When Chicago parents Jenifer and Zachary Korotko decided to enroll their son, who needs constant nursing care, in a Chicago public school three years ago, they were in for a big shock.
They had always assumed each city school had a full-time school nurse. That’s fairly common in suburban school districts and other parts of the country.
Their son has spina bifida, a congenital spinal defect. He needs special accommodations, including a school nurse to help him three times a day with a catheter.
But after enrolling their son in preschool at Drummond Montessori Magnet School in Bucktown, they learned several nurses would come to the school only for set periods of time each day to help their son.
And there was no way they could meet the nurse ahead of time. No one at school could say which nurse would be assigned to help their son.
“That made me very nervous and stressed out,” Jenifer Korotko said.
That was the beginning of an ongoing struggle to get quality nursing services for their son. Last school year, their son had four different nurses and a few substitutes, Korotko said. No one was assigned permanently to help him. On several days, her son didn’t have a nurse at all despite needing one three times each and every day, she said.
“A few times we picked him up and noticed that … he was soaking wet and so I had to figure out what happened,” Jenifer Korotko said. “Over time, that could be very problematic with his kidneys and cause some organ damage.”
Jenifer and her husband want a consistent, full-time nurse at their son’s school. And experts said that’s what each school should have.
But that doesn’t exist in Chicago Public Schools. No school has the same, full-time nurse all day to help students, a WBEZ analysis of CPS nursing data finds. Only a few schools have one or two nurses working all day because their students require continuous nursing services.
Instead, the school district has long relied on a chaotic deployment system based on student need — nurses are only assigned to schools to assist students with serious medical issues. And many of those students consider themselves lucky to see the same nurse on a regular basis.
On average, each CPS school saw five different nurses over a three-month period last fall, with a handful of schools seeing as many as 20 different nurses and one school hosting 32 nurses. And nurses themselves also visited an average of five schools last fall. Seventy-five nurses visited between 10 and 39 schools.
A district mandate last fall to perform background checks on all staff contributed to some scheduling problems, though the level of nurse churn is evident over the last three years.
CPS’ system, which relies partly on outside contractors, is designed to meet only the bare minimum of needs in each school, and sometimes it leaves students with complex medical conditions unattended, parents said.
CPS officials acknowledge problems with their nursing system, but said in a statement they are striving to “strengthen the continuity of nursing care” and denied students are left unattended. They also said some nurses are designated as subs who fill in for missing nurses, and therefore visit a high number of schools. The district also said students transferring from one school to another contributes to movement among nurses.
Bigger picture, CPS officials blamed the problems with their system on the nationwide shortage of nurses and noted several steps they have taken in the last six months to add more permanent nurses.
But district nurses said the chaos and churn in schools today also is caused by CPS’ own actions. They said a stressful work environment, low pay and the unpredictability all drive nurses away.
One nurse on Monday, another on Tuesday
About 700 students receive at least 75 minutes of nursing services a week — many with chronic conditions like diabetes, spina bifida and epilepsy. But Chicago Public Schools only has about 300 nurses on staff, not nearly enough to meet all those needs. CPS has more than 500 schools.
To fill the gaps, the district relies on a pool of private contractors to complete between 180 and 220 nursing assignments per day — a strategy CPS has argued is more cost-effective, efficient and allows the district to quickly fill short-term needs.
It’s also a bow to reality. In recent years, the number of CPS-employed nurses has been dropping. Over the last three years, the district lost more than 60 school nurses, records show. At the same time, the number of students with chronic medical issues has increased, and over time, the school system has dispersed special education programs to schools around the city rather than concentrating them, which increases demand for nurses.
Amid all these changes, a national nursing shortage and chronic budget shortfalls, CPS has been unable to hire enough CPS nurses at a pace to meet demands and is increasingly turning to outside nursing agencies.
RCM Technologies holds CPS’ largest nursing contract. In 2015, the Chicago Board of Education approved a $30 million four-year contract to train, recruit and schedule school nurses. District officials said they anticipated $1 million in savings the first year.
This nurse deployment system is creating scheduling confusion among school administrators, and panic among parents who claim CPS is failing to provide adequate nursing services to their children. Nursing timesheets reviewed by WBEZ show dates when no nurse showed up. CPS disputes this. It says nurses sometimes forget to swipe in but said documents show a nurse was present.
Consider Drummond, the school where Korotko’s son attends. On several days last spring, two or three different nurses showed up to assist the boy. Other times, the nurse at Drummond also was deployed to two other schools in one day. Jenifer Korotko said the nurses often seem overworked and in a hurry, constantly rushing from one school to the other. She notes, though, that things have improved this year.
The hectic picture at Drummond is common at schools across the city. Nurses are assigned based on need, with the level of care set out in Individualized Education Programs for special education students and what’s known as a 504 plan for students with physical disabilities.
Schools with a high demand for services have more nurses coming in and out. Lane Tech College Prep High School on the North Side, for example, had 25 different nurses last fall.
And even schools with moderate needs see a lot of churn.
Burroughs Elementary on the Southwest Side, for example, had 17 different nurses visit between October and December 2018. Some were CPS nurses who had up to five other schools to visit in just one week.
