On a single day this month, Linda Butcher treated two minor medical emergencies, conducted several hundred eye tests, supervised dental exams at a local school, taught a first-aid seminar for teachers and was home in time for dinner.
For Butcher, the sole nurse attending to the Oxnard Elementary School District’s 13,000 children, it was a typical day.
“You should see it when I get busy,” Butcher said from behind stacks of paper in her Oxnard office. “Any day can blow up on you.”
Three years ago, buckling under the pressure of a fiscal crisis, the school board voted to reduce its already spare nursing staff by asking two of its three nurses to retire.
The result, county health officials said, is an example of the decline in medical care that schools traditionally have provided.
For Butcher, it has meant a dramatic shift in how she does her job. She once had the luxury of visiting one-on-one with children and parents. She taught classes and treated children immediately if they were injured or sick.
Now she does most of her emergency work over the telephone. When there is an accident, the teachers and staff are trained to know what action to take in case Butcher cannot get to the scene herself.
If she is unable to respond, school officials call 911 and parents are billed for care that they may or may not be able to afford.
“It’s the best we can do given our constraints,” said longtime school board member Jack Fowler. “The days of a nurse at every school are gone, and they’re never coming back.”
That was the message from all five Oxnard school board members at a meeting last month.
Staff members from the cash-strapped district approached the board with a wish list, including new phones, extra help with clerical and custodial work and a second nurse.
All of the items, except for the nurse, were approved. The vote against hiring a second nurse was unanimous.
“When you find yourself on a wish list, you know that you’re no longer considered a priority,” Butcher said. “We knew we weren’t going to get more help. We got the answer we expected.”
District trustee James Suter said the school district simply could not afford to dip any further into its general fund this year.
“I felt bad about that,” Suter said. “But we had to do it because of financial reasons. She’s absolutely overworked and if we can find the financing we will be able to help her out.”
Fowler said the trustees had sound financial reasons for not hiring a second nurse.
“What good is two tokenisms instead of one?” he asked. “Either way, if you’re not going to be able to adequately maintain the nursing staff, why bother?”
One reason, county health officials said, is that school nurses play an integral role in the health of the county’s children. The decline in nursing staff sizes, they say, has had side effects.
“It’s difficult to make a tangible connection,” said Dr. Gary Feldman, Ventura County’s chief physician. “But the drop in numbers of school nurses definitely has had a major impact.”
One sign of trouble came in June, when health officials reported a “mini-outbreak” of strep throat among children in the county. It is an illness that spreads quickly through schools if no attention is paid to the problem.
The number of cases in Oxnard has been particularly high, Butcher said, because it was not being treated there.
The decline in nursing staffs has also meant that children are not getting the kind of health education they need, Feldman said.
“A lot of what school nurses are able to do is deal with problems of adolescents and pre-adolescents in a comfortable setting,” Feldman said. The school nurse “is a person they can go to to get a different perspective and some straight answers.”
Butcher said she missed the ability to interact in that way with the children. As the nurse at Driffill School, where she once worked, Butcher was able to know each child and the child’s family.
“I was very involved in helping the kids know how to take care of themselves,” she said. “It’s been very hard to give that up, especially now.”
Nurses in other school districts said they are facing similar problems. While no other district in the county has as great a disparity in the number of students per nurse, several have experienced gradual cutbacks in their health services, said Diane Garcia, president of the Ventura County Nurses Assn.
“They travel from school to school to try to put out fires,” Garcia said. “When they’re spread so thinly, the services are really diminished.”
The Conejo Unified School District, which has three nurses for 17,000 students, hired “health clerks” to work part time at several schools.
“Health clerks can put Band-Aids on, but they can’t do the health screenings and more extensive medical work,” said Donna Graeser, a nurse in the district. “It makes people feel better knowing there is someone there.”
At the 7,500-student Hueneme School District, where two nurses cover 11 campuses, school secretaries have taken on the role of health clerk.
“Most of our schools are in the situation where the staffs are trained in emergency first aid,” said Mary Samples, director of pupil support services at the district. “Would I like there to be a nurse at every school? Absolutely. Is that feasible? Not a chance.
“Instead, we do our best with what’s available,” she said.
The Santa Paula Elementary School District relies primarily on the state-funded Healthy Start program for its health care.
The program serves the families of children who attend Barbara Webster, Thille and McKevett elementary schools in Santa Paula and Fremont, Rose and Cesar Chavez schools in Oxnard. Services offered include mental health, substance abuse and family counseling as well as basic health care.
Dr. Chris Landon, director of the Pediatric Diagnostic Center in Ventura, calls the program a first step in reversing the trend of decreasing health care for children.
“School-based health is something we need to work toward, not against,” he said. “The school, in a way, is a super-parent. It’s a place where you have all the kids together, and where you have a trusting and familiar atmosphere.”
Landon said he believes that in the future, Ventura County will be able to bring health-care clinics to every school, thereby ensuring all children are receiving adequate care.
Feldman said he supports the idea.
“Collaboration between the schools and public health organizations is the wave of the future,” Feldman said. “Particularly in terms of bringing services to populations that have traditionally had difficulty accessing health care.”
Children of the working poor and undocumented immigrants find themselves at the greatest risk, Feldman said. “We need to be able to find the areas where problems are the greatest and fill those gaps.”
For Butcher, the help couldn’t come soon enough.
A number of the children she saw at a recent dental screening had never been to a dentist, she said. Many had only visited a doctor to get the physical exam required to start school.
“One case I had recently was a girl who had a skin infection. I checked her and then the others in her family and found the origin for the infection to be from rat bites,” Butcher recalled. “These are the kinds of problems that cannot go unnoticed.
“But these problems will go unnoticed if you leave one person to cover 17 sites. . . . I would hope that people realize that these kids need to be a priority,” Butcher said.
“They are, after all, our future.”