Ahead of the first day of school Thursday, Cincinnati Public Schools had a difficult math problem to solve: The district has 65 school buildings and 45 school nurses.
Those are nurses provided contractually by the Cincinnati Health Department. The district put a Band-Aid over the issue by hiring an additional 20 licensed practical nurses, or LPNs, with general fund dollars. Those professionals are typically assigned to specific students.
The nurse shortage means the district’s nurses will hop from school to school throughout the year, trying to reach as many students as possible. In their absence, school secretaries will administer medicine to children who need it. The arrangement creates challenges for both students and staff, and some worry it poses a risk to kids with potentially serious health problems.
"This is an ongoing issue," Fannie Carradine, president of the Cincinnati Federation of Office Professionals, said at a recent school board meeting. Carradine works as an executive secretary within the district.
"We do not feel that we are adequately trained to be nurses, nor do we want to be nurses," she told the school board.
CPS partners with the Cincinnati Health Department to provide nurses for its schools, but in recent years the school district has held money in its budget for nurses that never came. At the August school board meeting, Superintendent Iranetta Wright said the district reduced its contract with the health department because the department can't meet the district's demand.
"We have requested the most that they have been able to provide over the last several years, which is 48 nurses," Wright said. As of early August, 45 nurses had been hired and the department was still looking to hire three more for CPS. "The way that the nurses are organized right now is based on the needs of the students."
The Enquirer reached out to the Cincinnati Health Department for comment, but the department referred all questions back to the school district.
Wright said most schools have nurse support three to four days a week as part of a nurse and LPN rotation. Where there are medically fragile students, there is five-day nursing coverage.
"Ohio does not require all schools to have a dedicated nurse in each school building, and before the pandemic, CPS rotated a small staff of nurses to all schools," the district provided in a statement to The Enquirer. "CPS was able to expand coverage to every school as a result of ESSER (Elementary and Secondary School Emergency Relief) funding to meet the health needs of families and students due to COVID-19.
"Fully staffing registered nurses, per the contract with the Cincinnati Health Department over the past two years, has been difficult. CPS and CHD continue to work together to manage the RN school assignments and rotation based on schools with the greatest medical needs. With 65 total RNs and LPNs, the district is confident this coverage adequately serves the needs of all its students."
ESSER funding is federal money given to schools during and after the COVID-19 pandemic to help combat student learning loss. The money must be spent by the end of next September.
In the absence of a school nurse, who administers medicine to children?
CPS board policy states school nurses or district employees who have completed a district-approved drug administration training program can administer prescribed medications to kids. This includes oral and inhaler medications and injections and pumps for students with insulin needs.
"I am not comfortable providing medications," Tamala Paul, Cincinnati Federation of Office Professionals clerical specialist, said at the August school board meeting. "It's a major responsibility and has potential for mistakes, such as tracking dosages or inadvertently giving the wrong medication to a student or the student having an adverse reaction to their medication and we're not adequately trained to deal with that."
Having secretaries leave the main office to help with nursing coverage could also lead to potential security issues, Paul said, since there are times when an office secretary is the only one manning a building's entrance.
Wright said her team is working with schools to determine who should be trained to administer medicine in the absence of a medical professional.
Do other local schools outside CPS share nurses?
The Enquirer surveyed more than a dozen other local school districts on their nurse staffing and medication administration practices and got responses from six. Nearly all of them have at least one nurse per school building, and just one district besides CPS cited nurse vacancies going into this school year: Boone County Schools, with two vacancies. But Boone anticipates filling them in the next few weeks.
Like CPS, Boone County Schools has a full-time nurse assigned to most buildings and a few schools with a half-time nurse assigned. In case of a nurse absence at a Boone County school, the district said it trains staff support assistants to administer medication. The district's director of health services is always available, too.
Fairfield City Schools, which serves nearly 9,000 students, employs 10 nurses for 11 buildings.
"The nurse at Crossroads Middle also covers the alternative academy next door," Fairfield spokesperson Gina Gentry-Fletcher explained via email. "The academy has a very small population of students."
Gentry-Fletcher said Fairfield has a list of substitute nurses in case of absences. Sycamore Community Schools does, too. Those professionals are responsible for administering medicine and responding to medical emergencies when a nurse is out, along with a school administrator.
While Fairfield nurses are spread evenly among its school buildings, the district actually has more students per nurse than CPS. The student-to-nurse ratio at Fairfield is 890-to-1, while CPS' ratio is 747-to-1 if the district meets its goal of 48 nurses. Boone County's is even higher, at 901-to-1, assuming it fills its two vacancies.
Other local districts have much lower ratios. Oak Hills Local School District, which serves more than 7,300 students, employs 19 nurses. That's one for each building − though more than half of the schools have at least two nurses − plus a district nurse and assistant who travel between buildings.
"If a nurse is not in attendance at a school, the person responsible for administering medicine or emergency care is, first, the district nurse or her assistant," district spokesperson Krista Ramsey told The Enquirer. "If they are not available to be in the school where the nurse is absent, the building secretary and building administrators havebeen trained to administer medicine or respond to emergency care."
Middletown City Schools has a nurse in each building, too, plus two floating nurses to cover student needs. If there's ever an absence, the nurses work with principals to appoint a backup at each school to administer medications to kids. Those individuals are trained by the school nurses.
Sycamore and Milford trains other staff, including school secretaries, to stand in for nurses in rare circumstances when nurses are gone, their backups are out and kids need to be administered medication.
Union says training is online, not good enough for real-life medical situations
Julie Sellers, president of the Cincinnati Federation of Teachers, also spoke of the nursing issue at the August school board meeting. She said school secretaries' training module on how to dispense medicine is online and doesn't mimic real life situations.
"That's not training for when you're dealing with children's lives," Sellers said.
But the district told The Enquirer that backups at CPS schools are required to complete virtual and in-person training with a nurse.
Parents who send their children to CPS schools expect their kids will be taken care of in case of a medical emergency, Sellers said. Kids "don't get sick based on a schedule" and may need care every day, at any time.
Especially for students with significant medical needs, Sellers said, kids "need to have someone who is trained." She said office personnel shouldn't be the ones counting carbs for kids with diabetes to calculate insulin injections.
"This is not the job of a teacher. It's not the job of a clerical professional," Sellers said. "It's really the job of a medical professional."