Nursing a Broken Budget : Education: Health services have been the first casualties of cutbacks at many schools. Staffs lacking full-time medical care are scrambling for ways to meet the students’ emergency needs.

The girl came into the main office of Van Nuys Junior High School with a stab wound to the eye. Another student had accidentally poked her with a pencil, and the wound appeared to be serious.

But there was no school nurse on campus that day so a teacher administered first aid until paramedics arrived. “It was very frightening,” Assistant Principal Susan Lepisto said.

Increasingly, staff and administrators at junior high schools and middle schools are finding they must rely on their own skills to deal with medical emergencies on campus.

As a result of budget cuts, Van Nuys Junior High School has a nurse on campus only two days a week, down from four days last year. The rest of the week, administrators, clerks, secretaries and others assume the responsibility of caring for ill and injured pupils.

“The lack of a school nurse has had a tremendous impact on us all,” Assistant Principal Booker T. Moten said. “We’re all feeling the crunch. We have all become school nurses.”

For serious injuries, parents and paramedics are called, but staff members must still deal with the student until help arrives.

Help Enlisted

To prepare for their new, albeit unofficial, duties, administrators at the school have taken the unusual step of appealing to the Kaiser Permanente Medical Care Program for assistance. Kaiser has agreed to help, and the school hopes to set up a first-aid training program so teachers, clerks and administrators will be better able to handle their newfound responsibilities.

“What else can we do?,” administrative aide Ed Zubiati said. “We have to be able to do something when the students come in.”

Barbara Bradstock, who coordinates the nursing program in secondary schools for the Los Angeles Unified School District, said the situation at Van Nuys Junior High School is indicative of problems throughout the district caused by the recent round of budget cuts.

“The brunt of those losses were felt in the secondary school services, especially the middle schools,” Bradstock said.

Most junior high schools do not have a nurse assigned full time, Bradstock said. Previous cost restraints cut nurses’ visits down to two times a week at some schools. The situation has been made worse by the layoffs of 12 health-care personnel in the recent round of budget cuts.

And although in the past schools had been able to purchase more nursing hours with money from their individual budgets, that money has all but vanished.

Not all schools are experiencing the same level of difficulty.

Portola Junior High School in Tarzana has a nurse on campus five days a week. The school receives a full-time nurse because of its size--2,100 students--and the fact that there are many special-education students with physical disabilities who require a nurse, Bradstock said.

But at Walter Reed Junior High School in North Hollywood, “problems are daily and hourly,” Vice Principal David Gonzalez said.

“Kids come in with scrapes, bruises, fevers, and we handle it,” Gonzalez said.

The health office is staffed with a nurse only three days a week. When the nurse isn’t there, students are sent to the counselor’s office for care.

“They have to hand out Band-Aids and make phone calls home,” Gonzalez said of the counseling staff.

At Van Nuys Junior High School, secretaries are as likely to be comforting sick students as they are to be typing or filing.

“It’s not uncommon for us to have 10 to 20 kids a period,” said Brenda Clarke, a secretary at the school. “The teachers can’t help them. There’s no health office. So they send them here.”

When the nurse is not on campus, students are sent to the main office, where they sign in and wait to be seen by whomever is available, Clarke said.

Some of the requests are easy: a Band-Aid for a scraped knee, a headache that might be cured by resting on a cot. Others are far more difficult.

“This is putting us in a serious bind,” said history teacher Harry Talbot, who helped the child with the eye injury. “We really need a trained nurse here.

“When you have nearly a thousand active youngsters in one place . . . something happens every day.”

Talbot is often called out of class to deal with students’ medical emergencies because he has first-aid training. Other teachers must cover his classes.

“We’re all working together as a team to do whatever we can within the constraints of the system,” Talbot said.

And no one is exempt from nursing responsibilities. Moten said he often must leave his other administrative duties to care for ill students.

“We still have the same number of students with the same problems,” Moten said. “You can’t tell a seventh-grader, ‘The district has cut back services, so you can’t get sick.’ ”

Administrators decided to contact Kaiser after they realized how much time was being spent dealing with health issues.

For the past nine years, Kaiser has served as the school’s mentor through the district’s adopt-a-school program and has filled numerous requests from the school. The company has provided the school with tours of the hospital on career day, a skeleton for health classes, awards for outstanding students and speakers for students and staff, said Karen Large, Kaiser spokeswoman.

The request for first-aid training is by far the most urgent.

“It’s very tough, and it’s frustrating,” Large said of the situation. “The clerks are panicked because they are the front-line people. . . . They are the ones who have to play nurse.”

The plan is still in the early stages, but school officials see it as a way to thwart a potentially disastrous situation.

“We’re trying to take a proactive approach,” Principal Cecilia Costas said.

Aid Is Added Duty

The training will educate the staff, and they will feel more comfortable dealing with students, Costas said.

Some on the staff agreed.

“My real concern is that we’re not trained to take care of children,” Clarke said.

The first-aid course would be helpful, “but that’s another question of liability,” the secretary said. “If a student collapses in my office with a bloody nose, what’s the liability?”

Another clerk, who did not want her name used, opposed the idea.

“I don’t want it,” she said. “I have so much to do with my office. This is something added onto our duties.”

Deborah Schrader, a dean at the school, said the training, including classes in cardiopulmonary resuscitation, should be required.

“Any new teacher coming into the district should be required to hold a valid CPR card,” she said.

Bradstock, who is also president of the state school nurses association, said other districts have started looking at the idea of training staff in first aid as a means of dealing with cutbacks in nursing hours. In San Juan, Calif., 20 of 28 nurses were laid off, and plans are under way to train staff and administrators to assume some nursing responsibilities.

“That is not going to be a good situation,” Bradstock said of the idea. “They all have other full-time jobs. They don’t have the expertise. The students are the ones who are going to lose.”

Service Suffering

Even when the school nurse is on campus, there is not enough time to deal with the emergencies that arise while fulfilling other nursing duties, said nurse Sofie Friedman, who has been visiting Van Nuys Junior High School two days a week.

“The hearing, the vision, the physical problems, immunization. . . . We just can’t take care of them adequately,” she said.

Some students, such as diabetics, may need help taking medication. Others with serious health problems may need to be referred to other facilities.

The students who suffer most are those without access to any other form of health care.

“Some of these kids never get any medical care unless they see the school nurse,” Friedman said.

For now, administrators at Van Nuys Junior High want to ensure that they can provide basic service. They have appealed to parents to volunteer time in the health office, and they hope that Kaiser can help them fill the nursing void.

“People don’t realize how really deep those budget cuts are,” Zubiati said.