School nurse issue must be addressed now

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SCHOOL administrators are making a desperate plea for nurses to fill available positions being advertised islandwide as they seek ways to manage the novel coronavirus pandemic when schools reopen in September.

“The school nurse issue is a vexing one as many schools do not have a nurse, and in spite of several advertisements are still unable to fill the vacancy,” one school principal told the Jamaica Observer.

Owen Speid, president of the Jamaica Teachers’ Association (JTA) said since 2016 there has been a call for more nurses to be placed in primary and secondary schools, but it has fallen on “deaf ears”.

“There is a deficit in that some high schools are without a school nurse and no primary school, at all, has a school nurse, unless they are willing to take it on, raise funds and pay the nurse. We’ve been saying that to the Government for years, that we need the primary schools to have school nurses. We are calling on the Government every time. Almost all the time I get the chance to speak at a public function, I call on the Government to give us school nurses. This call is going for four years now. It was in the last negotiation. We carried it in the last negotiation and the Government flatly rejected it and we think it is a big mistake that they have made,” Speid said.

The JTA president, however, said it is now an imperative that the school nurse issue be addressed.

“It is something that should be there. Whether it is there as a policy is secondary now to the kind of situation we are in. It is an imperative now. We have seen in many instances where guidance counsellors have taken over the roles; sometimes the principals and vice-principals. Class teachers have taken over the roles and many times these class teachers are not even trained in first aid, needless to say in health care and so on. That is what goes on in the schools on a daily basis and it is untenable,” Speid said.

He added: “The high school children really may not even need a school nurse as much as the little ones. I think the little ones need the nurses more because they are not able to tell sometimes what exactly is going on in their bodies, but the bigger ones may be in a better position to explain, even though we know that some of the older ones sometimes can’t even explain themselves either. It is important that we get school nurses and we need to look at the ratio as well. Some schools have near 2,000 children – 1800 – they get one nurse, while a school with 500 or 600 students still get one nurse. A lot needs to be done to get the system where it should be. We should all put our voices together and try to get these things going.”

Carmen Johnson, president of the Nurses Association of Jamaica (NAJ), also agreed that the calls for experienced nurses in every school has been a long-standing issue.

But Johnson said that amid the myriad issues associated with filling the positions for a school nurse is the lack of appreciation from school administrators who undervalue the role of school nurses.

“We’ve been calling for years, but the schools tend to see it as a burden on their budget, and so you find that many of them [nurses] don’t want to do it. When you look at a school populace you cannot have one nurse to a populace of 1,000. It has to be at least two. When an emergency arises and that nurse leaves the compound, who is there to tend to the remainder of the populace and treat with them? Schools with a shift system – you need at least two per shift, but the school seems to see the budget as the priority, and so they hold that one nurse there until they leave at 4:00 pm and when they leave at 4:00 that’s where the health care provision ends,” said Johnson.

She added: “Another problem is some administrators in schools tend to think nursing is putting on a Band-Aid or gauze swab and mopping blood spewing or giving an ice pack, not understanding that even before you can do that you have to assess the tissue around it and the infrastructure to find out what is happening. Thinking there is no depth to the school nurse, not appreciating their technical competence or their [nurses] own challenges in the school system – that pushes some away. They [nurses] no longer go there and do not attract others to it because [school] administrators do not recognise that the technicality is totally different and you’ve got to be trained. They don’t see it that way. They just see you as a school nurse to give a Panadol or give a Baralgin.”

Further, Johnson said, in order to fill the urgent need, which she described as crucial, there would be a shortage in primary and secondary health care.

“It is going to affect the health centres, it is going to affect the hospitals. You would now have those nurses leaving their present employment to take the work in schools. Our hope is that they can get the nurses because we need them in the schools as we recognise the challenges in the schools and these challenges must be adequately addressed by the health care professionals. But at the same time, there must be greater appreciation for the work of the school nurses and greater support from the administrative level within the education system to support the school nurses to ensure they are able to function at the capacity and level at which they were trained in order to retain them,” Johnson said.

Moreover, Johnson said solving the issue will require a multisectoral effort.

“It needs a wholesome effort across the ministries of finance, health and education to ensure that they are properly remunerated, and they are treating our nurses in a manner that will encourage them to want to remain in the country, so when things like this come up that showcase what we’ve been speaking about we are not grappling to find a nurse where you can’t find it,” Johnson said. “It takes four years to train a nurse in a registered nurse position and another three years, as they need at least three years experience, before they can go and do a post-basic course, so you’re looking at seven years before you can find a nurse for school. You have to reach a point where you are training to retain or employing to retain so that we can meet the health care demand across all sectors of society without one being affected by the other negatively.”

Meanwhile, Health Minister Dr Christopher Tufton said the Ministry of Health and Wellness (MOHW) has been working with Ministry of Education on protocols for back to school as well as in-house training of relevant staff and this will continue.

He said that the policy of hiring nurses in the schools is a good one but will be affected by the unavailability of registered nurses in the system.

“Where shortage exists other options will have to be explored, such as training persons on infection control, and the MOHW will assist in this regard,” Tufton said.

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