The Howard County schools should hire more nurses and health assistants and add more supervisors to better care for the rising number of health needs of students, according to a report presented to the school board last week.
The 18-month study of the school system's health services rejects the idea of putting registered nurses in all schools as being too expensive and unnecessary. Instead, it proposes a "cluster" model in which registered nurses rotate among groups of three to five schools, each of which would have a full-time health assistant.
This school year, the schools are using what administrators call an "ad hoc" system -- with health assistants at most schools and nurses at some, creating disparities among schools in the levels of health care that can be provided.
The proposal "is what we came down to as the ultimate compromise on all of the pieces -- budget and responsibility and safety," said Dana Hanna, a former school board chairman who headed the health service committee, which conducted the study. "This is what we consider a reasonable response."
But some Howard school board members were reluctant to support the idea, questioning the recommendation to add layers of administrative supervision at a time when the rest of the school system is trying to cut back.
No money in budget
Board members also said there's no money in next year's budget for the proposal, which would add about $515,000 to the $1.5 million the school system already spends each year on school health services. So regardless of what decision is made, it's unlikely any changes could be made until the 1998-1999 school year at the earliest.
The proposal comes at a time when the school system is struggling with rapidly increasing demands for health services -- both in terms of the number of student visits to health rooms and the severity of health problems posed by students.
In the 1994-1995 school year, the number of visits to county health rooms increased by 18 percent over the prior school year, while enrollment increased by less than 5 percent.
The number of children with such diseases as diabetes, allergies and asthma is increasing, according to medical experts, and the inclusion of more children with disabilities in regular classrooms puts more children with severe health needs in neighborhood schools.
"It's overloading the system," said Dr. Alan Leffler, an Ellicott City pediatrician and member of the committee.
Most students' health needs can be handled by health assistants, who are required to be certified in cardiopulmonary resuscitation and first aid.
But Maryland laws limit how much health assistants can do -- prohibiting them from doing increasingly common treatments for severe asthma attacks and for diabetics whose blood sugar levels can drop critically low.
Some students who require care that can't legally be given by health assistants have been forced to transfer to other schools that have registered nurses -- upsetting parents who want their children to attend their neighborhood schools.
Details of plan
The committee's proposal would put health assistants in every school, though school nurses likely would remain in the health rooms of schools that have students with particularly severe health needs.
Registered nurses would be put in charge of clusters of three to five schools that are close to each other, and they would roam between the schools -- probably with pagers and cellular phones -- to supervise the health assistants and care for some children.
Three health specialists would supervise the nurses, and a health services coordinator would oversee the specialists under the proposal. The proposal also calls for extra health assistants at schools with large enrollment, management training for the school nurses, and extra medical skills classes for all health assistants.
Some school board members questioned the wisdom of adding more supervision for health services. A similar proposal made about two years ago was criticized by board members for the same reason.
"What I see here are a lot of layers," said board member Karen Campbell. "I'm very concerned about so many layers."
Other board members said they need more time to think about the report and what level of health care should be provided by the schools.
Board members did not say when they will next discuss the report, but it seems likely to be put off until the summer or fall.
Pub Date: 5/12/97