New nurse requirement to add to school districts' woes


SPRINGFIELD -- In July, Illinois’ financially squeezed school districts will have one more thing to check off their to-do lists: find certified school nurses, if they haven’t already.

For years, schools have hired less-expensive registered nurses to cut costs, but beginning July 1, the Illinois State Board of Education will require that certified school nurses, or CSNs, make any educational recommendations related to a student’s special-education needs.

Opponents say the timing couldn’t be worse, with state education funding facing additional cuts. Last week, Gov. Pat Quinn projected another $400 million reduction for education programs in his next budget.

Hiring additional staff has been the last thing on anyone’s mind, said Rochester School Superintendent Thomas Bertrand.

“We weren’t aware that something was broken,” he said.

Question of training

Having CSNs make educational recommendations related to a child’s special-education needs has been required since 1976, said Jessica Gerdes, the state board’s principal consultant for school nurse and health issues.

In 2010, after some school superintendents complained how difficult it was to find CSNs, the agency allowed RNs and advanced practice nurses to make such recommendations. 

But registered nurses are not trained to deal specifically with special-education students, said Linda Kimel, president of the Illinois Association for School Nurses. CSNs are the only nurses trained in educational philosophy, special-education rules and the special-education process, she said.

When a child is having difficulty learning in school, he or she can be evaluated by a team of people to determine whether he or she should be entered into an individualized education program. The team typically includes a psychologist, teacher, administrator, one or both parents and, if necessary, a speech or vision specialist. A nurse is involved if the child requires medical review.

Judy Vlach, whose daughter requires special-education services in Rochester’s district, said she’s never had an issue with a registered nurse evaluating her daughter.

One RN has worked with Vlach’s 11-year-old daughter since she was first evaluated for special education at 3 years old.

“(The IEP team) takes in information from every avenue and brings together my daughter’s educational plan that way,” she said. “It’s really been a team effort.”

Too few programs

Rochester hasn’t had a CSN on staff in about 10 years, Bertrand said. About 290 of the district’s 2,400 students receive some level of special-education services, and recommendations are made by the three RNs on staff.

“At this point, we’re going to continue to do what we have done, which has worked very well for students and for staff,” Bertrand said.

After the rule changed in 2010, Kimel said a number of groups, including the Illinois Association for School Nurses, Illinois Education Association, and American Academy of Pediatrics, pushed the state board to revert back to the original language.

Beyond the cost of additional staff, Bertrand said he’s concerned about even being able to find certified school nurses to hire.

There are three approved programs in the state that graduate people with this type of certificate. The University of Illinois at Chicago and Millikin University in Decatur continue to enroll students each year. However, Southern Illinois University-Edwardsville offers the required 300-hour internship only every other year.

National Louis University in Wheeling is eliminating its program in June because of reduced enrollment, said Linda Gibbons, the program’s director at NLU.

Anne Perry, associate dean for SIUE’s school of nursing, said she expects enrollment in that program to increase because of the state board requirement. RNs without bachelor’s degrees would have to go through additional schooling before qualifying for the program, she said.

Five students are enrolled in the program at Millikin, with one set to graduate by December, said Jo Carter, assistant professor of nursing at the university. While some complete the program in a year, others take two or three years to do so.

‘Difficult hurdle’

One reason that school districts hire non-certified RNs is that they can be classified as part-time seasonal employees, so schools don’t have to provide benefits or higher pay, Kimel said. CSNs are on the teacher’s salary scale and receive health benefits, she said.

Auburn School Superintendent Darren Root said the two RNs on Auburn’s staff work full time, and the district can’t afford to hire more, even if they were part time.

“With school districts making cuts, and then they have required mandates to add (staff), it’s a pretty difficult hurdle to jump,” he said.

Joining a special education co-op can save rural districts money, because a single certified nurse can handle IEP evaluations for multiple districts.

One such co-op is the Sangamon Area Special Education District, which serves 13 school districts in Sangamon, Menard, Macoupin and Cass counties. Auburn is included in the SASED’s coverage area.

Of the co-op’s 13 districts, one school, Pleasant Plains, has a certified school nurse on staff, said Christine Harms, SASED’s director. The rest have at least one RN.

Harms thinks it will be a challenge finding a certified school nurse to share among the districts, but splitting salary costs is more practical than finding one for each.

Hits keep coming

Despite superintendents’ frustration, the rule still allows physicians and certain nurses who were employed by school districts before 1976 to conduct students’ medical reviews, just not to make educational recommendations.

Sangamon County Regional School Superintendent Jeff Vose said the district superintendents he oversees believe they have enough to worry about without having to adhere to new, unfunded directives from the state.

“It’s a balancing act they’re trying to manage. They keep getting hits on their budgets,” he said after leaving a meeting Friday where superintendents discussed the requirement change.

Of the 10 districts Vose oversees, two have one or more CSNs on staff, he said.

When the compliance date rolls around in July, Gerdes said there will be some leeway if schools have made reasonable efforts to find someone. A school district would have to document its efforts, such as offering higher pay, posting advertisements or offering tuition reimbursements to potential hires.

“If the districts are motivated to comply, then they will do what it takes,” Gerdes said.

Lauren Leone-Cross can be reached at (217) 782-6292.

Nurse numbers

A total of 3,157 nurses with the school nurse certification have been reported to the Illinois State Board of Education as working in public schools during the 2011-12 school year.

ISBE does not have information on whether the 5,947 other certified school nurses in its database are employed.

The database also reflects retired CSNs, those working in other areas that require the certificate, those who have left the workforce, and those who work in other areas that don’t require the certification but keep it current in case they want to return to the profession, said Jessica Gerdes, ISBE’s principal consultant for school nurse and health issues.

There were about 168,000 registered nurses in the state as of December, according to the Illinois Department of Financial and Professional Regulation.