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By Jared Weber and Rose Hoban

Walking through the crowd of educators at the teachers rally outside the legislature Wednesday and holding up a sign that read, “Looking for a school nurse,” prompted a lot of shouted responses:

“So are we!”

“You got one?”

“Only on Tuesdays and Thursdays.”

“You’re looking for a unicorn.”

Allison Vogt used to be a school nurse. Vogt has now worked as a health education instructor at Apex High School for 12 years. Before that, she worked as three separate high schools’ lone nurse. Satisfaction in that gig, she said, was tough to come by. “It was always a job that was so big, everybody was dissatisfied,” she said. “You feel like you’re never doing what other people want.” Photo credit: Jared Weber

“I went to each school and they were like, ‘Oh, we really needed you yesterday,’” said Allison Vogt, who used to be a school nurse in Wake County.

Vogt worked as the nurse for three separate high schools. She cared for about 4,000 different students every week.

Over time, the job started to take its toll on her.

“It was always a job that was so big, everybody was dissatisfied,” said Vogt who’s now a health education instructor at Apex High School. She said she feels satisfied again.

“It’s a much more manageable job than being a school nurse,” Vogt said. “I have 90 students now instead of 4,000.”

During the 2015-16 school year, Wake County schools had a ratio of 2,017 students for each school nurse. In fact, in that year, only 46 of 115 school districts met the nurse to student ratio of one nurse for every 750 students set by the State Board of Education in 2004, according to a legislative report published last year.

That ratio was determined by the National Association of School Nurses more than a decade ago, but that organization has actually moved away from that hard ratio. Now, the NASN recommends the development of an acuity system that will assign nurses based on each school’s needs.

In Raleigh on Wednesday, the need and desire for nurses and other support staff was on the mind of almost every teacher.

Stretched thin

School support staff was one of the five priorities being pushed by Mark Jewell, current president of the North Carolina Association of Educators.

“We know what standards are the ratios of school nurses and school social workers and psychologists to students and we expect the state to meet them,” he said. Standing on the rooftop patio of the legislative building and looking down on the thousands of red-clad teachers marching, chanting and carrying signs across Jones Street on Bicentennial Mall, Jewell said, “If they don’t hold up to these priorities, this is a day of accountability.”

The need for nurses and support staff was also a hot topic during the legislature’s winter recess, where several committees addressed the needs of school support staff.

The legislative Program Evaluation Division presented a report to lawmakers concluding that the state was far off the mark in providing an adequate number of nurses. The report also suggested that getting a nurse into every school would cost between $45 million and $79 million annually.

During hearings for a separate committee examining school safety issues, lawmakers heard that on average, school counselors manage the emotional issues of more than 350 students, more than the ratio of one to 250 recommended by the American School Counselor Association.

During a press conference Tuesday, House Speaker Tim Moore (R-Kings Mountain) said there would be some money for school nurses and other support staff in the upcoming state budget, but was reluctant to provide details.

“We haven’t started session yet,” said Senate leader Phil Berger (R-Eden) during the same press event. “What the budget will look like will materialize as we move forward.”

Guilford County school counselor Laverta McMillan said she came from a school that had a school nurse and other student support staff to a school without them. But her current school is closer to home. “I’m dabbling in things that are not my job,” she said.  Photo credit: Rose Hoban

The state also lags on student to professional ratios for school social workers and psychologists.

“I’m the only full-time student support service professional at my school,” said school counselor Laverta McMillan, from Guilford County schools. “We have a part-time nurse who comes only one day a week and then we have a school social worker who comes every other week.”

On top of counseling and arranging career fairs for students, McMillan said she also does a lot of fill in for administration at her school.

“My current principal, he’s out of the building a lot, so I am… the assistant principal, the school counselor and sometimes the school social worker,” she said.

“We are having more and more students with mental health issues,” said Ann Bradley, who teaches social studies in Lincoln County. She said she sees more need for mental health services and advocacy.

“Every year for the past few years I’ve had at least one child whose parents are seriously affected by addiction,” she said. “Teachers are not equipped. We can listen but we don’t have the training to then take it that much farther.”

Mental health workers needed

According to the Association for Children’s Mental Health, one in five American children and youth “have a diagnosable emotional, behavioral or mental disorder.” It also said that many estimates indicate the majority of vulnerable students do not receive appropriate mental health care.

Nonetheless, Jewell said that 200 mental health professionals were cut from North Carolina’s education budget in 2013.

“Now we’ve had tens of thousands more students,” he said. “So the impact on the social and emotional and mental health of our students are suffering.”

Elizabeth Munson and Jennifer Bradley, who both work in student support services for Wake County Public Schools, attended Wednesday’s march together.

Jennifer Bradley, June Hysell and Elizabeth Munson (left to right) have all worked in student support services at one time in their education careers. Bradley is one of two counselors at her school — a rarity in North Carolina. According to the American School Counselor Association, there should be one counselor for every 250 students. Last month, North Carolina School Counselor Association President-Elect Tim Hardin announced that North Carolina averages one for every 386 students. “That was one of the reasons that I wanted to go to that school, is because they have two school counselors,” Bradley said. “We need more student support like counselors and psychologists at every school so that we can best serve our students.”

Munson said that, similar to nurses, counselors and social workers are stretched thin between multiple schools.

“When you have that many schools, you kind of end up being more like a triage unit, where you have to figure out and assess the highest needs and who you can impact the most with what little time you have,” Munson said.

Jewell said that the lack of mental health professionals is especially problematic for students who come from poor socioeconomic backgrounds.

“We have our kids coming impacted by poverty and we know that causes trauma in brain development and if kids don’t have early access to help it’s a challenge for them to learn, we must make that a priority,” Jewell said.

Medically fragile

Then there are the children who really need medical services, but who sometimes just don’t get them, like the kids in Lea Kenny’s special education classroom.

Kenny described having a room full of kids with intellectual and developmental disabilities who also are medically fragile. There’s another classroom like it at her school too, but there’s a nurse on campus only half time.

“There are definitely some situations that are very uncomfortable,” she said, noting that last year, teachers had to call 9-1-1 several times.

Democratic Gov. Roy Cooper took center stage for a brief speech during Wednesday’s teacher rally in Raleigh. Cooper, who supported the rally in his remarks, proposed an 8 percent average increase in teacher pay this year that would be paid for by freezing some tax cuts on high earners and corporations. Photo credit: Jared Weber.

While she talked about loving her work, Kenny said she wasn’t sure this was what she signed up for.

“My expectations were that I would have medically fragile students and that I’d be administering some medications, but I was also under the impression that I’d have a school nurse assigned to just my school,” she said. “There are some days that are very stressful, I just throw my hands up because I don’t know what to do.”

Kenny and her husband moved to North Carolina from New York because it was easier to break into teaching in this state. But now that they’re getting experience, they’re thinking of going elsewhere.

“We love Wake County, but looking at the pay scale even in bordering states, we have thought about moving back to New York where we know teachers who can help us get into positions there,” she said. “Also Virginia, which wouldn’t be too much of a move either.”

Lobbyists and lawmakers look at the crowd of red-clad educators that filled the mall across from Raleigh’s General Assembly building. The Downtown Raleigh Alliance estimated the crowd at about 19,000. Photo credit: Rose Hoban

Jared Weber

Jared Weber is NC Health News' 2018 legislative intern. He is a rising junior at UNC Chapel Hill where he's majoring in journalism and global studies with a minor in Spanish.