As the new coronavirus continues to sicken Coloradans, school nurses in Denver are calling attention to a concerning fact: While the school district’s protocol heavily relies on nurses to detect suspected outbreaks, only 11% of the city’s public schools have a full-time nurse.

The rest of Denver’s more than 220 schools have a nurse only part time. Alarmingly, 79 schools — or about 35% — have a nurse on campus just one day a week, according to district data.

“I feel like we’re waiting for something terrible to happen to do something,” said Jaye Horvath, the nurse at Gust Elementary, one of only 25 Denver schools with a nurse five days a week.

“I don’t want to wait.”

The lack of full-time nurses is a longstanding issue that’s gaining prominence because of the novel coronavirus, or COVID-19. As of Tuesday afternoon, no Denver students or school staff had tested positive for the virus, but state officials said they are bracing for community spread.

School principals have in recent years used voter-approved tax money to increase school-based mental health services instead of nursing. Nurses are hoping both Denver Public Schools and Denver voters prioritize nurses in the future.

In addition to providing consistent care for students with chronic conditions, full-time school nurses are better equipped to spot the symptoms of serious illnesses.

The very first bullet point of Denver Public Schools’ infectious disease outbreak process says “the school nurse is responsible for referencing and following the current [state health department] guidelines.” The second bullet point says the school nurse will contact the district’s central nursing services department to report suspected outbreaks.

When there is no nurse on campus, district officials said that responsibility often falls to school principals, who have little if any medical training and a host of other responsibilities.

The reporting process “is still working,” said Kathrine Hale, the district’s manager of nursing services. But “it’s not ideal that a school nurse isn’t present in the building five days.”

Whereas districts such as New York City, the nation’s largest, have pledged to put a nurse on every campus in response to the coronavirus, Denver has made no similar guarantee.

Part-time nursing

District data shows that 73% of Denver public schools have a nurse for half the week or less. That includes both district-run and charter schools.

The data breaks down like this: Twenty-five Denver schools have a nurse five days a week, six schools have a nurse four days a week, 25 schools have a nurse three days a week, 58 schools have a nurse two days a week, and 79 schools have a nurse one day a week. The remainder have part-time nurses who may spend 2½ days per week at the school, for example.

When a nurse isn’t at a school, the nurse designates another staff member — often the school secretary or a teacher’s aide — to see sick students and dispense medications. While the system is legal, several school nurses said it has potentially serious flaws.

Miriam Cavender is a nurse who splits her time among three Denver schools each week. She said she often sees secretaries send students home for minor things — a noncontagious rash or a 99-degree temperature — that don’t require time out of class.

On the flip side, when students do have serious symptoms like a 103-degree fever, she said secretaries often don’t know to tell parents their child can’t return until they’re fever-free for 24 hours without the use of medication. So parents will give their children Tylenol or Motrin and send them back the next day, making the spread of illness more likely.

“Too much falls through the cracks,” Cavender said.

What’s worse, Cavender suspects many parents don’t know the nurse staffing level at their child’s school. They figure whoever calls them to pick up their sick child is a nurse, when that’s not always the case. Thalia Ortiz is an exception. Ortiz used school choice to enroll her child in Gust Elementary specifically because it has a nurse, Horvath, who’s there full time.

Ortiz’s 6-year-old daughter has Type 1 diabetes. Ortiz said knowing the school has a full-time nurse to help her daughter monitor her blood sugar and take her insulin gives Ortiz, who is a single mom, the peace of mind to work full time.

Ortiz knows that Horvath routinely pops into her daughter’s classroom to check on her and has stashed her daughter’s “emergency medicine” — apple juice boxes — in the gym, the library, and anywhere else the first-grader might be.

“My daughter is so young and she can’t do it herself,” Ortiz said. “She needs that support.”

Her daughter’s diabetes also weakens her immune system and makes the 6-year-old more at risk for complications from viruses such as COVID-19, Ortiz said. While Ortiz said she’s terrified of the virus spreading in schools, she’s taking comfort in regular updates from Horvath.

“She can’t get sick,” Ortiz said of her daughter. “She wouldn’t survive it.”

A funding issue

The reason so few Denver schools have full-time nurses is money. Denver’s public schools are funded per-pupil, and student enrollment in many parts of the city is either flat or declining. Principals control their schools’ budgets, and with a sometimes shrinking pot of money, they are having to make tough decisions, said Robin Greene, the district’s director of nursing services.

The district has attempted to increase nurse staffing, but the solutions have come up short. A 2016 voter-approved tax increase included $15 million to beef up school health staffing. Principals could choose to spend the money on hiring more social workers, school psychologists, or school nurses.

In the face of rising student mental health needs and youth suicide, very few principals, if any, chose to spend it on nurses, Greene said.

The district is considering asking voters for another tax increase, known as a “mill levy override,” in November. Greene said the district’s nursing staff is working to convince other district officials to include a separate line item to fund more full-time school nurses.

“More and more people around the district are understanding the impact of nursing and the need for nursing,” Greene said — an impact that could become clearer if coronavirus spreads.

“This particular virus has brought that to the forefront in many people’s minds.”

These Denver public schools have a nurse five days a week, according to district data:

Escalante-Biggs Academy, preschool – kindergarten
Brown International Academy, preschool – grade 5
Cheltenham Elementary School, preschool – grade 5
Gust Elementary School, preschool – grade 5
Highline Academy Northeast, preschool – grade 5
John H. Amesse Elementary School, preschool – grade 5
Knapp Elementary School, preschool – grade 5
Maxwell Elementary School, preschool – grade 5
Rocky Mountain Prep Creekside, preschool – grade 5
Sabin World School, preschool – grade 5
Samuels Elementary School, preschool – grade 5
Swansea Elementary School, preschool – grade 5
Lena Archuleta Elementary School, grades 1 – 5
Farrell B. Howell School, preschool – grade 8
Florida Pitt-Waller School, preschool – grade 8
McGlone Academy, preschool – grade 8
Place Bridge Academy, preschool – grade 8
Marie L. Greenwood Academy, kindergarten – grade 8
Hamilton Middle School, grades 6 – 8
East High School, grades 9 – 12
South High School, grades 9 – 12
Thomas Jefferson High School, grades 9 – 12
John F. Kennedy High School, grades 9 – 12
CEC Early College, grades 9 – 12
Florence Crittenton High School, serves pregnant and parenting students