About an hour after the morning bell at Northwood Elementary School in North Baltimore, a boy came to the health suite looking for a mask. A few more kids streamed in with minor needs, like bandages. A second grader with butterflies pinned in her hair wanted someone to yank a wiggly baby tooth.
“I gave her some ice and wrote a note home to mom,” said said Brianna Gibson, a registered nurse who says she sees about eight kids a day.
But what if there was no nurse to tend the boo-boos, or worse, the chronic conditions like asthma, allergies and mental health issues that can keep students from learning or from school altogether?
Dozens of Baltimore public schools lack a permanent registered on-site nurse daily, despite a 2021 state mandate for all 149 city school health suites. Some have aides with less education, overseen by a registered nurse somewhere else. Gibson has worked full-time at Northwood since September, but was placed by a temporary staffing agency.
Officials from the Baltimore school system came up with a plan earlier this year that could be the first of its kind. They asked Baltimore’s nursing schools to act as a kind of staffing agency and hire and oversee registered nurses in 15 schools. Morgan State, Coppin State and Johns Hopkins universities are now ramping up programs.
“We’re up against so much, with mental health challenges, asthma, obesity, substance use,” said Courtney Pate, director of health and specialized student services for the city’s public schools. “The schools can be a hub to solve them. This partnership gives us the opportunity to fill some gaps.”
The five-year, $14.3 million program funded by the school system aims to place nurses across the city, including Northwood, which is under Morgan’s purview. Historically, the city health department had handled staffing at most schools, but began having trouble recruiting during a nationwide nursing shortage exacerbated by the coronavirus pandemic, school officials said.
Health department officials called the partnership between the schools and the universities a “creative solution that will hopefully help address critical nursing shortages in the short-term and promote the pipeline of more nurses working in our schools as a career in the long term.”
Pate and Alison Perkins-Cohen, the schools’ chief of staff, said the school system took over some schools. Then they got the idea to call on universities with whom they’d consulted during the pandemic. The school system found no national model where universities lean on their in-house expertise to find, vet and manage nurses not from their own staff or student bodies, so they requested proposals. The three universities offered plans.
Nationally, about a third of schools lack full-time nurses, according to the National School Nurse Workforce Study released earlier this year by the National Association of School Nurses. A big issue in recruiting school nurses is pay. Two-thirds of registered nurses in schools earn less than $60,000 annually compared with 30% of registered nurses in hospitals, according to the association’s 2020 nursing workforce study.
Additionally, said Kate King, president of the National Association of School Nurses, the nurses have to be comfortable working alone and able to handle a range of acute and long-term health needs. They need to build ties to the community and understand where to send students who need follow-up care or social services not provided by nurses.
The job is seen as a hybrid, a mix of clinical care and some public health work, like the efforts to manage the pandemic response. In the school where King is a nurse in Columbus, Ohio, language barriers are a particular challenge.
“There are 500 kids in my school; I see anywhere from 10 kids with acute and chronic conditions a day to 30, though sometimes not as many,” she said. “Today I’m working on identifying children who need to catch up on immunizations, but that requires consent from parents and they don’t all speak English. Some don’t have insurance. School nurses deal with a plethora of things every day.”
Some students at Northwood have chronic conditions including asthma, seizure disorders, ADHD and other health issues.
King said she knew of no other similar models as the one in the works in Baltimore. She called it innovative, and hoped an additional benefit would be that universities teach nursing students more about the unique school nurse role.
School officials say that is part of the calculus to help build the pipeline of school nurses. Perkins-Cohen said they expect the universities to rotate their nursing students through the schools to learn about the job from the registered nurses, though they can’t directly tend to patients until they are licensed. She also wants the registered nurses placed in high schools to take time to engage with those students, answer questions and perhaps inspire some to go into nursing.
Morgan professors also plan to mentor the nurses they hire for the school nurse positions, ensuring they have all the support they need and want to stay in their positions, said Maija Anderson, assistant professor and director of nursing and nursing programs at Morgan. They plan to offer competitive pay and tuition reimbursement for continuing education. School nurses also have regular daytime hours not always found in a hospital job.
Anderson said they don’t plan to hire their own recent graduates because school nurses need a bit more experience to provide care and navigate community programs for mental health and social services that some students may need.
“Morgan already has good relationship with the community,” she said. “It’s respected, and having Morgan nurses in the schools will immediately engender trust with staff and the parents — and as an extension, the students.”
Back at Northwood, Gibson said she likes the consistency, and may be interested in a permanent school position. She said she’s already developed relationships with many students, staff members and parents.
The modern and gleaming new school, rebuilt and opened in 2022, is also sure to help lure and keep staff, said Principal Erita Adams.
The health suite in the old building was cramped and had little privacy, she said as she showed off a waiting room, a well-organized supply closet, two private exam rooms, and a main bay with a row of beds complete with paper liners and privacy curtains.
“The kids come here to see Nurse Bri,” she said. “They get accustomed and like seeing one person when then have complicated issues, or simple ones. She knows what’s going on. That’s what we want when we go to our own physicians.”
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