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School nurses urge board to retain float nurse, warn of safety and revenue risks
Summary
Two Marshalltown school nurses told the board that a planned elimination of the district's float nurse position would raise safety and liability concerns, reduce Medicaid reimbursements the nurses said historically total about $1.3 million annually, and worsen coverage during absences.
At the Marshalltown Community School District board meeting on May 18, nurses and public commenters urged trustees not to eliminate the district's float nurse position, saying the change would create safety and financial risks.
"Having one nurse cover multiple buildings after COVID was intended as a short-term fix but has now become a long-term response to a growing problem," said Christine Bonzer, a Miller Middle School nurse. Bonzer told the board nurses regularly perform time-sensitive clinical tasks, respond to crises and provide documentation that allows the district to bill Medicaid for services. "Historically, our department has generated approximately $1,300,000 in Medicaid revenue for the special ed department annually," she said.
Brenda Villa, who identified herself as the float nurse role slated for elimination, said decisions about nursing practice have been made primarily by nonhealth-care administrators and warned that removing frontline health staff could increase liability and workload for remaining staff. "Eliminating direct student care positions only increases the burden placed on those who remain," she said.
Board members asked staff for details about backup plans and training. Administrators said the district intends to rely first on a substitute nurse pool and, when that is not available, a paired-school model in which nurses cover neighboring buildings. They also said trained staff with med-administration certification would administer medications when registered nurses are not present. A district presenter described the med-manager course as a required training that must be renewed periodically for staff who administer medication.
Board members pressed for clarity on what "trained staff" means in practice and how the district would avoid placing additional liability on classroom staff: "You absolutely need to give some more information around this," one trustee said, asking the administration to provide a detailed plan.
The board did not vote on any staffing changes during the meeting; the nurse comments and handbook language were presented for information and discussion. The district said it is convening planning sessions with school nurses to detail recruitment, substitute coverage and contingency staffing models.
The board accepted the nurses' public comments as part of its information agenda; no formal action on the float nurse position was recorded in the minutes excerpt provided.
