Theresa Cesarini took a short break from helping students at Dunmore High School.
Tomorrow, the nurse may be needed in a Scranton school, back in Dunmore or at another school in the region. With a shortage of school nurses, Cesarini always finds a placement.
The Moses Taylor Foundation partnered with the Northeastern Educational Intermediate Unit to launch a Travel School Nurse Pilot Program this school year. Cesarini is the first in that role — one that she finds fulfilling, important and needed.
“I'm grateful to be able to do it,” she said. “I think school nurses are a very integral part of the education that kids are getting, because they not only come in for meds, they come in for support.”
Not enough substitutes
The Moses Taylor Foundation worked with the Center for School Health Innovation & Quality in 2022-23 to examine school nurse staffing and funding in Northeast Pennsylvania. The report looked at issues and trends regionally and beyond.
The report found that the nursing shortages happening throughout the medical sector also happen in schools. Of school nurses in the region, 89% stated they did not have adequate school nurse substitutes. Several districts indicated they were required to use a staffing agency to find substitutes, who were often not oriented in school nursing and were not reliable.
“Sometimes they wouldn't take days off because of the moral distress it put on their fellow co-workers or the school. There just weren't the substitutes available, or the substitutes that came had no idea what to do in school health, school nursing and just access issues,” said Erin Maughan, director of the Center for School Health Innovation & Quality.
School nurses have growing role
While schools struggle to find substitute school nurses, the position’s role has grown more important and complex over the last few decades.
School nurses do more than send sick kids home, distribute bandages and check for lice, said Christine Marcos, senior program officer of the Moses Taylor Foundation.
“We just keep trying to raise awareness of the importance of the school nurse role,” Marcos said. “The role has become so much more complex in terms of managing children with chronic conditions like diabetes and asthma. The mental health piece has become huge. In the school nurse office, they're often the first person in the school to really flag a child with mental health issues …The role of the school nurse is really vital to our community.”
The 2022-23 report found that when a substitute nurse cannot be found, that 53% of the time, school staff are pulled from other buildings. In nearly one-fifth of the cases, nothing happens, and a school is left without coverage.
“Many school nurses indicate they just do not take days off, even when they aren’t feeling well, because they know it would leave their school without a nurse,” according to the report.
Planning for coverage
After identifying the need, the foundation looked at nurse coverage models from other school districts across the country. Some larger districts employ their own float nurses, and in more rural regions, districts work together.
Moses Taylor Foundation and the NEIU, one of 29 regional educational service agencies statewide, brought the travel nurse program to reality.
Cary Laboranti, certified school nurse at the NEIU Learning Campus in Dunmore, coordinates the pilot project. The districts reach out for coverage when there’s either an absence or the nurse needs assistance with state-mandated in-school health screenings.
“I'm just excited that we've been able to take on the opportunity, and hopefully it will prove to be beneficial, and after the three years, we'll see what it may evolve into… hopefully providing some extra support to school nurses, where it's feasibly possible,” Laboranti said.
The ultimate plan is that school districts will be willing to cost-share to maintain the travel nurse position after the three-year pilot, Marcos said.
Maughan is collecting data that will hopefully show districts that it would be less expensive to pay for a float nurse than to use an agency nurse substitute who is less familiar with the school building, Marcos said.
Cesarini has worked in health care for more than two decades, including as a pediatric nurse. She was unaware of the shortage of school nurses before she started her position last fall.
“I had never expected to see what I'm seeing, and the need is so great,” she said. “I truly love the pediatric population, so I'm grateful to be able to do this. I love what I do.”
