Nineteen schools in Indianapolis Public Schools will lose their nurses provided through Indiana University Health when this school year ends, prompting concerns from parents about schools’ ability to respond to emergency health situations or oversee other health care needs.
The announcement from IPS last month means IU Health will end its three-year pilot with the district prematurely. The district, meanwhile, has said that it will search for other nursing providers to fill in at those schools — although four of the 19 are slated to close at the end of this school year.
The partnership with IU Health was meant to last from 2021 to 2024 with funding from federal coronavirus relief dollars. But Indiana University officials cite the nursing shortage as a ubiquitous challenge that has worsened since the start of the pandemic. IU Health officials did not detail why staff shortages prompted it to pull the plug on the nursing program in IPS, but said in a statement it is investing in its workforce to ensure it can meet patient demand and “provide the best clinical care possible.”
The end of the IU Health partnership could leave a large number of IPS schools without a registered nurse or licensed practical nurse to dispense medication or respond to health emergencies, such as hypoglycemic shock. IPS board documents from April 2022 show that 49 buildings out of the district’s 76 school programs (a figure that includes traditional district schools and those in the IPS Innovation network) had either a nurse employed by IPS, a health professional staffed through IU Health, or a school-based health center.
“We understand the vital role that school nurses play in ensuring the health and safety of our children and we are working in close partnership with IPS to find alternative solutions and ensure a seamless transition for student care,” Melissa Cash, vice president of retail and employer health solutions at IU Health, said in a statement.
The district did not respond to several requests for comment, but said in its March statement that it is exploring other potential ways to keep nurses at the schools.
“We have begun early conversations with other community partners who are eager to come alongside IPS to continue this invaluable service,” the district said.
The news has left some parents concerned about whether their children will have their health needs properly addressed while at school.
Krista Searles, whose daughter at Butler Lab School 55 has asthma and a condition known as ketotic hypoglycemia, said having a qualified nurse at the school provides an extra layer of protection for her if she becomes hypoglycemic.
But there are other students at her daughter’s school who have even greater health care needs, said Searles, who is a nurse herself.
“I think it’s really important that we’re providing those resources in the community because those kids are already working hard enough just to get through the day,” she said.
Searles also worries that the lack of nurses at some schools — particularly those that offer special programming such as Butler Lab — could also exacerbate educational inequities.
“It really creates a lot of disparities for kids with more significant health care needs and it really limits their educational options,” she said.
COVID fallout, salary disparities affect school nurses
School nurse shortages have been a perennial issue in Indiana and across the country. Indiana Administrative Code recommends a ratio of one registered nurse for every 750 students, but does not impose any penalty on districts that don’t meet that ratio.
A November 2018 report from the Indiana Department of Education found that 1,017 nurses responding to a statewide survey reported a ratio of roughly one nurse per 917 students.
State code does require, however, that school districts hire at least one registered nurse with a bachelor of science in nursing to coordinate all health services.
In the absence of a school nurse, state law allows school staff to administer certain medications or health care services to students with immunity from any damages in a potential civil lawsuit that may follow. Registered nurses can also delegate certain tasks to those without nursing credentials.
School nurses were often receiving the brunt of parent anger over health rulings during COVID, said Deb Robarge, executive director of the Indiana Association of School Nurses.
“There’s been a lot of older nurses saying, ‘I don’t need this, I was doing this because I loved doing it for the kids,’” she said. “And they had a pretty good relationship with their families and stuff. But just as the U.S. in general has descended into so much incivility to each other, I think school nurses and teachers and administrators have more of the brunt of a lot of that.”
School nurses also generally make less than nurses in a hospital setting, Robarge said.
A 2022 report from the Indiana Governor’s Public Health Commission recommended implementing policies to improve the student-to-nurse ratio and to address low pay.
Board documents show that registered nurses provided through IU Health had a maximum pay of $57 an hour working 37.5 hours per week, while licensed practical nurses had a maximum pay of $33 an hour.
Parents at schools slated to lose nurses through IU Health hope the district will be able to keep nurses at their schools.
“She does so much for our students and helps our teachers focus on their job: teaching,” Megan Alderman, a parent at Center for Inquiry School 70, wrote in a public comment to the school board last month. “Without our school nurse, medical care will once again be relegated to our teachers who do not have medical training and are busy in the classroom.”
Amelia Pak-Harvey covers Indianapolis and Marion County schools for Chalkbeat Indiana. Contact Amelia at apak-harvey@chalkbeat.org.
