►
Description
During a Joint Hearing of the Council Committees on Education and Children and Youth held February 18, 2016, School District of Philadelphia Nurses Peg Devine (Lincoln HS) and Eileen Duffey (Academy at Palumbo, Allen M. Stearne ES) testify about the challenges of serving the health needs of students in the wake of drastic staff cuts that eliminated hundreds of and nurses and counselors.
B
I'm
peg
divine
on
the
school
nurse
at
lincoln
high
school,
and
I
want
to
thank
you
for
the
opportunity
to
give
testimony
today,
I'm
currently
serving
on
the
Executive
Board
of
the
Philadelphia
Federation
of
Teachers
I
am
a
member
of
the
school
nurse
practice
committee.
The
committee
for
professional
standards
for
the
school
district
of
philadelphia,
I'm
a
member
of
past
nap,
which
is
the
penn
station
of
school
nurses
and
practitioners,
and
a
member
of
the
national
association
of
school
nurses.
B
I'm
here
today
to
discuss
the
impact
of
the
budget
cuts
on
the
school
nurse
service
in
philadelphia
and
the
effects
these
cuts
have
had
on
our
most
precious
resource.
Our
children,
school
nurses
in
Pennsylvania,
are
licensed
and
are
required
to
hold
professional
certification
in
accordance
with
the
public
school
code,
which
was
enacted
in
1949,
and
this
is
a
point
of
clarification.
Donna
Cooper
earlier
suggested
that
we
have
the
health
centers
provide.
B
The
nurse
service
to
the
schools
and
part
of
the
school
code
says
that
school
nurse
service
shall
be
provided
through
the
public
school
system
and
administered
administration
of
this
is
the
responsibility
of
the
school
district.
So
that's
right.
In
the
school
code,
the
certified
school
nurse
provides
school-based
services
to
all
students,
not
just
those
who
are
covered
with
health
insurance
companies.
This
the
school
nurse
performs
mandated
screenings
that
are
required
under
the
school
code,
including
growth
and
vision.
B
Screening
annual
annually
from
kindergarten
through
12th
grade
screening
for
hearing
is
done
in
grades,
12
k
through
three
six
and
nine
and
scoliosis
screening
is
done
in
sixth
and
seventh
grade.
The
state
mandate
also
requires
school
nurses
to
plan
for
an
administer
first
aid
services
and
to
instruct
personnel
who
are
responsible
for
administering
the
first
aid.
In
the
absence
of
the
school
nurse
in
1975,
when
Congress
passed
the
education
for
all
handicapped
children
act,
the
role
of
the
school
nurse
became
even
more
essential.
B
Today,
the
certified
school
nurses
duties
include
many
nursing
procedures
beyond
administering
medication
orally,
such
as
blood,
glucose
monitoring,
insulin,
administration,
providing
rectal
valium
administration
of
medication
by
way
of
gastric
tubes,
nasogastric
tubes,
tracheal,
suctioning
and
catheterizations,
just
to
name
a
few.
The
nurse
develops
individualized
healthcare
plans
for
each
of
the
medically
fragile
students.
The
nurse
collaborates
with
the
faculty
and
staff
to
remove
barriers
so
that
these
students
are
ready
to
learn
this.
B
They
may
create
50
for
service
agreements
to
accommodate
the
students
who
are
protected
under
the
office
of
civil
rights
and
or
they
participate.
In
writing
the
individual
education
plan
necessary
for
the
medical
and
nursing
components
for
the
students.
School
nurses
maintain
confidential
health
records
on
every
student.
B
The
state
of
Pennsylvania
requires
the
school
district
to
hire
the
school
nurses
for
every
one
school
nurse
for
every
1500
students,
and
please
remember
that
this
law
was
enacted
prior
to
I
DEA
and
the
inclusion
of
individuals
with
disabilities
in
the
least
restrictive
environment.
The
national
association
of
school
nurses
recommends
a
ratio
of
one
nurse
to
every
750
students
in
Philadelphia.
This
ratio
was
maintained
prior
to
the
layoffs.
At
that
time,
Philadelphia
was
nationally
recognized
for
the
excellent
compliance
that
we
had
in
reference
to
our
immunization
compliance
rate.
Today,
our
immunization
is
much
lower.
B
The
nurse
is
not
when
the
nurse
is
not
in
the
building.
