Chicago Teachers Union members fought successfully during the October 2019 teachers strike to secure a written commitment from Chicago Public Schools for a nurse in every school.
In their 11-day strike last fall, Chicago teachers won a commitment from the school district to hire hundreds more nurses over five years based on the idea that Chicago Public Schools would finally have one nurse in every school, every day.
But the school district and union left open the question of what kind of nurse — whether each nurse could treat and manage students with chronic illnesses as well as work to help keep the entire student population healthy.
It is now clear the nurses likely won't primarily be certified school nurses, who are specially trained to do it all.
Matt Lyons, CPS's chief talent officer, said the problem is that almost all of these school nurses already have jobs and are not on the market.
"Our goal is to get the most qualified people into the schools as possible," Lyons said. "This is a question of what is possible."
Though the school system does not say cost is a factor, if it hired fully trained school nurses, the budget for school nursing would skyrocket. On average, these nurses make almost $85,000 a year, and the district would need to quadruple their numbers to get one for every school.
These nurses are trained to work in schools, which includes taking courses in child development, identifying mental health issues in children, special education law and providing health education.
"This is a specialty practice," said Robin Adair Shannon, who runs a large school nursing program at the University of Illinois at Chicago. "It is highly complex. The needs of children are highly complex. Illinois itself has a zillion rules and regulations around school health. There is just a ton of stuff."
Instead of hiring all school nurses , Chicago Public Schools will continue to hire two types of nurses with less training — licensed practical nurses and registered nurses — and will provide avenues for them to receive special training to get the school nurse endorsement. These nurses earn on average $30,000 less than certified school nurses.
Lyons said the school district is committed to getting more nurses in schools, not just to comply with the Chicago Teachers Union contract, but also because leadership wants to overhaul nursing. For years, the school district only focused on following the law that requires services for students with chronic medical conditions.
Florencia Guzman check her daughter's glucose levels. Mia has Type 1 diabetes and needs constant care. Guzman is concerned about the churn of nurses at Mia's school. "I am always at home now worrying and wondering," Guzman said.
Nurses, some on staff and other working for private agencies, traveled from school to school checking on blood sugar levels, making sure students were taking their medications and tending to students with complex medical needs. A WBEZ investigation last year found some schools had as many as four nurses in and out in a week, and no school had a single full-time nurse. On average, each CPS school saw five different nurses over a three-month period.
"We are not simply just looking to increase the number of nurses that we have," Lyons said. "We really are changing from a medical need model of nursing to a model that is about consistent care in schools that serves both the special needs population and the general education population."
Jen Johnson, chief of staff for the Chicago Teachers Union, said the goal is to have nurses with specialty training in all schools. But short of that, getting a health professional daily who students know and feel safe with will be a significant improvement, she said.
"We expect in five years for schools to feel different," Johnson said, "that [students]are not having to wait to get in front of the adult who cares for them, who knows their name, who is there hopefully all five days of the week."
School nurse shortage?
According to the Illinois State Board of Education, only 900 certified school nurses work in schools across the state. Illinois has more than 4,100 schools and 850 school districts.
There are just 57 school districts that have one specialty nurse for every school, including Naperville School District 203 and Wheaton School District 200, each with more than 20 schools, according to state data.
But most schools don't have a full-time, fully trained school nurse and must get waivers from the state to fulfill some legal requirements that only certified school nurses can do.
Over the years, the number of fully trained certified school nurses in Chicago Public Schools has been steadily declining. It currently has 114 on staff, down from 160 in 2014 and 200 in 2009, according to employee rosters.
It is unclear how much the decrease in certified school nurses is due to a lack of supply — or whether it's also because the school district has been cutting staff or failing to hire available candidates. Some also may also not want to work in Chicago.
Earning a school nurse credential, which is a professional educator license, has been difficult. Getting into the program requires a B average and, up until this year, required passing a test of basic skills. Then, students have to complete 10 hours of graduate work and 300 hours of field experience.
Lyons said the cost, upwards of $10,000, is a barrier as well. There's also a general nursing shortage, which means schools are not the only institutions hiring.
Illinois has 4,100 schools but only 900 certified school nurses currently working.
But Laurie Combe, the president of the National Association of School Nurses, said her experience is that districts who regularly hire nurses with advanced training to work in schools don't have trouble finding them.
"My question is, has Chicago really tested that argument?" she said.
Combe said school districts have cut school nurses over the years because they are looked at as non-education related. She said about a quarter schools nationwide currently don't have a full-time nurse of any kind in the building.
But studies show that having a school nurse saves money because otherwise staff have to spend time tending to sick children and even providing some services to those who have chronic conditions, she said. She also said school nurses can be instrumental in improving attendance among students.
Shannon said there are a lot of nurses interested in going into schools. The hours are better than working for a hospital, especially for parents who are looking to line up their schedule with their children. Also, some nurses like the idea of working with students.
But, in recent years, few of her graduates went to Chicago Public Schools. She said working conditions are important to school nurses.
"I am not sure we can say that there's a shortage of qualified people or [are there] gaps where qualified people want to work," she said.
Hope for the future
But Shannon said the way school nurse candidates look at Chicago Public Schools can change as the district shifts its approach to nursing. And she's looking forward to working with the district.
Dennis Kosuth, one of Chicago Public School's few certified school nurses, is optimistic the situation will improve. Kosuth said he decided to leave a hospital to go into a school because he wanted his schedule to line up with his son and his wife, who is a Chicago Public Schools teacher.
He said he was excited about the impact he thought he could make.
"The big thing we learned in classes was the role that nurses could play in schools, educating students about healthy habits, keeping kids safe, really setting them up for a lifetime of health," he said. "A big part of being certified is that you learn about child development and education."
So far, he said he is bogged down with treating students with medical issues and doing paperwork.
But this year he is covering three schools, which is better than last year, when he was covering five. He said it would be great for all schools to eventually have fully trained nurses with the certifications, but having a nurse of any kind will be a big help.
The school district has been more successful at hiring lesser trained nurses, with more than 50 new hires on staff this year compared to last, according to CPS. But there are only eight more certified school nurses.
Teachers during the October strike demanded commitments in writing from the school district, including a pledge to hire a nurse and social worker for every school.
Lyons said the prospects for hiring nurses of all levels are improving. For one, the teachers contract increases the salaries for lower-level nurses, which should make the job more attractive.
The contract also compels the school district to spend $2 million to help pay for nurses to get fully trained to work in schools. This fall, the school district partnered with Lewis University to offer a school nurse credential program. Classes take place after school in a CPS building on the West Side.
Linda Gibbons, who runs the program, said 17 nurses earned school nurses certifications last month and were moving into the higher-paid positions.
She said the "grow your own" certified school nurse program is particularly important for Chicago Public Schools, as these nurses are already in the school district so they know what to expect.
"It is not an easy job because there are a lot of students and a lot of needs," she said. "But it is a rewarding job because you are helping students get healthier and get better grades as well."
Sarah Karp covers education for WBEZ. Follow her on Twitter at @WBEZeducation and @sskedreporter.