Education

NC charter schools lag behind traditional public schools in access to nurses

Posted February 4, 2020 7:00 a.m. EST
Updated February 4, 2020 11:02 a.m. EST

— As a school nurse, Nanette Merritt has seen it all. An eraser stuck up a child's nose. Dislocated shoulders. Broken hands, wrists and fingers. Bloody noses. Sore tummies. Warm hugs and cold ice packs can work wonders in many situations, she says, and her work in an urgent care helped prepare her for everything from common complaints to the more serious school health issues.

Merritt cares for more than 700 kindergarten through eighth-grade students at Envision Science Academy in Wake Forest, one of the few charter schools in the state with a dedicated school nurse. Last school year, 45 of the state's 184 charter schools – about 24% – employed a registered nurse, but not all of those nurses serve the entire school population like Merritt does. Some work with individual students with serious health issues, but the exact number is unknown.

Nanette Merritt, a school nurse at Envision Science Academy in Wake Forest

Nanette Merritt, a school nurse at Envision Science Academy in Wake Forest
Photographer: Kelly Hinchcliffe

North Carolina charter schools, which are publicly funded and privately run, have an average of one nurse for every 3,129 students, while traditional public schools have one nurse for every 1,021 students. Ann Nichols, state school health nurse consultant with the N.C. Division of Public Health, warns the numbers are state averages and vary widely by school.

"Of course, we believe that all students in North Carolina should have access to a school nurse," Nichols said. "It just that, like everybody else, people are strapped for resources."

Both charter and traditional schools as a whole fall behind the ratio of one school nurse for every 750 students, as recommended by the National Association of School Nurses. Charter school advocates say limited funding and competing demands are the main reasons they lag behind traditional schools in access to nurses.

"If you're going to have a full-time nurse, that means you're sacrificing something somewhere," said Charles Fuller, executive director of Envision Science Academy. "If you went to any school and said, 'Would you like to have a full-time nurse?' They wouldn't bat an eye ... But wanting one and being able to have the funds for one are not necessarily the same thing."

Fuller says his school gave up hiring extra teacher assistants to be able to hire a nurse, a decision that has freed up his teachers, front office staff and even himself from those responsibilities.

"I don't mind giving a student their medication, but that's not something I would prefer to do," Fuller said.

Charles Fuller, executive director of Envision Science Academy

Charles Fuller, executive director of Envision Science Academy
Photographer: Kelly Hinchcliffe

Charter schools' 'lack of access' to nurses noted in report

Each year, the N.C. Department of Health and Human Services collects data for the "Annual Charter School Health Report," which is shared with state education leaders but not posted publicly. WRAL News requested the report to learn more about health in charter schools. Charters, which are public schools and do not charge tuition, have been booming in North Carolina with more than 100,000 students enrolled at 196 schools across the state.

During the 2018-19 school year, North Carolina charter schools reported the following health results. (More details are available in the full report).

  • 24% of charter schools employ a registered nurse either full or part time, up from 16% in 2016-17
  • 64% of charter schools have at least one child with diabetes
  • 85% offer generalized diabetes training to staff each year
  • 59% have at least two people intensively trained on diabetes care
  • 98% have at least two epinephrine auto injectors
  • 95% have at least one person trained in the emergency use of epinephrine
  • 89% have a plan to help students who return to school after a concussion, up from 59% in 2016-17

The report found that the "comparative lack of access" to nurses in charter schools "directly impacts the ability to be compliant with statute related to school health and the ability to safely care for students with health needs."

Dave Machado, director of the state Office of Charter Schools, said charters "are not required to have nurses on staff but are required to have a nurse if a student needs particular health attention." The lack of nurses "is a funding issue," he said.


At Envision Science Academy, the addition of a school nurse was so popular that "parent after parent after parent" told Fuller and other school leaders how much they appreciated the hire.

"They noticed right away, even parents whose children do not have any specific medical needs," he said. "It's very comforting for them to know that there's a medical professional on campus."

Fuller's wife, a retired school nurse, helped get the school's program started, and the school hired Merritt to be the new nurse in 2018. Fuller says he sympathizes with charter schools that want a nurse but haven't been able to hire one due to competing financial demands.

"It's not that they don't want to, because I promise you they want to," he said.

Now that his school has access to a full-time nurse, Fuller can't imagine going back to the old days when he and other staff members handled students' health issues. Parents have also become accustomed to having a nurse at the school and would likely rally if the school discontinued that resource.

"I think our parents would say, 'Look, we'll have a special fundraiser ... whatever it takes to keep her,'" Fuller said.

Nurse Merritt says she definitely feels needed, sometimes so much that she misses her lunch break or has to cut it short to help a student. But she understands that's part of the job. Along with helping students, she trains school staff on things like CPR and how to help students who return to class after suffering a concussion.

She even scrutinizes snacks that are served in class to make sure they don't affect students with allergies. When the school opened a garden classroom and let students taste some of the fruits and vegetables they grew, she asked teachers what dips they were serving with the food so they didn't cause an allergic reaction in any students.

"I have to do some in-depth education with the teachers," she said.

But, by far, there is one part of her job that is her favorite.

"The hugs," Merritt said, smiling.

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