The
students
are
registered
and
there
is
a
much
greater
chance
that
they
be
allowed
to
enter
the
building
without
being
properly
in
the
our
most
fragile
students
are
receiving
inconsistent
care
from
non-medical
staff,
who
have
been
given
basic
instruction
on
how
to
keep
them
safe.
Any
principal
is
capable
of
walking
into
a
classroom
and
teaching
because
of
their
educational
background.
The
same
cannot
be
said
when
they
are
expected
to
act
as
the
nurse
in
the
building,
because
they
don't
have
the
same
skill
set.
B
Yet,
since
the
budget
cuts,
they
are
expected
to
handle
all
emergencies
and
administer
medication
when
the
nurse
is
assigned
to
a
different
building
in
the
absence
of
the
nurse
medications
are
sometimes
mismanaged.
Students
are
given
asthma
inhalers
without
a
nursing
assessment
to
determine
if
medication
is
in
fact
needed.
B
The
risk
of
medication
and
errors
increases,
especially
missed
doses,
and
far
too
often
they
are
not
documented,
and
it's
not
documented,
who
has
administered
the
medication.
Students
who
are
assessed
by
the
school
nurse
are
often
able
to
remain
in
school
if
they
receive
a
dose
of
tylenol
or
ibuprofen,
but
these
same
students
are
sent
home
in
the
absence
of
the
school
nurse.
B
The
most
tragic
example
of
what
can
occur
when
a
nurse
is
not
present
is
all
too
familiar
to
the
school
nurses
of
Philadelphia
laporta
Massey,
who
died
as
a
result
of
an
asthma
attack,
spent
much
of
the
day
in
the
school
office
where
she
was
where
the
nurse
was
not
assigned
that
day
and
hadn't
been
two
days
prior.
So
for
that,
she
was
waiting
for
someone
to
recognize
her
distress
and
care
for
her.
B
Had
a
nurse
been
present
that
she
would
have
listened
to
the
child's
lungs
with
her
stethoscope
or
his
stethoscope,
and
immediately
recognized
the
danger
today.
Far
too
frequently,
students
are
at
home
with
my
are
sent
home
with
minor
injuries,
and
principals
will
are
on
the
side
of
caution
and
qualifier
rescue
to
escort
the
child
to
the
hospital
for
care
that
would
have
been
handled
easily
by
the
school
nurse.
Had
she
been
present,
this
place
is
an
unnecessary
burden
on
the
EMS
system,
and
parents
are
strapped
with
exorbitant
bills
for
these
services.
B
Another
direct
result
of
having
these
unfair
budget
cuts
is
fewer
staff
to
monitor
lunch
rooms,
polls
and
recess
yards.
We
eating
two
more
injuries
sustained
by
students
who
have
less
supervision.
This
causes
an
increase
and
visits
to
the
health
room.
Consequently,
increased
visits
to
the
nurse
result
in
less
time
for
the
nurse
to
perform
mandated
screenings
difficulty
in
managing
the
health
records
or
difficulty
monitoring,
immunization
compliance
an
inadequate
time
to
accomplish
health-related
teaching
among
several
other
tasks.
Another
population
that
is
unduly
burdened
by
the
budget
cuts
are
the
diabetic
students.
B
The
diagnosis
of
diabetes
is
devastating
to
families.
The
number
of
cases
of
this
life-threatening
condition
has
risen
dramatically,
and
these
students
deserve
the
protection
of
a
certified
school
nurse
all
day
every
day,
while
they're
in
school.
The
school
district
has
opted
to
provide
outside
agencies
to
provide
nurse
service
to
come
to
the
school,
on
a
part-time
basis,
to
monitor
the
blood
sugar
of
these
fragile
students.
B
They
camel
in
the
quadratic
ount
the
carbohydrates
that
the
student
has
eaten
and
they
administer
insulin
accordingly,
the
risk
the
agency
nurses,
that
they
may
not
show
up
is
very
real
and
when
they
do
come
to
school,
it's
it's,
there
is
no
consistency
and,
as
a
result,
no
relationship
develops
between
the
child
and
the
nurse.
As
a
result,
subtle
changes
in
the
child's
affect
or
behavior
that
would
have
been
recognized
by
this
certified
school
nurse
or
often
missed.
