In most Baltimore City schools, a student has less than a 50% chance of seeing a registered nurse if they go to the health suite for anything from COVID-19 to a scraped knee.

Unlike other surrounding school districts, each nurse oversees care in three schools at the same time. So most students will be seen by a certified nurse’s assistant on any given day.

Wendy Smith, president of the AFSCME union representing school nurses in the city, said she believes fewer nurses will be in schools this coming year because the city health department has given nursing assistants 90 minutes of training so they can take on an expanded role there.

“We have always been super short. We have never had the nurses to take care of the workload,” Smith said. The city health department has employed 43 to 45 full-time nurses in the city schools. The remainder of nurses are supplied through contracts with vendors.

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“At this particular juncture they cannot provide services to schools,” she said. “To meet the needs of the kids who have the health conditions, what they are doing is training non-licensed individuals.”

City health officials said they haven’t reduced the number of nurses or contracts for them. In addition to the school nurses employed by the city health department, there are two community agencies that provide school health services, said Francine Childs, who heads the health department’s bureau of school health. Baltimore Medical System oversees a health center at a small number of schools and Johns Hopkins has a school-based health center at one school that is staffed by a nurse.

In addition, Childs said, the department still has contracts with a nursing agency that will provide nurses for schools.

She said administrators believe they will have the equivalent of 75 full-time nurses in 155 schools and are working to hire more. They will oversee 124 certified nursing assistants.

”While the nurse may not be in the school every day, there is typically a health professional in the school every day,” she said.

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Smith said some of the nurses are concerned about signing forms that will allow a nurse’s assistant to handle care of a child with diabetes or other serious illnesses.

“We are so upset,” Smith said. “This is a disaster. There is a reason why we went to school. There is a reason why these doctors write the orders that require the oversight.”

The health department has said it can’t find enough nurses to staff schools, and is raising the current pay range for 10 months of work from $55,572-$63,818 to a range of $60,719-$69,729. They hope to draw more nurses away from hospitals because in-school jobs have more traditional hours — five days a week during the day — than the typical nursing job.

After years of combating a nursing shortage, Childs said a nursing salary study done by a number of city agencies led to the increase.

“We want those who have a desire to make a difference in the life of a child,” Childs said.

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The city health department is also offering bonuses.

Childs said the health department is working toward the “gold standard” of having a nurse in every school. The Centers for Disease Control and Prevention recommends one nurse for every 750 students. The National Center for Education Statistics’ latest data for the 2015-16 school year shows that about half of public schools in the nation had a full-time nurse.

School systems in Baltimore, Howard, Carroll and Harford counties all hire their own nurses and have one nurse in every building. Anne Arundel County also staffs its health suites with nurses from the county health department, and like Baltimore City, it doesn’t have a nurse for every school.

The disparity is particularly relevant in Baltimore because one in five city residents are living below the poverty line, according to Census data, and therefore the school children are less likely to have access to adequate health care.

“There are a lot of needs that our students have,” said Alison Perkins-Cohen, chief of staff in the city schools. “Having students in school have their health needs attended to is very important.”

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Money doesn’t appear to be a roadblock to hiring nurses. The city spends $17 million a year on providing health services to students, just enough to put a registered nurse in every school, Perkins-Cohen said.