AUSTIN (KXAN) — When Tiffany Washington, also known as “Farmer Nancy,” isn’t farming, you can catch her at Mueller Lake Park twice a week watching over about a dozen students.

“We’ve got you scared — what? Shaking in your knees!” chants the ATX Horns cheer squad.

Many of them attend schools in the Austin Independent School District, including Washington’s own three kids. She’s worried for them, after learning school nurses may not always be present on campus.

“I’m a farmer, when it comes to health and wellness and nutrition, it’s very concerning,” she said.

AISD contracts with Ascension Seton to staff school nurses. Alana Bejarano, AISD’s health services director, said they’ve increased the contract amount for Seton this year.

A spokesperson for the hospital system said they increased pay for all nurses, including school nurses, to attract and keep nurses “in a highly competitive market” as they face a shortage in applicants.

“With a primary focus on all AISD students’ health, and in order to work within AISD’s approved budget for Ascension Seton’s contract, we made adjustments to the staffing models,” a spokesperson wrote to KXAN.

“Most elementary schools do not now have a full time RN,” said one AISD registered nurse, who wanted to remain anonymous to protect their job.

The nurse said they were informed of the staffing changes over the summer.

“Now, we’re doing more schools… or the same responsibilities on one campus, but half the hours,” the nurse said.

  • Tiffany Washington coaches her ATX Horns cheer squad. Washington is concerned about the impact of school nurse staffing changes at AISD on some of these students and her own kids. (KXAN photos/Tahera Rahman)
  • Tiffany Washington coaches her ATX Horns cheer squad. Washington is concerned about the impact of school nurse staffing changes at AISD on some of these students and her own kids. (KXAN photos/Tahera Rahman)
  • Tiffany Washington coaches her ATX Horns cheer squad. Washington is concerned about the impact of school nurse staffing changes at AISD on some of these students and her own kids. (KXAN photos/Tahera Rahman)

Seton said clinical and health assistants will help cover campuses, and the staffing model for each campus was based on school enrollment numbers and risk factors of the student population.

“Clinical/Health Assistants are highly trained in addressing student health needs and also have multiple layers of nursing support available at all times through their campus supervising nurse, clinical supervisor, clinical manager and more,” the spokesperson added.

But the anonymous AISD nurse said while clinical assistants are helpful, they are not licensed or trained like registered nurses are.

“RNs are on campus for a reason, because we are trained really well to respond to medical emergencies, and we have a lot of experience with different health care needs of children and the adults on campus,” the nurse said.

Karen Schwind, president of the Texas School Nurses Organization, agreed.

“The clinic assistant is oftentimes not educated, does not have a license, and therefore is providing care to students without that comprehensive medical model in their background,” said Schwind, RN, BSN, CSN. “We’re taking care of students with diabetes, with seizures, with life threatening anaphylactic circumstances to foods and other allergens.”

Bejarano said if the RN model can’t be utilized, the district has trained medical personnel in the office, adding CAs are always supervised by clinical staff.

She and Seton said Seton supervisors will always be available to help campuses.

“If the nurses can be well-staffed and have clinical assistants that they are comfortable delegating to, because they’re trained, you know, that’s great that you can make it work,” Schwind said. “But if you’re going to have less nurse hours, actually registered nurse hours available to those students, and to that health aide, it is — it would be a concern for me as a parent or grandparent.”

Schwind said their group’s philosophy is all students should have access to a registered nurse all day, every day.

“I can say that as a parent, I would be concerned. As a grandparent now of school-aged children, I would be very concerned, especially if I had a student with a chronic issue,” she said.

“I can say that as a parent, I would be concerned. As a grandparent now of school-aged children, I would be very concerned, especially if I had a student with a chronic issue.”

Karen Schwind, Texas School Nurses Organization president

She added an RN is also important for students who don’t have a medical condition.

“There’s always that emergency on the playground or that unknown allergic reaction that might occur by ingesting a food they’ve not ever ingested before,” Schwind explained.

Washington worries communities of color might feel the hit, most, as she feels there’s already a health gap.

Schwind said that’s part of why they and the National Association of Nurses believe all students should have access to a nurse.

“For students who face barriers to accessing healthcare, especially those living in predominantly low-income, rural and minority communities, a school nurse may serve as their only regular healthcare provider,” the NASN website states.

“It’s gonna widen the gap, not only there’s gonna be widening the gap, we’re gonna have fewer health care professionals, which means we’re gonna have fewer health care professionals that are of color,” she said. “Let’s stop cutting the system, especially when it comes to the kids.”

Staffing challenges

Schwind said aside from a nursing shortage, her school district, New Braunfels ISD, is finding it hard to fill CA slots.

“We’re not paying them very much. We are expecting them to be assisting in the clinic and frankly, we’re not seeing the applicants come through,” Schwind said.

Bejarano said they’re working with Seton to fill vacancies for both RN and CA positions.

Texas rules on nurses

Texas law does not require public schools to have full-time registered nurses.

“As a result, there isn’t a mandate that says each district has to have a school nurse, and there’s not funding associated with any school nurse positions. So it truly is up to each district to make that a priority,” Schwind said.

According to the Texas Department of State Health Services, many don’t.

In 2019-20, 27 out of 254 Texas counties did not have a school nurse in a public or charter school.

Schwind pointed to a 2018 NASN data compilation indicated nurses help more kids stay in school and reduce chronic absenteeism.