Industry News

D.C. School Nurses Cover 4 School Each in New Staffing Model

  • D.C.’s Department of Health unveiled its new cluster staffing model to help cope with the city’s nursing shortage.
  • This new staffing model has reportedly already lessened the number of D.C. school nurses working full-time.
  • The DC Nurses Association is asking for the staffing model to be considered in favor of a collaborative solution.

Marcus L. Kearns

Nursing CE Central

September 18, 2023
Simmons University

New cluster staffing model in D.C. schools leaves half without a fulltime nurse. This is the new reality as the city’s Children‘s School Services (CSS) and Department of Health (DOH) strategize on how to best serve students during the nursing shortage.

This new model breaks away from D.C.’s Public School Health Services Amendment Act of 2017 which states that each public or public charter school must have an RN or LPN assigned for 40 hours a week each week the school is open to students.

What is the Cluster Model?

Under the proposed model, each cluster will consist of four public or public charter schools that are geographically close to one another. Each cluster will have a nurse manager overseeing the staff.

Including the nurse manager, there will be at least five healthcare workers assigned to each cluster, two being either RNs or LPNs and at least two being health technicians. Every school will still be assigned one full-time employee from this group, but each employee is expected to know the health needs of all students within their cluster.

The Department of Health provided an example cluster of four D.C. public schools totaling 1750 children. This would mean each healthcare employee would be responsible for approximately 438 students (or 350 if the nurse manager is also involved in direct patient care).

Health technicians are required to have AOM Certification, First Aid Certification, and either be a Nursing Assistant, EMT, or certified Patient Care Technician. This is in comparison to RNs and LPNs who are required to have some undergraduate education (bachelor’s or associate’s degree respectively) and pass the NCLEX exam.

The Department of Health does recognize the difference in responsibilities that nurses can handle compared to health technicians and has broken them down as follows:

Responsibilities of Nurses
  • Administration of injectable medications, excluding insulin
  • Acute Illness Assessment
  • Medical Procedures
  • Health and Nutrition Education
  • Reporting/Tracking of Communicable and Infectious Diseases
  • Health Suite Oversight
  • Individualized Health Plan Participation
  • Act as the primary point of contact for school health teams
  • Consult with medical specialists via telehealth regarding children’s illnesses
  • Act as the point of contact for Immunizations
Responsibilities of Health Technicians
  • First Aid
  • Consult via telehealth with one of the cluster’s RNs
  • Asthma Care Management, including administering Albuterol, Flovent, and Nebulizer treatments
  • Mental Health screenings
  • Administration of Medication
  • Care Coordination, such as referrals to medical/behavioral specialists
  • Reviewing immunization records
  • Vision/Hearing Screenings
  • Collection of health forms such as UHCs and AAPs
  • Entering school health forms into School Health Management
  • Communication with parents and guardians
  • Diabetes Care (under supervision of one of the cluster’s RNs)

In the example cluster, the farthest schools are located less than a mile and a half apart, which is 10 minutes of travel by car or bake and up to 30 minutes of travel if taking public transportation or walking. This distance is important as just 64.6% of households in D.C. have access to a vehicle.

Additionally, D.C.’s school system will now be continuing a telehealth program originally piloted in 2021. These telehealth services include care for rashes, nose/throat/ear irritations, minor injuries, and common colds.


Response to the Changes?

The District of Columbia’s Nurses Association stands against the cluster model, promoting a petition to stop the change. They claim that these changes coming from the Children’s School Services (CSS) and the District of Columbia Department of Health (DOH) prioritize “profits over student health by implementing downsizing measures that compromise quality healthcare services in schools.”

This complaint concerns the hiring of health technicians, who have fewer qualifications than nurses and lower wages. D.C. councilmember Christina Henderson says that this year, there are about 96 full-time nurses and 88 health technicians across 184 schools compared to last year when 102 of the 183 schools had at least one full-time nurse.

However, Henderson also states that having a full-time nurse at every school for 40 hours a week has never been a reality. Instead, this program “will deliver quality care to our young people and provide a level of consistency that our schools have been asking for.”

These changes come alongside an 11% increase to the district’s total budget, splitting $2.2 billion between public and public charter schools. This puts D.C.’s spending per student in the top 15 across all states in the U.S.

Mary Hines, a D.C. school nurse, speaks to both sides of the issue. On the one hand, she believes that the CSS needs to focus on long-term solutions to this shortage or at least involve current staff in the decisionmaking. On the other hand, she laments the difficulty in keeping nurses working in schools.

The average nurse in D.C. makes $150,000 a year compared to the average school nurse, who makes $61,112 a year. Nationwide, nurses in other healthcare facilities earn 15.8% more than the average school nurse. Hines has been a nurse for over 50 years and working in schools for more than 20 years, but she still makes less than $100,000 a year.

D.C.’s Nurses Association urges the CSS and DOH to collaborate with a nurse representative and reconsider the cluster model in favor of a solution that works “towards a solution that ensures every school has a dedicated nurse who can provide the highest standard of care to our students.”





The Bottom Line

There is no easy solution here, and conversations are likely to continue as the cluster model takes effect. Nurses are a necessary part of pediatric care, and schools should not forget their essential role in emergency care.

While students in D.C. will likely benefit from the stability of the cluster model, it is hard not to wonder what other solutions may be on the horizon if nurses and schools are able to work together.

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