NEW YORK (Reuters Health) - A Massachusetts program that put full-time registered nurses in schools more than paid for itself by averting medical costs and lost work for parents and teachers, according to a new study.
Many school districts have cut or reduced the hours of school nurses in recent years, and nationwide less than half of public schools have a full-time nurse, the authors of the report note.
They say their results warrant “careful consideration” from districts that are thinking of making such cuts in an effort to save money.
“The findings of this study suggest that from a societal perspective, the benefits of school nursing services may well exceed the cost for those services,” Li Yan Wang told Reuters Health.
She led the research at the Centers for Disease Control and Prevention’s Division of Adolescent and School Health in Atlanta, Georgia.
To assess the Massachusetts program, the researchers compared money spent putting full-time nurses in schools with money the program saved by reducing doctors’ visits and keeping parents at work and teachers in front of the classroom.
For the 22 types of procedures school nurses performed during the study, from testing blood sugar to administering physical therapy, the researchers calculated how much it would cost to go to a clinic or hospital for the same care.
To measure lost wages for parents, they determined the time parents would have to take off work if children were dismissed early, as well as how often they would have to come to school to help kids take their prescription medications if no nurse was on site.
Finally, to assess teacher productivity, they referred to an earlier study that found teachers spent 20 fewer minutes per day dealing with student health issues once a nurse was assigned to their school.
Massachusetts records showed that during the 2009-2010 school year, about 477,000 students at 933 schools covered by the program received school health services. Paying nurses to provide those services cost $79 million.
The same care provided outside of school would have cost $20 million. In addition, with no school nurses parent productivity losses would have totaled $28.1 million and teacher productivity losses, $129.1 million.
Wang and her colleagues calculated that every dollar invested in the school nurse program saved $2.20 overall, according to the findings published Monday in JAMA Pediatrics.
Anne Sheetz said those savings are just a start.
“We haven’t looked at the number of emergency room visits saved, we have not looked at the number of hospitalizations saved . . . we have yet to look at the big savings,” she told Reuters Health. “This is just a drop in the bucket.”
Sheetz, the study’s senior author, retired last year as the Director of School Health Services at the Massachusetts Department of Public Health.
When she started the position, she said, “I could not believe the amount of health care that was being done in schools and the critical nature of it.”
School nurses, Sheetz said, see 60 to 70 kids each day. They have to be ready to provide emergency care and mental health services and help manage chronic conditions like diabetes. Nurses are also charged with teaching other members of the school community about issues such as life-threatening food allergies.
“The role of the school nurse has really expanded,” said Martha Keehner Engelke, who has studied that topic at East Carolina University in Greenville, North Carolina but wasn’t involved in the new report.
“People think of it as doing vision screening and putting on Band-Aids,” Engelke told Reuters Health. “Those things are there, but that’s a really small part of what school nurses do.”
Two local doctors who have worked with the Massachusetts school health services program, pediatric allergist Dr. Michael Pistiner of Harvard Vanguard Medical Associates and endocrinologist Dr. Maryanne Quinn of Boston Children’s Hospital, agreed that it has had a considerable impact on kids’ health in both of their specialties.
“Cost has been a very real barrier,” Pistiner said.
The new study, he added, “may change these conversations. It may put getting a full-time school nurse back on the priority list.”
SOURCE: bit.ly/1adWrco JAMA Pediatrics, online May 19, 2014.
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