The D.C. Department of Health plans to change the way nurses are assigned to city schools, using a stricter formula to decide which schools get part-time nurses and which get full-time nurses as part of a push for more holistic child health care that focuses on preventive and community-based care.
Many of the details of the plan are still unclear, and city leaders admonished the health department for not effectively communicating the changes to the public. LaQuandra Nesbitt, who leads the city’s health department, said there would not be a reduction in school health care but rather a reshuffling of how resources are allocated, but she has not yet said how individual schools would be affected.
On Thursday, council member David Grosso (I-At Large) introduced emergency legislation to delay the implementation of the new school nursing assignments until the beginning of the next academic year, in August.
“We’re really all in the dark,” Chris Sondreal, a parent of a second-grader at School Without Walls, testified Tuesday at a council education committee hearing. “It’s not clear as to how this is working.”
By law, the Department of Health provides a nurse for at least 20 hours each week to D.C. Public Schools and charter schools that have proper nursing rooms. The 20-hour minimum would not change under the new plan, though most schools currently have a nurse on site for more than the minimum.
In the 2014-2015 school year, 72 percent of schools that received the services of a city nurse had nursing coverage on site for 40 hours each week, according to data analyzed by the nonprofit DC Action for Children.
Beginning in January, nursing assignments will vary based on the needs of the students, with some schools probably having a nurse on site for fewer hours than they currently do. Schools with high rates of asthma among its students, for example, could receive a nurse for more hours than those with lower rates. Any school with a student who needs daily administration of medication would get a full-time nurse.
The department has not said which schools would receive a reduction in nursing hours, and Nesbitt said she would make individual school nursing assignments public by mid-November.
“If we determine that a school needs 40 hours of coverage, then that school will receive 40 hours,” Nesbitt said.
Nesbitt argued that nurses are currently burdened with administrative work and other minor medical requests that do not require a nurse, such as hearing and vision testing. Her plan calls for alternating nurses with medical assistants and making basic medical training more accessible to teachers and staff members. She said the department hopes to take advantage of nursing expertise while saving money when tasks do not require a trained nurse.
The health department has an annual $19.8 million contract with Children’s National Medical Center, which provides the city’s school nurses. The department plans to continue spending $19.8 million on school health services, but that money would be split among Children’s National Medical Center and other health-care providers.
Grosso, who leads the council’s education committee, pressed Nesbitt to explain how, if the department is spreading the same amount of money to more places, she can ensure that nursing hours would not be reduced.
Nesbitt said she is working toward equity in services across the city’s schools while ensuring that health needs will be fulfilled.
“Has anyone considered that I might be achieving an efficiency in government?” Nesbitt asked. “I’m getting more for the same price.”
Nesbitt, city officials and health advocates agree that the current school health model is ineffective and that health outcomes are not improving. A DC Action for Children report published in June found that 33 percent of D.C. public school students — 28,000 — have at least one chronic health condition. Nearly 6,000 students require some form of regular health services at school.
The city’s new school health program is based on a Centers for Disease Control and Prevention model called “Whole School, Whole Community, Whole Child.” Teams of health professionals will work with schools and families to ensure children receive preventive health care and regular exams.
“To move toward models that are more responsive to the needs of students, we must move away from the one-size-fits-all approaches like standard students-to-nurse ratios,” DC Action for Children’s executive director, HyeSook Chung, testified.
The possibility that some schools could receive fewer nurse hours has received intense backlash. More than 1,500 parents have signed an online petition calling for a full-time nurse at every D.C. school. Former D.C. schools chancellor Kaya Henderson and D.C. Public Charter School Board Executive Director Scott Pearson sent a letter to Nesbitt with concerns about the program in May. On Sunday, Pearson sent another letter to Nesbitt saying that schools are still unclear about the health resources they will receive in January.
“As I had feared, this rushed implementation is causing tremendous concern and uncertainty in our schools,” Pearson wrote.
Before introducing the emergency legislation Thursday, Grosso asked Nesbitt at the hearing whether she would consider delaying the new nursing assignment system until the start of next school year. Nesbitt said she is confident in the program and its timing.
