Many rural Wisconsin school districts don’t have full-time nurses. Some don’t have any at all.
August 18, 2020 | By Naomi Kowles
Across Wisconsin in small, rural districts made up of just a few hundred students, full-time school nurses are a scarce commodity. It’s not a new issue, but the implications of a school year unfolding mid-pandemic with incomplete access to medically-training staff is one that’s concerning to district administrators as they plan for an uncertain, and often in-person, return to school this fall.
About 150 K-12 students are served by the White Lakes School District, buried in the heart of rural Langlade County and 25 miles from the county seat, Antigo. There, district administrator Glenda Boldig says they’re fortunate to have a nurse in their building four hours a week, where she catches up with students, families, questions and paperwork while also working elsewhere in the community’s health care. When she’s gone, she’s reachable by email and text, and Boldig is grateful for how well she’s served them. But for the daily, on-site decisions that she anticipates having to make as the school year unfolds, she’s worried about the gap.
“Making those daily decisions sometimes is going to become more important, to be responsive to the situation that’s happening in my building and in my district,” Boldig noted.
In Clark County, Greenwood School District has none, serving about 350 students.
“We do the best we can with what we have,” administrator Todd Felhoffer noted, adding that the gap was just one of a lot of components he was concerned about. “We’ve got a very good relationship with our county health officer.”
In Loyal, Superintendent Chris Lidner says he’s concerned about their school nurse situation. Sometimes they might bring a local nurse in for a one-off check-in, but otherwise rely on the Clark County Health Department.
“There is a concern,” he explained. But like so many districts strapped for funding or other constraints—”We’ll make it work.”
Statewide, the data on school nurses through the Department of Public Instruction is incomplete, as only nurses employed directly by the school district are reported. However, many districts (in central Wisconsin, including Merrill and Stevens Point which both have multiple school nurses) contract for their nursing services, meaning they have full-time nurses on site that are (typically) employed by the local health department and contracted to the school.
“Many school districts – and I would say most school districts in Wisconsin—do not have a full time school nurse,” DPI school nurses consultant Louise Wilson explained. “What people in districts do is they have to rely on people who have no medical background to take care of students.”
In Neillsville, district administrator John Gaier says they’re extremely fortunate to have their contracted certified nursing assistant through the Marshfield Clinic Health System—something that isn’t always shared by other similar-sized districts.
“As school budgets get tighter districts are forced to make difficult decisions, and school nursing positions were often cut, because there is no additional funding for that type of service,” he told 7 Investigates in an email. “In order to pay for those services the district has to take money from the same funds that are used to educate children, so many districts have had to choose between funding educational programs or school nursing positions.”
For the 2018-2019 school year, 260 schools reported school nurse data of any kind in a survey, Wilson said, out of 420 districts. In an independent survey conducted this summer by the Wisconsin Rural Schools Alliance (WiRSA), 18.5% of the 70 rural districts responding said they had no school nurse at all. About 37% of responding districts reported a full-time nurse; about 44% reported a part-time nurse or other forms of health services. Where a gap exists, districts say they usually rely on local health departments, health care facilities.
Some school districts are moving forward with plans to bring on school nurses, according to that survey and districts 7 Investigates spoke to. (Colby School District just had a 80%-FTE school nurse position approved by their board.) But where a willingness to hire exists, funding or personnel availability can become a roadblock.
“Trying to find a school nurse in some of our rural areas is sometimes very difficult,” WiRSA executive director Kim Kaukl explained. In an environment nationwide where nurses are (and have been) in high demand, district administrator Glenda Boldig says hiring for them in areas where few social opportunities outside of work exist can be a challenge.
Additionally, while the National Association of School Nurses recommends at least one nurse per school building, the state of Wisconsin only requires by law that a registered nurse assist with developing the school’s policies—not that a district has one on-site.
For many working in rural school districts, the gap in school nurses represents an ongoing environment where staff have grown accustomed to a job where their roles may stretch far beyond their official titles. Craig Albers, with UW-Madison’s Rural Education Research Implementation Center, says he hears that from the districts they research all the time.
“Teachers say, ‘One day I could be a bus driver, the next day I’m out on the playground, the next day I’m doing this other activity,” he explained.
“Being in the profession as long as I did, I learned that I’m not just a school administrator or a teacher,” Kaukl noted. “I’m a jack of all trades.”