By Joanna Miller, Staff Writer

Nurse Cindi Isaacson told the Prior Lake-Savage Area School Board that the district’s health care staff is spread too thinly.

“We are absolutely pushed beyond safety limits for our students,” Isaacson said during Monday night’s meeting.

The Center for Disease Control and Prevention and the National Center for Health Statistics recommend a student to licensed school nurse ratio of 750 to 1. Minnesota does not have a law requiring a specific student to nurse ratio, but it does require districts with more than 1,000 students to have at least one nurse on staff.

Isaacson reported the Prior Lake-Savage Area Schools surpass all of these numbers with ratios topping 2,000 per each of the three registered nurses on staff. Licensed nurses have ratios of 2,087 to 1; 2,741 to 1; and 2,726 to 1.

The heath staff estimates its workload has increased about 15 percent per licensed school nurse since the district returned special education programming to its buildings last year rather than working with the Minnesota River Valley Special Education Cooperative at their sites.

Isaacson said after the meeting that she hopes the board heard the message that there are staffing needs.

“I’m really hoping they heard an S.O.S. that we might need to take action prior to the continuous improvement process,” Isaacson said. “We’re really at a crossroads with the staffing piece.”

In addition to the three RNs, the district has 10 health aides who assist nursing staff. Health aides are unlicensed staff members who have American Red Cross First Aid and AED certifications.

“They can work within those guidelines,” Isaacson said. “We can delegate if we feel the client’s condition is sufficiently stable.”

Isaacson said individual school districts handle the balance of licensed nurses to health aides differently. “Each district has its own unique staffing model,” Isaacson said.

When numbers rise

Isaacson said higher ratios mean more pressure on staff members to meet screening and vaccination management needs, while maintaining everyday health needs, family communication and emergency situations in the district.

“Screenings can stop small problems from being big problems,” Isaacson said.

For example, the Minnesota 2020 survey of school nurses conducted in September shows that mental health issues were more likely to go undetected as the ratio of students to nursing staff increased. More than 85 percent of Minnesota school nurses said that mental health care needs for students were not being met in their districts.

How the district enforces its “no shots, no school policy” also puts an additional strain on resources at the beginning of the year.

The school district does not withhold student schedules until students provide proof of vaccination.

Major vaccinations for school are necessary at the kindergarten and seventh-grade levels.

Schedules are provided to seventh-grade students at open houses to reduce anxiety about transitioning through grade levels.

Isaacson told the board she understands its policy to disperse schedules, but withholding schedules is one way to get families to make sure their students are vaccinated for school.

This year, the Hidden Oaks Middle School seventh-grade class had 43 students not vaccinated on the first day of school, and Twin Oaks Middle School had 52 students who came to school not vaccinated.

“We have not been withholding schedules, and that’s why our numbers have been so high,” Isaacson said.

Because so much vaccination paperwork comes to nurses during the first week of school, Isaacson said it detracts from their time working with teachers on other health issues, such as students in their classrooms with asthma or diabetes.

Nurses also spend time giving general screening updates, such as body mass index (BMI). This year, Isaacson said that the computer program Skyward will be used to communicate BMI results to parents, in an effort to combat childhood obesity.

“The BMI letters were well-received,” Isaacson said.

Some students require interaction with nurses beyond basic screenings. Isaacson said diabetic students now make more trips to the nurse’s office for insulin shots, since new treatment plans call for insulin injections with each meal – breakfast, morning snack, lunch, afternoon snack and any treats during the day.

Isaacson estimated the district serves six diabetic students at Prior Lake High School and about three at each of the other school buildings.

While some students can administer their own insulin, Isaacson said it’s been protocol to have students come to the office, as it helps the nurses become familiar with students who are diabetic in case of an emergency, and it helps the students in their education process about the disease.

“We want to have visual recognition of who they are,” she said.

Changing economy

The nursing staff also is responsible in emergency situations at the school.

So far this year, Isaacson said there have been three 911 calls placed, and staff has handled the calls appropriately.

Last week, a power outage at the District Services Center and some schools resulted in the loss of e-mail communication and landline phones, Isaacson said. With high wind speeds outside and dropped cell phone calls, Isaacson said they realized a weakness in their communications system.

“We weren’t able to get through at multiple buildings,” Isaacson said.

She said that the team that handles the district crisis management plan would review this scenario for possible solutions.

Another concern on the horizon is the care of students without insurance. Isaacson anticipated that with a weakening economy, the nursing staff would be the primary healthcare provider for more families in the district, whose only other resource would be the emergency room.

 Joanna Miller can be reached at jmiller@swpub.com.