1. Winner of the North Carolina Department of Public Instruction
School Bell Award
Shortage of school nurses plagues county
JOAN PLOTNICK
The Clayton News-Star, October 20, 2004
Johnston County has a severe shortage of school nurses, and the problem will only get
worse as more low-income, chronically ill children enter the system yearly due to the
county’s relatively low housing costs and proximity to the children’s hospitals in Durham
and Chapel Hill.
Jean Tripp, Johnston County Schools health coordinator, told the Board of Education last
Tuesday those facts and she backed up her statements with some disturbing statistics.
Last year, there were nine school nurses. Two more were hired this year with local funds.
This has caused the ratio of school nurses to rise from one nurse per 2,400 students to one
nurse per 3,000 students.
The nationally recommended ratio is 1:750. The state average is 1:1900.
Tripp said school nurses have become the primary health care providers for more than 33
percent of the county’s students. Out of the 1,800 students seen over the first two months
of this school year, nurses managed the primary care for 1,100.
There also are 510 medically fragile students in Johnston County (such as those needing
chemotherapy drips, insulin pumps, feeding tubes and Epi-pens). They all have detailed
nursing care plans that require special attention from a school nurse.
At a conference on chronically ill children with special needs held in Chapel Hill last
year, Tripp was told that the population of medically fragile students in Johnston County
likely will increase. The reason is that Johnston is the only county with affordable
housing within driving distance of the specialty children’s hospitals at Duke and the
University of North Carolina at Chapel Hill.
The state has recently funded 450 new nursing positions in the state, but none were
allocated to Johnston County.
Supt. Anthony Parker said the reason is that the state used unfair criteria – such as the
number of failing students – to determine which systems should receive nurses. Several
school systems with lower nurse-to-student ratios than Johnston County received
additional nursing allocations, he said.
Perhaps more telling than the statistics are stories told by the school nurses themselves.
Each of the county’s school nurses serves three or four schools within five miles of one
another.
Tripp serves Princeton, South Campus middle and high schools in Smithfield and the
Academically and Intellectually Gifted Center in Smithfield.
She said many of her students don’t have private medical providers, and fewer and fewer
doctors in the area are taking new patients, especially Medicaid patients.
“They (students) are going to the Health Department, but the Health Department itself is

2. swamped. They just see as many as they can possibly see, but there is a long waiting
time,” she said. “Students may be sitting there for several hours, though it’s no one’s
fault.”
As a result, sometimes students who get sick or injured on a weekend will wait until
Monday to be seen by a school nurse.
One day last week, Tripp saw 23 children, including:
• A severely vision-impaired student whose family did not speak English. Due to a
lack of Social Security numbers, the parents did not qualify for any form of
assistance, and they had little money. Finally, working with a bilingual social worker,
Tripp was able to secure glasses for the student through a state English as a Second
Language Program.
• A new student with severe seizures. Tripp had to contact the parents, prepare a plan
of care and teach school staff how to deal with the problem.
• A diabetic student with a blood sugar level of only 69. Normal is around 80-120.
• A child with a life-threatening allergy to peanuts. Tripp had to train the teachers and
cafeteria staff, teach the students in the child’s class about the problem and send
letters to the parents of all his classmates asking them not to send food with peanuts
for class projects or snacks.
• A child recently released from a mental health facility who decided not to take his
medications and was creating chaos in the classroom.
Many of these cases go beyond normal school hours.
“This is not a 7 a.m. to 3:30 p.m. job. It’s a seven-day-a-week, 24-hour-a-day job,” Tripp
said. “A lot of times I can’t get in touch with the parents during the work day. So we
arrange to talk over the phone at night, or meet at the workplace before or after work.
Sometimes we meet on weekends.”
She said the problem of students not having primary care providers is less severe in the
Clayton and Cleveland communities, but those areas still have their challenges.
Lynn Carter is the school nurse for Cooper and West Clayton elementary schools,
Clayton Middle School and Clayton High School. She is responsible for 3,500 students
and has a caseload of about 170 students a month.
Some of the more severe health problems she deals with include children who need tube
feeding or psychotropic drugs, require catherization or have severe asthma or diabetes.
Carter said many of the students she works with are low-income, live in public housing
and/or don’t speak English.
“There are quite a few Latino students in my schools,” she said. “The ESL teachers or
other employees who are bilingual have been a tremendous help with that.”
Fortunately, help is available.
“The Health Department is a wonderful resource. They work extremely well with us,”
she said. “There is State Health Choice for children and Horne Memorial (United
Methodist Church) Pastor’s Discretionary Fund has been very gracious helping several of
our children over the years.”

3. Carter said she loves school nursing, especially the opportunity to serve as educator as
well as nurse.
“I do a lot of teaching with children, such as helping asthmatic kids understand what is
going on in their body and how their lungs react,” she said.
She teaches many hygiene classes about topics such as germs, including experiments
with germ culture plates (provided by Johnston Memorial Hospital) and black lights.
“I love the education end of it. I not only care for the students, but I teach them
physiology, at their level, so they can understand what is going on with them and that
their body is a fascinating machine,” she said.
As with Tripp, however, the hours can be long.
“It is not uncommon for me to be at school until 5:30 or 6 p.m. I know I should stop
seeing students at about 2 p.m., but I can’t do that,” she said. “I also talk to parents after
hours over the phone. If it is a better time, a more convenient time for parents, then I
don’t have a problem with that.”
Beth Thomas, a nurse in four low-income schools in the eastern portion of the county,
said some of the biggest problems her students face are severe dental problems, with no
money to pay for a dentist or dental insurance.
“You just can’t let the kids sit there in pain,” she said. “Lots of kids don’t get the dental
care they need. For many students, the only time they will ever go to a doctor or clinic or
whatever is if they have an accident or are sick, but not well visits.”
The problem is not easy to solve. Most nurses can get higher salaries in other settings,
and school systems have limited finances to hire more nurses or pay higher salaries.
Johnston County school nurses earn between $32,000 and $48,000.
In Wake County, the ratio of nurses to students is 1:2194. Most of their nurses are paid
through the county health department.
Tripp said this strategy might save the school system money, but it has a major
disadvantage.
“If there is no nurse in the clinic that day, they take one from the school system because
manning the health department is the first priority,” she said. “I hear that from all
counties that pay for nurses through health departments.”