Massachusetts study: School nurses provide economic benefit

2 Jun

The National Association of School Nurses provides the following information about school nurses:

How many school nurses are there in the United States?
According to the Health Resources and Services Administration (HRSA), there are 73,697 registered nurses working as school nurses (HRSA, 2010).

Click to access rnsurveyinitial2008.pdf

How are school nurses funded?
Local school district budget, state budget, EPSDT, Title I, Medicaid (accessed by only 42% of schools), and community sponsors.

The Robert Wood Johnson Foundation reported in School Nurse Shortage May Imperil Some Children, RWJF Scholars Warn:

Demand for school nurses is growing.
Medical advances are allowing more premature babies and others with severe health conditions to survive into adulthood, but these children often require complex, continuous care at home and at school. There is a rising incidence of diseases with life-threatening implications such as diabetes, seizures, asthma, bleeding disorders, and severe allergies, according to a 2010 report on the future of nursing by the Institute of Medicine (IOM). And there is an increase in mental health disorders, such as substance abuse problems, eating disorders, anxiety, depression, and aggression. “What we saw 20 years ago in acute care hospitals is what we’re seeing now in the schools,” Newell said.
Growing poverty rates are also taking a toll, Newell added. She sees students with rotting teeth who can’t afford dental care; students who share asthma inhalers and insulin strips with relatives because their families cannot afford enough supplies for each individual member; and students who go to school sick because their parents can’t afford to take unpaid time away from work to care for them.
Under these circumstances, an inadequate supply of school nurses can be deadly. In September, Laporshia Massey, 12, died after suffering a severe asthma attack at a Philadelphia school on a day when no nurse was present. Massey’s father has said that an on-site school nurse could have saved his daughter’s life. “We’re worried that more tragedies like this will occur” if students don’t have access to a school nurse, Maughan said.
A Vital Role
School nurses serve nearly 50 million students nationwide in nearly 100,000 public schools, according to the IOM report. They are a subset of the nation’s public health nursing workforce; learn more about this workforce in a 2013 RWJF report….

See, Are school nurses disappearing?

Denisa Superville and Evie Blad reported in the Education Week article, Philadelphia Tragedy Highlights Role of School Nurses:

The value of full-time, registered school nurses is not limited to the medical assistance they provide; there is also an economic benefit to society, according to a study published last month in the Journal of the American Medical Association.
Researchers studied 78 Massachusetts districts that participated in the state’s Essential School Health Services Program during the 2009-10 school year to demonstrate the benefits of having a full-time registered nurse on staff. The program cost $79 million, but researchers estimated that it saved $20 million in medical-care costs; $28.1 million in parents’ productivity loss; and $129.1 million in teachers’ productivity loss, generating a net benefit of $98 million.
Despite their medical and economic value, nurses are often among the first to go when districts face budget constraints because not every state requires a nurse to be in every school building, according to experts in the field. The U.S. Department of Health and Human Services recommends a ratio of one full-time, registered school nurse to every 750 students. The National Association of School Nurses suggests a lower ratio for schools with high numbers of students with special health needs, chronic illnesses, or developmental disabilities.
But in a 2013 survey of nearly 7,000 school nurses by the National Association of School Nurses, only 48 percent of respondents said they worked in environments that met or exceeded the federal recommendation—an improvement over 2011, when 43 percent met or exceeded that standard.
In the 2013 survey, 21.7 percent of the responding nurses reported that they covered several buildings and thus trained unlicensed co-workers to perform daily routines. And 16.2 percent of respondents said school nurse jobs in their areas had been threatened by cuts. Nearly 6 percent of nurses surveyed said other nurses in their district had been cut…


Cost-Benefit Study of School Nursing Services
Li Yan Wang, MBA, MA1; Mary Vernon-Smiley, MD, MPH1; Mary Ann Gapinski, MSN, RN, NCSN2; Marie Desisto, RN, MSN3; Erin Maughan, PhD, MS, RN, APHN-BC4; Anne Sheetz, MPH, RN, NEA-BC2
[+] Author Affiliations
JAMA Pediatr. Published online May 19, 2014. doi:10.1001/jamapediatrics.2013.5441
Importance In recent years, across the United States, many school districts have cut on-site delivery of health services by eliminating or reducing services provided by qualified school nurses. Providing cost-benefit information will help policy makers and decision makers better understand the value of school nursing services.
Objective To conduct a case study of the Massachusetts Essential School Health Services (ESHS) program to demonstrate the cost-benefit of school health services delivered by full-time registered nurses.
Design, Setting, and Participants Standard cost-benefit analysis methods were used to estimate the costs and benefits of the ESHS program compared with a scenario involving no school nursing service. Data from the ESHS program report and other published studies were used. A total of 477 163 students in 933 Massachusetts ESHS schools in 78 school districts received school health services during the 2009-2010 school year.
Interventions School health services provided by full-time registered nurses.
Main Outcomes and Measures Costs of nurse staffing and medical supplies incurred by 78 ESHS districts during the 2009-2010 school year were measured as program costs. Program benefits were measured as savings in medical procedure costs, teachers’ productivity loss costs associated with addressing student health issues, and parents’ productivity loss costs associated with student early dismissal and medication administration. Net benefits and benefit-cost ratio were calculated. All costs and benefits were in 2009 US dollars.
Results During the 2009-2010 school year, at a cost of $79.0 million, the ESHS program prevented an estimated $20.0 million in medical care costs, $28.1 million in parents’ productivity loss, and $129.1 million in teachers’ productivity loss. As a result, the program generated a net benefit of $98.2 million to society. For every dollar invested in the program, society would gain $2.20. Eighty-nine percent of simulation trials resulted in a net benefit.
Conclusions and Relevance The results of this study demonstrated that school nursing services provided in the Massachusetts ESHS schools were a cost-beneficial investment of public money, warranting careful consideration by policy makers and decision makers when resource allocation decisions are made about school nursing positions.

According to Truth About school nurses are a first defense against disease and injury. See, Why School Nurses Are Good for Children and Schools

In Why do we need school nurses? Truth About Nursing summarizes the importance of school nurses:

School nurses save lives, increase student attendance and decrease early dismissals. Here’s what school nurses do. They:
• are the first line of defense against epidemics and disease outbreaks, monitoring the health of the overall population and connecting with public health officials;

• are the first responders to critical incidents on school property;

• provide direct health services for students;

• identify threats to health in the school community (peanut butter, dogs, traffic, broken equipment and facilities, bullies, lack of clean water or hand soap) and work to elimate those problems as a cause of ill health;

• provide leadership for the provision of health services, health policies and programs;

• provide a critical safety net for the most fragile students;

• provide screening and referral for health conditions such as vision, hearing;

• promote a healthy school environment;

• enable children with chronic health conditions to attend school;

• promote student health and learning;

• serve as a liaison between school personnel, family, community, and health care providers.
Important information from the National Association of School Nurses:
“The Role of the School Nurse”
Student-to-School Nurse Ratio Improvement Bills

Also see:
“Unlocking the Potential of School Nursing: Keeping Children Healthy, In School, and Ready to Learn,” by the Robert Wood Johnson Foundation.

The study indicates that in the long run school nurses save money and increase the quality of life for children, their parents, and their communities. There is a nursing shortage and financially challenged school districts are in no position to compete for the scarce supply of nurses.

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