B
The
practice
also
makes
a
very
dangerous
assumption
that
the
diabetic
student
will
have
no
variation
in
the
blood
sugar
levels
when
the
nurse
is
not
present.
Another
undesirable
alternative
being
offered
to
families
is
to
have
their
child
transfer
to
a
school
farther
from
home,
where
there
is
a
nurse
present
every
day.
This
isn't.
This
is
unacceptable
to
families
who
have
already
been
devastated
by
the
diagnosis,
along
with
all
the
other
life.
Changing
complicate
complications
that
go
consequences
that
go
with
this
disease.
B
Working
with
community
partners
such
as
the
Eagle
Eye
mobile,
an
oral
health
impact
project
have
seen
reductions
in
the
number
of
students
served
because
when
the
school
nurse
is
not
present
in
the
building,
they
are
unable
to
coordinate
these
services
as
effectively
when
a
nurse
is
not
in
the
building.
They
are
not.
They
are
unable
to
point
dissipate
in
the
IEP
and
the
504
meetings
for
medically
fragile
students
and
the
vital
input
regarding
the
student's
health.
History
is
often
missing.
B
Case
management
is
challenging
when
the
nurse
is
responsible
for
1500
students
on
a
daily
basis,
and
when
these
students
are
spread
over
multiple
buildings,
it's
next
to
impossible
to
provide
safe
care
as
certified
education
specialists.
School
nurses
are
also
charged
with
developing
health
and
wellness
programs
for
their
schools.
This
is
virtually
impossible
to
do
with
the
current
staffing
ratios.
B
C
Good
afternoon
my
name
is
eileen
duffey,
I'm
a
certified
school
nurse
at
the
academy
at
palumbo
and
at
the
end
Alan
M
Stern
School
in
frankford.
I
have
worked
as
a
pediatric
nurse
for
over
30
years,
21
in
the
school
district
of
philadelphia.
My
prior
experience
includes
15
years
working
at
Children's,
Hospital
of
Philadelphia
and
the
University
of
Pennsylvania
I.
Thank
you
for
inviting
me
here
today
to
discuss
the
impact
of
the
budget
cuts
on
essential
services
to
our
vulnerable
school
population.
In
many
regards,
the
information
peg,
Devon
and
I
provide
today
is
not
new.
C
C
We
have
done
so
in
op-eds
letters
to
the
editor
on
the
radio
at
community
meetings
in
a
photography
exhibit
at
weekly
rallies
for
six
consecutive
months
and
at
countless
school
reform
commission
meetings
we
brought
national
attention
to
the
Philadelphia
School
Children's
unmet
needs
when
a
child
died
as
a
result
of
an
asthma
attack
that
occurred
in
a
school.
We're
no
nurse
was
on
duty.
C
It
can
reasonably
be
stated
that
we
have
left
no
stone
unturned
in
our
persistence
in
advocating
for
our
students
rights
to
essential
school
health
services
performed
by
certified
school
nurses.
I
have
been
requested
to
speak
on
the
impact
of
the
reduced
funding
on
the
services
my
colleague
described
a
few
minutes
ago,
while
much
warranted
hand-wringing
has
occurred
regarding
the
times
there
is
not
a
nurse
in
the
school.
C
I
would
like
to
make
it
clear
that
the
doubling
and
sometimes
tripling
of
our
caseloads
up
to
1500
students
to
each
nurse
has
wreaked
havoc
on
the
quality
of
services.
Each
nurse
provides
in
the
day
the
nurse
is
in
the
building.
Each
school
nurse
finds
herself
in
a
professional
double
bind
situation
in
which
doing
one
essential
service
results
in
not
providing
another
essential
service,
hence
mandated
screenings.
They
get
done
while
non-compliant.
Immunization
follow-up
calls
do
not
get
done.
C
Most
school
district
nurses
agree
that
it
takes
about
three
years
for
a
qualified
certified
school
nurse
to
reach
her
stride.
After
leaving
a
clinical
setting
in
which
a
medical
model
is
used
and
entering
a
school
setting
in
which
she
is
the
only
medical
professional
in
the
building
long
before
the
draconian
budget
cuts,
we
nurses
commiserated
about
the
responsibility
we
felt
adequately
addressing
the
mandated
professional
duties
enumerated
by
my
colleague
earlier
today.
