Funding cuts force health department, Fayette schools to alter school nurse program

The school nurse program for all Fayette County schools would be pared back to a mix of registered nurses and licensed practical nurses next year, focusing on serving students with chronic or long-term health care needs, according to a proposal by the schools and Fayette County health officials.

The change is necessitated by an expected $500,000 cut in federal funding to the Lexington-Fayette County Health Department for the fiscal year starting July 1, according to Dr. Rice Leach, the county health commissioner.

Some details remain to be worked out, and the new nursing proposal must be approved by the Fayette Board of Education. Officials described it as a stopgap measure for next year only.

The nurse program is a joint effort by the schools and the health department.

Instead of the roughly 30 RNs now providing care in Fayette schools, the plan for next year would offer roughly 13 RNs and about 14 licensed practical nurses, plus some clerical workers, school and health department officials said.

In effect, the LPNs would work under the supervision of the registered nurses, who also would provide direct health care to students, according to the proposal.

As is the case now, each nurse would cover several of Fayette's 50-plus schools. District officials said they've never had enough nurses to put one in every school.

Teachers and school staffers sometimes see school nurses now. But that would end as services would be limited to youngsters only.

Under the proposal, Fayette school staffers would handle routine health matters, such as bandaging cuts and scrapes and administering some medicines. That would free the trimmed-down nursing staff to care for students with chronic or specialized health needs.

"If a kid comes in with a scratch or an earache or a bellyache, that's not part of the package," Leach said Wednesday. "The package generally is to take care of those children who have conditions that might keep them out of school were it not for this health care presence."

Jack Hayes, the Fayette Schools' student achievement support director, said some of nursing positions would be part-time. But he emphasized that students who need nursing care while at school will get it.

"Services will be there; if a student needs a nurse to provide treatment, that's going to be done," Hayes said. "The plan calls for fewer full-time positions, but there will be more people overall.

"Some schools will see RNs every day because they have students who need treatment that an RN must provide," Hayes said. "Others would see LPNs more often."

Hayes and Leach said the health department and the school system worked out the nursing plan over the past few months, after it became apparent that federal cuts would leave the health department unable to afford the current program. The funding cut is a general reduction and is not related to the federal budget sequestration, department officials said.

Leach said he asked health department nurses and supervisors to come up with alternative solutions, which are reflected in the new plan.

Hayes said the Fayette School District will provide about $1.4 million for the school nurse program this year and the same amount next year. In the past, the health department matched the schools' annual allocation. But the health department's donation is expected to fall to about $275,000 next year, Hayes said.

Registered nurses, or RNs, have more training than LPNs and generally can take on more medical responsibilities. Typically, RNs define the scope of responsibilities of LPNs working under them, and the LPNs are not supposed to go beyond those responsibilities.

"I think the system will work," Hayes said. "As far as medical services, ... parents who have students with a need for services won't see any difference at all."

Leach said using a mix of RNs and LPNs would be a "new approach," and "we'll be keeping our eye on it."

"I think we can take care of these special-needs children," he said. "We have four or five physicians and one nurse on our board of health, and at least one of the doctors takes care of kids. He has a keen interest in how this is going to work."

The health department has trained Fayette Schools staffers in handling basic medical treatment needs for the past few years. That training would expand under the new program, Leach said.

One unresolved issue is to how to provide nurses for special-needs students on school field trips next year, Hayes said.

He emphasized that the mixed nursing program will be for next year only. After that, the district might consider other approaches, such as bidding out some nursing services, he said.

Meanwhile, the ultimate effect of tighter funding on the health department remains to be seen, Leach said.

He said he couldn't predict how many staffers would ultimately be laid off.

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