School Secretaries say they are Not Nurses; Worry about Student Health, Safety

According to Karen Seiser, North Bend Elementary secretary and president of the Snoqualmie Valley Secretaries Union (SVASA), a sticking point in her union’s yearlong contract negotiations with the school district is nurse room duties.

Secretaries want more school nurse hours in Snoqualmie Valley school buildings. They say over the years, as enrollment has swelled, school nurse room hours have not kept pace.

Seiser says secretaries are the “front line” when it comes to the health and safety of students, but the fact is, they aren’t licensed health care professionals – and that it is challenging to perform administrative duties when wearing two hats of secretary and nurse.

Karen Seiser, addresses school board about contract on 1/9/2014
Karen Seiser, addresses school board about contract on 1/9/2014

Snoqualmie Valley Schools have an average of about a .5 nurse  in each of its 10 buildings. Secretaries are trained to perform certain nurse room duties when nurses aren’t in the buildings. Nurses supervise and can respond to schools in emergency situations.

Some schools may have more than a .5 nurse and some may have less. According to SVSD Nurse Supervisor, Margie Blackmon, it’s dependent on the specific school’s student needs. Blackmon says currently the district has a nurse-to-student ratio of about  1:1,250, which is lower than the state recommended 1:1,500 ratio.

When the district closed Snoqualmie Middle School this year, its school nurse stayed to serve the needs at the Freshman Campus. Twin Falls Middle School now has one .7 nurse for its larger 740 student population. Chief Kanim Middle School has .6 nurse time (shared between two nurses) for its population that increased from about 440 to 720 students this year. Each school also has three secretaries.

Secretaries say the nurse room issues are felt more at the elementary level, where typically there are only two secretaries. In Snoqualmie, one nurse covers both Cascade View and Snoqualmie Elementary Schools. When Cascade View opened in 2005, the two schools had about 950 students combined. Today, that combined enrollment sits at about 1,350 students  – with one nurse covering both student populations.

More Students with More Health Concerns

Over the past decade, Washington State has experienced a growing number of children with health concerns, along with increased severity of health conditions – like diabetes, asthma, obesity, anaphylactic (life threatening) allergies. The state has also seen a rise in the number of special needs students with state-required IEP’s  (Individual Education Plans) and an increasing number of students with 504 health plans. School nurses set up and help administer both types of plans.

According to the Washington State Nurses Association, since 2008, leading U.S. health agencies (American Academy of Pediatrics, Center for Disease Control, National Association of School Nurses) have collectively recommended a nurse-to-student ratio of 1:750 for regular (non-special needs) education students. (One nurse serving 750 regular students.) Washington State does not have a mandated ratio, just a recommendation of 1:1,500.

Margie Blackmon says the highest SVSD nurse-to-student ratio she can remember during her tenure was 2-3 years ago when it reached one nurse for about 1,700 students. She said she has consistently pushed district administration for more nurse hours to bring that number down.

In fact, for the 2014-15 school year, SVSD Health Services is asking to increase its 5.6 full time equivalent (FTE) nursing staff to 6.5, with an additional 3.75 hours a day of Health Tech position time shared across 10 school health rooms. That proposal, though, is not in place at this time.

Secretaries are also requesting increased Health Tech position time for the health and safety of their students. Seiser commented, “I don’t truly believe parents realize the lack of nurse time in all of our buildings. It’s very scary. I am not a nurse.”

SVSD Public Information Officer, Carolyn Malcolm, says the district and secretaries definitely share a common interest in the nurse room duty issue and that the most recent contract proposals included language about how to move forward regarding nurse room duties. The district is “optimistic” that the matter is close to being resolved.

Malcolm added, “It is also an issue that may have significant costs associated with it, which impacts overall negotiations given the salary proposal that SVASA has on the table at this time.”

Malcolm said the district does have well-established protocols and systems to ensure student health and safety at all times, including times when a nurse is not in the building.

For now, contract negotiations will continue. Union members have worked the 2013-14 school year on an expired contract. Their previous contract expired in summer 2013.

Seiser said they may negotiate again on June 30th.  If not, then talks won’t resume until August at the start of the 2014-15 school year..



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  • I believe we should have more nurses with more hours at the elementary level. My daughter (a fourth grader at SES) has struggled with anxiety this year which has led to stomach issues. I have been called multiple times by the secretaries who seem to be the ones dealing with her at least as much as the school nurse. I would like to support this if any proposal comes up for public vote.

    1. There are many times that kids come to the health room with chronic issues such as this and others. I am not saying that they should not come, but many use the schools health room as a free clinic. School nurses have many other tasks not only with medical issues, but mental health issues, district wide vision and hearing screening, IEP meetings, yearly mandated staff trainings, policy and protocol implementation and the list does go on. School buildings are all over worked and under paid for sure.
      If parents would keep their kids home when they need to be – not put them on a bus with a cough and fever and tell the kids to go and see the nurse at school, this would help cut down on the kids who come to the health rooms steadily during the day.

  • Somebody fix my math, Isn’t 1:1,250 actually a higher number of nurses to students than the state recommended 1:1,500?

    1. You’re correct, 1:1250 means fewer students per nurse t
      Than 1:1500. Must be common core mathused in this article

      1. The article does not state that SVSD’s ratio is higher than state recommended ratio. SVSD’s ratio falls in between what the state (subject to lack of education funding and responsible for paying school nurse salaries) recommends and what the American Academy of Pediatrics, Center for Disease Control, National Association of School Nurses recommend, which is 1 to 750 students. Even at the current levels, 1:1,250, it still requires secretaries to perform health room duties on average half of the day. Hence, secretaries (and SVSD health services dept.) are asking for more nurse health room hours to help optimize the health of students.

  • I’m not arguing about whether more nurses are needed, This is the part of article that confused me “Blackmon says currently the district has a nurse-to-student ratio of about 1:1,250, which is below the state recommended 1:1,500 ratio.”

    Seems to me it should state that the SVSD is above what the state recommends.

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