quantity and acuity—and she’s not alone in that observation or circumstance.

Nationwide, particularly in California, school nurses care for an increasing number of children. And they don’t just treat cuts and bruises—they administer injections, change urinary catheter bags and stop seizures. Sometimes they do all of this in one day, on multiple campuses.

“There’s just never-ending work,” said Sagers recently. She has worked for the Paradise Unified School District (PUSD) for 10 years. “The more you know about the job, the more there is to do.”

Sagers wasn’t complaining; she was explaining reality. She and Janine Roy are the two registered nurses for approximately 3,700 PUSD students from kindergarten through 12th grade. Sagers covers one elementary school, the intermediate school, the comprehensive high school and the alternative high school—but if a call comes from another campus, she may need to rush from Paradise to Magalia.

PUSD is typical of districts across cash-strapped California. The National Association of School Nurses conducted a study in 2009 that found school nurses in our state, on average, have 2,187 students under their care. HealthyCal.org reports that one Southern California district has just one nurse per 13,000 children, and some rural districts assign a single nurse to cover students in schools located hours’ drives apart.

Staffing levels have decreased since the 1970s, when the passage of Proposition 13 impacted the revenues state and local governments receive from property taxes.

“Before Prop. 13, every school in California had a school nurse,” Linda Davis-Alldritt, the Sacramento-based president of the National Association of School Nurses, told HealthyCal.org. “After that, the number of school nurses gradually declined.”

The state has approximately 2,500 school nurses, down more than 400 in just three years. Davis-Alldritt told HealthyCal.org that nursing positions are among the first cut by districts during budget crises.

Ironically, nurses generate money for the schools they serve. Both Medicare and Medi-Cal pay districts to perform medical services that require certified professionals like registered nurses. “Health secretaries”—secretaries with training in basic health-care—work at each PUSD campus, but the scope of their treatment has limits.

Health secretaries represent “a decent compromise not to lose that service when bad budget cuts hit the district—all districts,” said Mary Ficcardi, PUSD’s director of special services, which include special education and nursing. “Whoever comes to us, we serve. The more high-need the students, the more involved the nurses are with them.”

Sagers worked as a pedi-atric nurse and a home-health nurse before joining the Butte County Office of Education (BCOE) 13 years ago. She transferred to the Paradise school district in 2002, the same year Ficcardi left BCOE for PUSD.

Her job is diverse and multifaceted. As a school nurse, Sagers’ responsibilities include:

• managing—and educating staff, students and parents to manage—chronic conditions such as cerebral palsy, asthma and diabetes;

• conducting assessments, such as vision, hearing and scoliosis tests;

• administering immunizations;

• coordinating services with outside agencies such as Butte County Public Health, the Far Northern Regional Center and California Children’s Services; and

• documenting all these services for state and federal entities, which monitor as well as reimburse school districts.

“There are a lot of reports,” Sagers said. “You just do it.”

With her credentials, which include a master’s degree on top of her RN degree, Sagers could fill a number of other nursing positions—ones where she might not have to work five hectic days a week, and where she’d have more face-to-face time with patients.

But, she offered, “I like what I do. I like it when a first-grader comes into the office to show me her new pair of glasses, and no one knew she had a vision problem. I like seeing progress. I like being out and about. I like the people I work with.”

Ficcardi said she feels “blessed” to have two “very, very seasoned nurses” on staff. She also points to collaboration within PUSD to meet the growing needs of students.

Health secretaries handle myriad scrapes and aches. Counselors take care of some mental-health matters that in other districts fall to nurses. Community members and groups step up to meet needs, including the rush of Tdap immunizations (for tetanus, diphtheria and pertussis) mandated by the state last year for students entering the seventh through the 12th grades.

“Even though we’ve had to tighten our belts like everyone else, we’re used to living with less and are creative about helping each other,” Ficcardi said. “When you aren’t rich, you’re not used to what you’re missing. But, we’re really rich in our people.”