While the health needs of Massachusetts’ students have grown increasingly complex, many thousands of students receive no, or inadequate, school health services. At the same time, Governor Romney has proposed elimination of the School Health Program in his FY’05 Budget. By discontinuing this successful program, school nurses will be laid off and thousands of children will no longer have access to needed nursing services which, in turn, will impact their ability to attend school.

To help address this problem, school nurses, parents, students and health care advocates converged on the Massachusetts State House on Wednesday, March 24, 2004 from 8:30 A.M. – 11:30 A.M. for a School Health Advocacy Day.

The event, hosted by the School Nurse Services Collaborative, featured a number of speakers including government officials, parents, school administrators and school nurse representatives. All hoped to educate legislators and demonstrate strong support for legislative efforts to reject the governor’s proposals and to reinstate the $12 million in funding that is needed to maintain the standard of care needed to service the growing population of students with mild to severe health needs. Among those speaking at the event was Anthony Delmonaco, a 10-year-old 4th grader from Pembroke, who helped galvanize support for this issue with letters he wrote that were published in both the Boston Globe and Patriot Ledger detailing his fears of losing access to his school nurse, who helps him cope with his asthma.   (CLICK HERE to read Anthony's full speech in support of his school nurse.)

In 1998, the Massachusetts Department of Public Health presented a plan to the House and Senate Ways and Means Committees for the expansion of school health services. In FY 2001 and 2002, the legislature responded by increasing funding for school health services. In 2003, the legislature rejected the governor’s first attempt to eliminate the successful Enhanced School Health program that funds school nurses in cities and towns with children lacking access to adequate health care.

School nurses provide a valuable social and health care safety net, particularly in tough economic times as school nurses are a primary source for poor or uninsured children to have access to health assessment. Also, in the wake of growing concerns over bioterrorism, school nurses provide a readily available resource for early detection and rapid response in local communities to a public health emergency.

As early as 1992, a special commission relative to the practice of school nursing recognized the unmet needs of Massachusetts students and concluded, “Children attending schools in the Commonwealth today are faced not only with the usual and common infectious disease, they face the threat of other major health problems not always well understood by teachers, parents and the community. Special needs children integrated into classrooms of every town have significant health and nursing needs, including such things as catheterization, suctioning and the administration of complex treatments. The administration of medication and the monitoring of their effects, couple with the needs of children from dysfunctional families, further complicates the picture of school health.”

According to Marcia Buckminster, Director of School Health Services for the Framingham Public Schools, the commission report accurately depicts the conditions in her schools, as well as schools throughout the state. “Within the last school year, our nurses have cared for acute, chronic and emergency health problems such as asthma, attention deficit disorder, migraine headaches, epilepsy, heart conditions, diabetes, life threatening allergies, arthritis and hemophilia. We have had students coming to school requiring colostomy care, intravenous medications, nasogastric feeding and other procedures.”

School nurses are also required by law to conduct annual postural, hearing and vision screening tests on all students and monitor compliance with school immunization regulations. They also provide health education to students, teaching healthy lifestyles, as well as management of illnesses.

Good morning.

I appreciate the opportunity to speak with you today and lend my voice and that of my colleagues in educational administration to the support of essential and quality nursing services in our schools. We should be proud that our commitment to educational opportunity has opened the school door wider than ever before. Today’s schools have very different demographics than those of the past. Our schools are more accessible to medically challenged students and families than ever before. Twenty-five percent of our students come to school today with some form of medical impairment. This number increases in our urban areas. Almost twenty-one percent of children in the United States, between the ages of nine and seventeen, have a diagnosed mental or addictive disorder. (Department of Health and Human Services, 1999) In Massachusetts, twelve percent of our school age children live in poverty and do not have appropriate access to primary care and many lack insurance.

The advances in medical technology have enabled more children with significant health care needs to attend school. Medical procedures that at one time could only be provided in hospital settings are now being performed in school settings by our school nurses such as catheterizations, tracheostomy care, colostomy care, intravenous infusions, feeding tubes, and insulin pump care to name just a few.

The students who attend our schools today have chronic health conditions that range from the minor to the severe. Today’s school nurse must be prepared to treat allergies, asthma, substance abuse, injuries from domestic violence, sexually transmitted diseases, pregnancies, emotional distress, and conditions resulting from congenital defects. The list is endless.

Added to that are the responsibilities of screenings for the early detection of hearing, vision, and postural defects, and special needs. The school nurse responds to the incidence of communicable diseases such as sexually transmitted diseases, chicken pox, hepatitis, and meningitis. Nurses not only work to prevent the spread of disease, but also to allay community fears. Each day hundreds of medications are administered. And it should be understood that requests for treatment are not made by appointment. The flow of service requests defies even the best schedules and organization.

Why do we do all of these procedures in our schools? Is it to increase jobs and expenditures in our schools? Of course not. We do it because it is an essential component of our commitment to serve all children and youth. We do it to provide equal access to education and provide the support necessary to achieve a positive outcome.