All that change is tough on kids who need regular care, principals and parents say.
“They certainly don’t like having strangers. I mean, who would, especially a little kid,” said Burroughs Principal Richard Morris.
And there is rarely anyone available to take on run-of-the-mill health problems, like scraped knees or sore throats.
“We have situations all the time,” Morris said. “I mean we have recess, kids fall, kids have accident … kids get sick too.”
When the RCM nurse assigned to Burroughs doesn’t show up, a social worker or a staff member must figure out how to help students with serious medical needs, Morris said. He added that the agency nurses sometimes come late and don’t seem to know what they’re doing.
“Worrying and wondering”
Florencia Guzman and her 7-year-old daughter Mia, a student at Pickard Elementary on the South Side, worry constantly. Mia was diagnosed with Type 1 diabetes about a year ago. She needs insulin several times a day to stay alive.
Mia has a 504 plan. By law, the school needs to provide a school nurse to help her.
Her treatment involves pricking her index finger to check glucose levels multiple times a day, and calculating the right amount of insulin based on her carbohydrate intake. It’s a complicated process for a child her age.
One time, the nurse didn’t show up at all, Guzman said. And another time, the school called because the nurse wanted to know how much insulin to give Mia even though it is outlined in her 504 plan. If her blood glucose levels go down drastically it could be life threatening. She and others complained that the agency nurses sometimes seem unsure what to do.
“I am always at home now worrying and wondering,” Guzman said. “How is she? How are her sugar levels? Are they going up? Is she going to faint?”
Pickard had nine CPS nurses in three months — one of those nurses visited 39 other schools in the same time frame, records show. If a nurse doesn’t show up, which has happened in the past, a school employee has been trained to assist Mia, Guzman said.
Parents like Guzman and the Korotkos have been speaking out about CPS’ chaotic nursing system for months. At last month’s board of education meeting, the parent group Raise Your Hand delivered a report with a list of recommendations, including hiring more full-time CPS nurses and more training.
Despite the outcry, CPS in December renewed RCM’s contract for two more years and expanded the pool of eligible nursing agencies. CPS said since December this has allowed it to add 21 more private nurses who provide direct care to students.
“School nursing isn’t just bandaids, it’s much more intense”
CPS repeatedly justified hiring private nurses instead of all permanent nurses by citing the shortage of school nurses locally and nationally.
It also defended its deployment system, saying most schools don’t have enough serious need for a full-time nurse. At the same time, it argued that a one-nurse-per-school approach wouldn’t cover all student needs across the school system and additional nurses would be required.
But CPS said it shares the same goals with parents — hiring more CPS-employed nurses. And, since December, the school district said it has hired 20 more direct service nurses, with six more open positions. These new hires aren’t reflected in the fall data reviewed by WBEZ.
CPS is also paying Lewis University up to $450,000 dollars to cover tuition for nurses who want to upgrade their credentials to become school nurses. There are three main types of nurses, only one of which primarily does direct care. The other two assess students for services, manage paperwork and supervise. CPS started the Lewis initiative last year. Twenty-six nurses have finished the program or are completing coursework.
It’s a move retired nurses wish CPS had done long ago. They argued Chicago’s shortage is mostly the district’s doing. For years, they said school nurses have been underpaid, undervalued and overworked.
“We lost a lot of staff, primarily because of the load,” said Nancy Lagesse, a CPS nurse until her retirement in June. “The burn out comes from that nurse not coming, and you having to run and cover … that constant running, that constant stress.”
As schools nurses left through retirement or exhaustion, CPS didn’t do enough to recruit new nurses or incentivize current ones to stay, Lagesse and other nurses argued.
With the constant revolving door of school nurses, there is limited communication between agency and district nurses. Irregular schedules, no shows and lack of planning also make it hard for many of them to work as team. Some say, at times, they don’t have access to computers or know where to find student records.
Maria, a RCM nurse, said schedules can change every day. “Sometimes they’ll call me in advance, sometimes they call me the day off, so it’s kind of unpredictable.” WBEZ isn’t using her last name so as not to jeopardize her position.
Under this system, agency or district nurses who are constantly traveling between schools don’t build relationships with school officials or students. They often have little or no time to help other students who come down with a fever or who sprain their ankle on the playground.
“Every school is completely different,” Maria said. “Some of the schools, you feel welcomed, some of the schools you feel like you are a stranger just for the day, you’re just there for the numbers or you are just there to cover.”
At February’s CPS board meeting, Elizabeth Keenan, CPS chief of diverse learner supports and services, said parents protests haven’t fallen on deaf ears.
“We do know we are trying to continue to scale up internally, quality checking, making sure we have managers, [communicating] with parents and those things,” she said.
CPS also said it is taking a broad look at alternative nursing models.
Meanwhile, as CPS officials figure out a solution, retired nurses said the district needs to take a step back and rethink the role of a school nurse.
“The outside world doesn’t understand that school nursing isn’t bandaids,” Nancy Lagesse said. “It’s much more intense than that … it’s identifying, assisting, teaching, prevention. Providing care is a lot of things and I don’t think that central office even understands that.”