25 Investigates: Dozens of Mass. school districts don’t meet safe nurse-to-student ratios

BOSTON — From tending to cuts and bruises to administering medication to students with chronic illnesses, school nurses in Massachusetts have a lot to deal with.

The state requires school districts to staff nursing offices based on the size of the student population. But as 25 Investigates’ Ted Daniel found, dozens of school districts are failing to do that.

At Melrose Middle School, one full-time nurse and a part-time nurse are responsible for the well-being of 818 students. Anthony Sarno’s son, Christopher, is among them. The sixth-grader visits the school nurse’s office each afternoon to receive medication for his attention deficit hyperactivity disorder.

“He gets a month prescription at a time, so when he gets low, she’ll call and tell me, and I have to bring more. She’s been pretty on top of it,” said the Melrose dad.

Massachusetts school nurses administer roughly 84,000 doses of prescription medication each month to students. They manage medications for conditions like allergies, asthma, diabetes, and ADHD.

“I’m sure she’s a very busy person there. They should have more than one [full-time nurse]. You don’t see a hospital with one nurse. So, I think the kids should be treated the same way,” said the elder Sarno about the Melrose Middle School nurse.

There are no federal laws mandating school staffing. However, state guidelines established in 1998 recommend 1 full-time nurse for every 500 students.

>> Previous: School nurse under scrutiny for mishandling student meds previously investigated

25 Investigates examined Department of Public Health data and found that 34 school districts were recently cited for not meeting the minim nurse to student ratio. Some of the districts not in compliance include Boston, Worcester, Bristol-Plymouth Regional, Scituate, and Revere.

“Some of the concerns with being out of ratio are the nurse is overwhelmed and overworked,” said Kayce Solari-Williams, president of the American School Health Association, adding that when a nurse feels overwhelmed it can lead to errors. “You want to make sure that you have that responsible and certified professional making sure that things are being taken the way they are supposed to be taken by the person they are supposed to be taken.”

Nursing shortfalls, according to Solari-Williams, are usually the result of budget constraints, and the impact is usually greater in low-income communities, where school nurses are often the only health care professionals some children see during the year.

“[Students’] care seems to suffer and when their care suffers their academic performance and other performance areas suffer as well. So, it becomes this unfortunate cycle,” explained Solari-Williams.

>> Read more from 25 Investigates

The city of Melrose says it’s planning to hire an additional nurse to get in compliance with the Department of Public Health regulations. They must first seek funding approval from the city council.

Anthony Sarno believes that will be money well spent. But until then he will monitor his son’s medication schedule a bit more closely.

“Hopefully nothing would happen - a slip up or a mess up,” said the elder Sarno. “He’s usually on top of it anyway. But I would be more aware of it because it would just be harder for him in school. He wouldn’t be as focused.”

School districts can apply to have unlicensed staff members dispense medication on school property. One of the requirements is meeting safe nurse to student ratios first. Schools that do not meet these ratios are issued warning letters and ultimately their applications may be denied.

>> Previous: Drugs with high potential for abuse going missing at Mass. public schools

In a statement, the Department of Public Health tells 25 Investigates:

“Massachusetts public schools should have school nurse ratios that reflect the size and level of need of their student populations. It is essential for students to have access to a school nurse when they need it. The Department of Public Health supports school districts in providing school health care that is grounded in best practices through its dedicated School Health Unit Staff.’’

Do you have a tip for a story that you think needs investigating? Contact 25 Investigates or leave us a message at (800) 883-6925. If your story is one we think we can dig into, we’ll contact you back.