Posted by Jenna Libersky, June 11, 2010

Six years ago the City Council passed a law requiring more nurses on site at public and private elementary schools in the city. Mayor Bloomberg’s Executive Budget would “expel” some of those additional nurses from their schools.

The nurses affected by the Mayor’s plan are funded through the Department of Health and Mental Hygiene. The proposal has some challenges ahead, including the need to first have a change in existing law which requires the presence of a nurse at schools with a certain number of enrolled students. For the cuts to take effect, that threshold number would have to rise.

If that happens, the health department estimates that 19 public schools and 127 private and parochial schools would lose publicly funded nursing coverage for about 33,000 students. Others outside the Bloomberg Administration have cited larger effects.

The Mayor’s proposal would have a minimal effect on middle and high schools, as they are not currently required by law to have nurses on staff. The budget would reduce the number of full-time equivalent school nurses directly employed by the health department by 62 through attrition, saving the department $3.1 million in 2011 and more in subsequent years. Contracts with nurse providers that supplement the nurses on the health department’s payroll would also be reduced.

The department’s school health budget has grown from $53.4 million in 2004 to $90.6 million in 2009, with about 60 percent of the total coming from city funds. The number of full-time equivalent nurses on the department’s staff has increased from 697 in 2004 to 802 in 2009, with the bulk of the positions in both years filled with part-time nurses. The department also contracts out for nurses; currently, an additional 84 nurses work under contract with the agency.

The growing school health budget is largely the result of the changes in city policy. In 2004 the City Council enacted Local Law 57 to require more elementary schools to have nurses on staff. The law lowered the enrollment threshold at which an elementary school was required to have a nurse on staff to 200 students. The Department of Education has also been pushing the development of new small schools, further increasing the number of nurses required. Between 2004 and 2009, 68 new elementary schools were added to the list of sites requiring nurses. The total number of public elementary school sites with health department nurses now totals 717, excluding 52 sites where special School Based Health Centers provide more intensive primary health care services to children.

Not all of the schools that would lose a health department nurse due to the proposed increase in the eligibility threshold would be left without access to a health care professional during the school day. The Department of Education is responsible for providing nurses to public schools enrolling students with special medical needs as required by Section 504 of the federal Rehabilitation Act and the Individuals with Disabilities Education Act. The education department employed 549 full-time school nurses of its own in 2009, up 24 percent since 2004. The Executive Budget does not cut funding for Department of Education nurses.

The joint Office of School Health manages both the education department and the health department school nurses but maintains their budgets separately. Since there are many schools that qualify for a nurse based on both local and federal standards, the two agencies have reached a labor agreement to avoid duplicating efforts. Schools that fall into this category are assigned either an education department or health department nurse. The nurses from both departments are licensed professionals with either associate or bachelor’s degrees in nursing, have similar skill sets, and according to the labor agreement, provide similar services in the schools they serve.

The overlapping requirements that govern school nurse coverage mean that enrollment is not the only factor used to determine which public schools would lose their nurses under the plan. The Bloomberg Administration estimates that the proposed change to Local Law 57 would leave 68 public schools at risk of losing nurses based on current enrollment; however, 36 of these sites enroll students with daily medical needs that would qualify them for nurses under Section 504, leaving 32 schools at risk of losing coverage.

Moreover, many of the public schools in New York City are co-located with other schools. Even though co-located schools are administratively separate, the Department of Health and Mental Hygiene stresses that they could share a nurse if needed. Of the 32 schools that are eligible to lose a nurse, 13 of the schools share a site with another school whose nurse would remain. Consequently, if Local Law 57 is amended and the Executive Budget cut is not restored, 19 public elementary schools would lose nursing coverage, according to the Mayor’s estimate.

While Department of Health and Mental Hygiene officials estimate that 19 public schools would stand to lose a nurse, the result would be greater at private and parochial schools. The Bloomberg Administration estimates that 127 private and parochial schools would lose nurse services, meaning that 3,000 public school children and 30,000 nonpublic elementary school children could lose access to the services that school nurses provide. These services include monitoring vaccine compliance, administering daily medication, screening for hearing or visual impairments, and linking children to additional health services. Losing these services might be a hard pill for some New Yorkers to swallow.