Registered nurse Angie Koenig will be responsible for the health of 750 Lawrence elementary school children next year.

Here’s the catch: They’ll be divided between two schools located 5 miles apart.

“At least they let us turn in mileage,” said Koenig, a six-year veteran of school nursing who is being reassigned to Quail Run and Woodlawn schools.

Her move from Schwegler School is part of the district’s nursing staff reorganization adopted last month by the Lawrence school board. It’s designed to save $60,000 annually by relying on four fewer RNs.

The plan, which will put more responsibility for students’ health in the hands of relatively untrained, low-paid employees, worries Koenig and other Lawrence school officials.

The new system relies on 13 nurses, most of whom will be teamed with a “health office attendant.” Job openings for the 11 assistants were advertised last week for the first time, but none have been hired.

“That’s the scary part about it,” Koenig said. “What kind of people will we get into that position?”

Covering two schools

Under the new system, Lawrence High School and Free State High School will keep full-time RNs.

At the district’s 18 elementary and four junior high schools, RNs will be paired with an assistant to share responsibility for two schools. For example, Koenig and an assistant working a six-hour shift will cover Quail Run and Woodlawn. Koenig will have supervisory responsibility for the assistant. As such, that person will fall under Koenig’s nursing license.

Assistants won’t be required to have previous medical training, and are expected to be paid about $8 an hour. Each will receive two days of training, including first aid and CPR, from the district before school starts. They’ll also be shown how to dispense medication and made aware of professional limits on their workplace decision-making.

“We have to select good people who enjoy kids, make good decisions and are courteous with families,” said Katy Buck, the district’s nursing coordinator.

She said the change in the district’s health-care delivery came at a time when challenges facing nurses continued to expand beyond applying Band-Aids, conducting vision screenings and maintaining student records.

The number of students on prescription medications continues to increase. Children walk into district schools with a variety of serious medical conditions: asthma, severe allergies, diabetes, cystic fibrosis, cancer and seizure disorders. Nurses also help students grappling with substance abuse, pregnancy, eating disorders and hygiene issues.

“It’s a change that we’re all going to have to work together to make work,” Buck said.

Opposition

Buck spoke out against the hiring of health office assistants before the school board. Instead, she proposed employing 16 RNs and two health secretaries. Under that scheme, it might have been possible to have full-time nurses at the four junior high schools.

Lisa Johnson, the nurse at Southwest Junior High School, said reliance on unskilled assistants in nursing offices was a “step back” from having professional people handling health care for the district’s 10,000 students.

Concerns about diminished quality of care, especially in junior high schools, prompted two school board members, Leni Salkind and Jack Davidson, to vote against the reform. The vote was 4-2.

“I don’t like the idea of health office attendants at all,” Salkind said.

Davidson said his concern was the care of medically fragile children.

“I’m deeply troubled with children I’ve seen in wheelchairs and tubes in their throat,” he said. “They need more than somebody who will pass out the pills.”

Supt. Randy Weseman said the nursing model approved by the board was the result of budget pressures tied to inadequate state funding of public education. He said he expected the new strategy to meet students’ needs.

‘An imperfect world’

“I think it will work. I don’t believe it is perfect,” Weseman said. “This is an imperfect world with limited resources, and to cover the schools, we have to spread the RNs thinner.”

Weseman said the district’s facilities study should be completed in several months. That might include recommendations for elementary school consolidation. If that happens, he said, it opens the door for more schools to have a full-time nurse in the future.

Buck said a parent with questions about the new health-care model should contact his or her child’s school nurse. If a medical situation emerges this summer, she said, parents ought to contact the nurse when school starts in August.

The new assistants will be under close scrutiny by district staff and parents, she said.

“We’ll be looking very carefully how … health office attendants are doing,” Buck said. “Are they doing proper first aid? Are they following up as they’re asked to do? I want to hear the positive things as well.”