Crucial, but not consulted

September 2, 2009 -- Today the New York Daily News published a very good report by Juan Gonzalez about the reaction of New York City school nurses to the city's plan to vaccinate elementary students for H1N1 flu in the fall and winter. The article includes substantial comment from local nursing union leader Judith Arroyo. She reportedly liked much of the plan but urged the city to consider having special traveling teams perform the vaccinations, in order to avoid overwhelming school nurses who already have their hands full with their usual case load. The piece might have noted that the critical shortage of school nurses will likely make the situation even harder. But the piece does give a good sense of the role school nurses will play in the city's flu plans. And perhaps the best part of the report is Gonzalez's pointed statement that "the front-line nurses--who were not consulted by the city--will be crucial this fall and winter to containing the epidemic and keeping schools open." We thank Gonzalez and the Daily News.

The article is headlined "Front-line nurses question how massive swine flu vaccination plan will be executed." The report explains that public school nurses will "spearhead" Mayor Michael Bloomberg's plan at elementary schools, as they will vaccinate all elementary students who have parental permission (older students who want the vaccine have to travel to designated vaccination centers). School nurses will also "handle" all students who develop flu symptoms. The article says that 600 school nurses will be given a half day of training the following day at the Brooklyn Marriott, and that several hundred more will be trained the following week. The piece quotes an unnamed nurse who attended an orientation session as noting that, while nurses have many questions about the plan, "at least the city has a plan this time."

The report says that nurses are "balking" at some parts of the plan, and here it relies on Arroyo, president of the United Federation of Nurses Local 436. She notes that when H1N1 "exploded" last spring, some of the city's school nurses were "overwhelmed."

At a school with say, 1,300 children, the nurse will have her hands full with the normal load of children who are sick with asthma and other problems, she said. "How can she be expected to administer so many vaccines as well?"

To solve that problem, the union is recommending that "special traveling teams" give the vaccinations. Arroyo notes that "we used that model several years ago with hepatitis B vaccinations and it worked fine." She also urges the city to plan for adverse reactions, which are possible especially in view of the short time frame in which the vaccine was prepared and the high volume of vaccine the city hopes to use.

Arroyo's reported comments are an excellent example of a journalist consulting nurses for input on a vital health issue in which they have expertise, something we might expect government health officials to do as well. However, the report says that "the front-line nurses--who were not consulted by the city--will be crucial this fall and winter to containing the epidemic and keeping schools open." This makes the point well: How could New York City design a comprehensive health plan that school nurses would spearhead without consulting them? The obvious answer is that those responsible did not know that the nurses would have anything meaningful to contribute, perhaps assuming they were unskilled laborers there to perform simple physical tasks.  

However, nurses are skilled professionals with years of college-level science training, and they are well qualified to play a central role in such plans, as Arroyo's comments show. In fact, it was New York City school nurse Mary Pappas (right) who reportedly became a "folk hero" to nurses for her quick thinking in setting in motion the governmental response to the April H1N1 flu outbreak, identifying and managing hundreds of her students' symptoms, as well as for her compelling testimony at a flu summit held by the Obama Administration in July.

Of course, it is this same undervaluation that has fueled the critical under-staffing of school nurses throughout the U.S. Even without the flu to contend with, no nurse can adequately care for 1,300 or more kids in today's school environments, in which more and more students attend with serious chronic conditions like diabetes and asthma.

We commend Juan Gonzalez and the Daily News for a good report on the role of school nurses in the response to the H1N1 flu.

See the article by Juan Gonzalez: "Front-line nurses question how massive swine flu vaccination plan will be executed" posted September 2, 2009 on the New York Daily News site.

You can send comments to Mr. Gonzalez at jgonzalez@nydailynews.com