C
We
had
professional
meetings
several
times
a
year
in
which
we
shared
best
pract
is
honed
our
skills
and
support
at
one
another
in
our
difficult,
but
rewarding
jobs
serving
Philadelphia
still
dhryn.
Our
passion
for
this
work
is
unmatched,
but
let
me
be
abundantly
clear
here.
Before
2011
we
were
able
to
get
our
job
done
before
2011
our
quality
Philadelphia
School
Health
Program
was
nationally
recognized.
In
fact,
prior
to
the
2011
budget
cuts,
school
nurses
were
rarely
in
the
news,
precisely
because
adequate
well-functioning
school
nurse
services
did
not
constitute
a
newsworthy
topic.
C
In
spite
of
our
vigilance,
perhaps
because
of
our
persistence,
the
school
district
of
philadelphia
administration
has
sidestepped
the
school
district
nurses
on
numerous
occasions
in
their
attempts
to
provide
school
health
services
on
the
cheap
bureaucrats
who
are
not
professional.
Certified
school
nurses
have,
on
numerous
occasions,
suggested
simplistic,
half-baked
solutions
to
meeting
what
they
perceive
to
be.
The
health
needs
of
philadelphia,
children,
time
and
again,
they're
shoot
from
the
hip
solutions
ignore
the
pennsylvania
school
code
and
the
complicated
needs
certified.
Certified
school
nurses
are
able
e
prepared
to
meet.
C
I
would
add
that
medical
professionals,
however
prestigious
their
pedigree,
who
do
not
hold
the
school
nurse
certification,
are
not
the
appropriate
persons
to
weigh
in
on
issues
of
school
health.
As
a
case
in
point,
no
one
here
who
suffered
a
brain
tumor
would
seek
the
expertise
of
an
orthopedic
surgeon
to
perform
a
delicate
brain
surgery.
C
One
of
the
solutions
put
forth
by
non-experts
is
to
think
an
innovative
quote-unquote
idea
is
to
engage
in
partnerships
with
area
universities.
This
idea
is
not
innovate
at
all.
In
fact,
long
before
the
word
partnership
became
code
for
abdication
of
financial
responsibility.
School
health
services
have
been
engaged
in
university
partnerships
to
supplement
health
related
services.
C
No
partnership
can
be
effective
when
engaged
without
the
direct
cooperation
of
the
certified
school
nurse.
All
partnerships
require
more,
not
less
work
on
the
part
of
the
school
nurse.
Current
partnerships,
such
as
vision
and
dental,
are
experiencing
the
jarring
recognition
of
this
fact
as
they
seek
to
provide
services
in
schools
without
a
school
nurse
on
site.
If
I
can
leave
you
with
just
one
realization.
C
After
hearing
my
remarks
today,
please
disabuse
yourselves
of
any
thoughts
that
vital
school
services
can
be
done
by
anyone
other
than
a
certified
school
nurse,
and
restoration
of
adequate
school
nurses
should
be
a
priority
in
the
next
school
budget.
Thank
you
for
inviting
me
to
speak
to
this
assembly
today.
Thank
you.
I.
A
Just
want
to
acknowledge
miss
Devine,
miss
Duffy
for
doing
yeoman's,
work
and
heroic
work
around
raising
attention
to
the
issue
of
school
nurses.
This
issue
would
not
reach
the
level
that
it
had
had
it
not
been
for
your
organizing
activism
and
passion
for
this
issue.
I
know
that
we
have
another
panel,
but
I
just
had
a
few
very
quick
clarifying
questions
for
for,
for
you
miss
Devine.
Are
you
the
only
school
nurse
at
Lincoln,
High,
School.
B
A
All
right,
thank
you
very
much
and
then
miss
Duffy.
What
who
mandates
physicals
state
or
city
or
what's
the
Samantha
state
and
is
that
your
I
mean
I,
think
some
of
the
testimony
that
came
out
today
raises
some
serious
questions
about
whether
the
School
District
of
Philadelphia,
again,
it's
in
violation
of
state
law
in
terms
of
delivery
of
records
in
terms
of
whether
physicals
are
being
mandated
in
terms
of
504
plans,
and
we
will
continue
to
follow
that
up.
I
do
want
to
make
sure
that
both
your
testimonies
are.