We have set some very challenging academic goals for our schools, Massachusetts Comprehensive Assessment System (MCAS); No Child Left Behind (NCLB), with high standards of academic excellence and proficiency for all. Educators want to meet those challenges. We are not afraid of accountability, but we want the tools necessary to attain those very challenging goals. Consider the following. NCLB requires that we maintain a 95% attendance rate in our schools. The school nurse helps us to provide the necessary accommodations to keep students in school, in class, and in the least restrictive environment. Absenteeism would soar without the support of school nurses. Can we expect our teachers to cover more rigorous material and at the same time attend to the medical and emotional needs of our most challenged students?

We need to provide the right supports to our classroom teacher. When a student is distressed and distracted for physical and/or emotional reasons, it won’t be extra tutoring that gets him or her back on track. More often it will be a school nurse.

If we are truly concerned with achievement of high standards for all, we will recognize and support the work of our school nurses. Study after study supports the fact that good school health programs are essential to increased academic performance. Desmund O’Byrne in a 2001 study for the World Health Organization wrote, "Good health supports successful learning. Successful learning supports health. Education and health are inseparable."

An U.S. Department of Health report, 1992 stated "Health is a silent partner to education. The health and wellbeing of children are directly related to their academic performance." (Novello, DeGraw, and Kleinman)

The 1989 Carnegie Council on Adolescent Development reported "Students who are hungry, sick, troubled or depressed cannot function well in the classroom no matter how good the school."

There are those who, despite the research evidence from a wide range of sources, believe that schools should not or cannot take on health issues. This position is absurd when we realize that 95% of our children are in school and that there is such a profound link between health and learning.

We should not underestimate the importance of school nurses. They are critical to our ability to address the health and education needs of our students and their families. Nurses are one of our greatest resources for closing the achievement gap between the advantaged and disadvantaged.

To be effective, education must address the "whole child."

In a joint statement on school health former Secretary of Education Richard Reilly and former Secretary of Health and Human Services Donna Shalala said, " America’s children face many compelling education and health development challenges that affect their lives and futures. To help children meet these challenges, education and health must be linked in partnership… school health programs support the education process… integrate services for disadvantaged and disabled children, and improve children’s health prospects."

In the long run, our ability to keep students in school, healthy, and focused will do more for academic achievement than the drill of academic tutoring. I’ll take a school nurse over a tutor any day of the week.

With effective healthcare we can help students learn more, we can reduce discipline problems in our schools and cities, we can produce more productive citizens for our future. Investment in Essential School Health Services should be a "no brainer."

The school nurse plays an important role as a health educator. Most serious illness and early mortality are the results of high health risk behaviors established in childhood. Six of these behaviors can be altered to prevent disease or death, poor eating habits, physical inactivity, tobacco use, drugs and alcohol abuse, accidental or intentional behaviors causing injury, and unprotected sexual activity. Education can help prevent children from engaging in these behaviors. (L. J. Kolbe, 1990, Health Education Epidemiological Surveillance System to monitor youth risk behaviors that most affect health)

C. Everett Koop, former U.S. Surgeon General stated "Health care is vital to all of us some of the time… but public health is vital to all of us all the time." The school is a very important public health setting. We all recognize that the "biggest budget buster" is the cost of Medicaid. We will never get those costs under control by cutting back on front-end health services in our schools. We must promote healthy lifestyles from an early age if we expect to curtail cost for medical services.

The full funding of the Essential School Health Services program in our schools needs to be increased not eliminated. It is a critical component of a successful school.

The fight for sufficient and quality health services and education in our schools is more than a fight for academic excellence. It is our commitment to the whole child, our commitment to a healthy future, and our commitment to a productive economy and to a healthy society.

I would like to thank the legislators who support essential school health services, the Massachusetts School Nurse Organization, Massachusetts Nurses’ Association, and those organizations that have joined this advocacy.

In Support of My School Nurse (A Speech Delivered at the Sixth Annual School Health Advocacy Day) Fourth-grader Anthony Delmonaco

My name is Anthony Delmonaco. I am 10 years old, and I live in Pembroke, Massachusetts. I go to Bryantville Elementary school. A few months back I heard that Governor Romney was going to cut back on school nurses. It made me very upset and mad. I was yelling, and my mom told me getting mad isn’t going to help and that if it means a lot to me that I need to write a letter. So I wrote my letter and sent it out to the papers. I didn’t think that anyone would print it because I was a kid. But I was wrong. People did listen to me, and people from all over read my letter. I even got a call from Baltimore Maryland. They asked if they could reprint my letter and I said yes. I like my school nurse. She is also my friend. I have known her since the first grade. I have asthma. Mrs. Regan has taught me how to use my inhaler. Some other things she has helped me with – I broke my leg last year. Mrs Regan said my cast was too tight, and she was right. I had to go back to Children's, and they gave me a new one. Just a few months ago I had my eyes tested, and I didn’t pass. My glasses were only 4 months old. I can see much better now.

I speak not only for myself but for my friends. Yesterday my friend, Aaron, cut his finger bad at recess. Blood was gushing out. He went to the nurse. I have friends in 2nd, 3rd, and 4th grade who have asthma, peanut allergy and diabetes. I am afraid what will happen to them if we don’t have a nurse at our school. What will happen if at North Pembroke someone hurts themselves real bad and at the same time my friend's blood sugar goes too low. It scares me. I don’t want my friends to die. People can die.

We need a school nurse for every school. I don’t understand why Governor Romney wants to spend money on changing the cape rotary , and at the same time take away our school nurses. To me a school nurse is more important than a rotary.