Three months after the latest round of layoffs of school nurses — 47 in December, bringing the total for the school year to about 100 across the Philly School District — a couple of nurses who had survived the cuts (but weren’t so confident as to allow their names in print) met up with a reporter after school. Their bottom line: They and their colleagues now go to work terrified.

“It’s a time bomb,” one said, describing distribution of medication by nonmedical professionals, the increase in 911 calls from schools, the out-of-whack diabetics, and the compounding crises of Medicaid cutbacks, parents’ loss of employer insurance and the reduction in school nurses.

Eileen Duffy, a nurse who has spoken out on the issue and leads weekly demonstrations in front of School District headquarters on North Broad Street, now divides her time among three schools; she knows one nurse who oversees seven schools. She worries she could be liable for incidents that occur when she’s away, since she was tasked with creating an action plan for care in her absence.

It happens all the time: An asthmatic kid, for example, gets into a fight or has a panic attack and asks for his inhaler — the opposite of what he should have, since it will only accelerate his heart rate further. “A nurse would know that,” one said.

Then there are the subtler impacts, in a school system where counselors are often former teachers, not social workers. Referrals for insurance assistance and family planning, in particular, often fall to nurses. One nurse said a girl recently walked into her office 24 weeks pregnant, having received no prenatal care until the nurse finally referred her. Another nurse, at a high school where one in four female students is pregnant or parenting, said it doesn’t help that sex education is virtually nonexistent; girls often confuse cramps with stomach aches, and don’t understand the workings of the reproductive system.

“The majority of our calls would be from school nurses,” confirms Jaime Beck, program manager at CHOICE, which provides counseling and referrals for reproductive health in Philly.

Colleen McCauley, health policy director at Public Citizens for Children and Youth, says the center’s hotline has seen an explosion of requests for help in obtaining care and insurance, and nurses are their top source of referrals. “We’ve had more families that have lost that employer coverage, and the school nurses are an important source of information for those parents who never used the safety nets before. The school nurse is a critical linker for those services.”

School District spokesman Fernando Gallard insists that ?all students who require care — termed “medically fragile” — have nurses available, and that there has been no impact on safety. But nurses say mistakes are bound to be made. “To some extent, all kids are fragile,” Duffy? says.

“We were at the bone before that last cut,” McCauley says, “and now, with laying off this next set — you can’t go much deeper than the bone.”

Philadelphia City Paper – March 29, 2012 – Read article online.