From a Veteran School Nurse

I am almost speechless at the District’s solution to its well-documented failure to provide safe schools for our medically fragile students.  The solution is, of course, to hand it to an outsider, not hire more school nurses and tighten up on policies.  Pray tell me:
  • Who will review the immunization data at the beginning of the school year and compile a list of students who are not vaccinated or under-vaccinated so they can be excluded if there is an outbreak?
  • Who will follow up on each under-immunized student to complete their immunizations, thus protecting the school community?
  • Who will identify the medically fragile students and plan for their care in school?
  • Who will insists on a comprehensive physical from every new student to this school? Who will read and understand that physical, once it is completed?   
  • Who will check each student’s vision every year, near and far, expresses the results in easy to understand terms, your child can see at 20 feet what the normal eye can see at 200 feet, and then refer the students for a vision evaluation? Who will periodically follow up on those failures and give them an extra push to see the specialist?
  • Who will check hearing on all the 9th graders and new students?
  • Who will advise medical input for IEP’s and 504’s?
  • Who will assess a child in a health crisis?
What is the District doing? We have cut the nurses almost in half. State law requires one Certified School Nurse for every 1500 students. We are just about there in Philly. These are impossible numbers, given the circumstances that our students come from. We need to increase school nurses, not cut more. Clinics in the school will further fragment care. Students need to be seen and followed by their PCP, not a clinic appointed by the School District. How would this look? Is there a potential or actual conflict of interest there?
Students should get their physicals from their medical home. That home should remain a constant in their lives. The School Health Code is meant to build on that concept, not replace the family doctor, or the pediatrician. These ideas have been tried. The more we outsource: the more we fragment. What are they thinking?
I’m done. 
Onnie Kelley
Agnes  Kelley is Certified School Nurse working in the Philadelphia Schools since 2000. She has practiced nursing in Pa, NY, NJ, Ill, the Virgin Islands, and England. Her last clinical post was as an emergency room nurse. She has had a varied and long nursing career, first passing her Boards and thus the title RN, in 1970.  She was trained by the Sisters of Mercy, renowned for their excellence in nursing education.