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How Chicago Teachers Won a Nurse in Every School

The recent Chicago Teachers Union strike put adequate school staffing at its center, including putting a nurse in every school. A school nurse explains how the union won that demand.

Thousands of demonstrators take to the streets, stopping traffic and circling City Hall in a show of support for the ongoing teachers' strike on October 23, 2019 in Chicago, Illinois. Scott Heins / Getty Images

A colleague of mine came to the 2019 Chicago Teachers Union (CTU) strike picket line with the same sign she had made for the 2012 strike. It outlined the cost of various medications — updated with 2019 corporate price gouging — and ended by stating, “A nurse for every school is priceless.” That demand, for a nurse in every school, has been around for a while in Chicago Public Schools (CPS). It was a central demand of the strike this year — and one that the recently ratified contract takes great strides toward implementing.

From a strict legal standpoint, due to a 1995 state law engineered by CPS’s chief negotiator Jim Franczek, CTU was not allowed to strike for more nurses or over any non-wage issues. While pay-related disputes remained on the table until the end, an argument could have been made that CTU was in no position to strike over nurse, counselor, and other staffing issues, or capping class sizes, things that directly impact our students’ learning conditions. Yet we did anyway.

The state of nursing in our schools has long been poor. A study by the CTU Education Policy Department in 2016 outlined CPS’s long-term addiction to outside agencies that provide nursing services to students. The district claimed it was impossible for them to find nurses to work in CPS. But somehow these private companies have located two hundred of these impossible-to-find workers — and made a profit while doing so. Over the next five years, these agencies will largely be phased out, and these currently subcontracted workers can become CPS-employed nurses.

The significance of weaning CPS off of these temp-worker companies is important, because the district’s dependence on them has not been good for the schools, the students, or the nurses themselves. These organizations do not provide decent benefits. One nurse I worked with last year had to quit their agency job when they developed debilitating nerve pain in their jaw and had no health insurance. That a provider of health-care services had no access to health care herself is criminal.

Parents have long complained about CPS’s quality of care. Many have reported on the lack of continuity in care, where schools and individual students would see dozens of different nurses over the course of the year.

Consider the important relationships that are built with a teacher over the course of a year in a classroom. Imagine how a student would feel having one stranger after another work with them on their medical issues. While services are completed by a qualified licensed professional, why should we accept a seemingly endless rotation of health staff cycling through a student’s life, especially with such a personal issue?

Another common complaint is poor communication. The nursing agencies sometimes failed to let a school know that their nurse would be absent, and others would be left scrambling to figure out how to meet the students’ needs. CPS’s solution to the myriad complaints about RCM Technologies — which, for many years, was the sole supplier of agency nurses — was to double down on a bad bet by expanding the number of agencies, and increase the budget for these companies to $10 million annually through June 2021, up from the previous $7.5 million per year. It was never a good plan to cede the oversight of a key facet of schools’ operation to an outside organization. Bringing the direct management and control of nursing services under CPS should significantly improve the delivery of care in Chicago schools.

Schools only get a nurse every day if one of the students is diagnosed with a condition requiring daily services. What generally would be considered an unfortunate and stressful event, such as a young person getting diagnosed with diabetes, perversely becomes a boon to the school that student attends, because their condition brings a daily nurse to that community.

Most medication is being given to students by clerks and paraprofessionals, people who are already overburdened with other tasks and are not licensed health-care providers. To give medication in a hospital, I scan my fingerprint to get the drug out, I scan the patient’s wristband, I scan the pill, and a computer checks if this is a double dose, if there are any allergies, and if any contraindications exist. In hospitals every year, despite these multiple safety checks, tens of thousands are still victims of medical error. I shudder to consider the “known unknowns” of medical care that happen in schools, which have nowhere near this amount of precautions.

The staffing agreement includes a promise that the board will hire fifty nurses a year over the next five years, increasing the number of CPS nurses by 250. While this in itself will not result in a nurse in every school every day, it brings us much closer to that goal. Prior to the strike, the board’s negotiators were refusing to put this into our contract. By insisting that CPS “put it in writing,” we now have a way to hold CPS accountable.

One of the primary arguments CPS posed against establishing the commitments to nurses was that we are a limited resource. Leaving aside the fact that private agencies somehow found 200 nurses on a daily basis, it is true that there are more nursing jobs than there are nurses. This pending contract does two things that will attract nurses to CPS: increase nurse pay and create an educational pipeline to fill the empty nursing slots.

There are about 325 CPS nurses in total: 125 are licensed practical nurses (LPNs), and 90 are health service nurses (HSNs). Both LPNs and HSNs are on a lower, non-teacher pay scale, and each are being advanced a pay grade on that scale. The new salary schedule will also reward those with associate’s and bachelor’s degrees starting next school year, bumping up pay for both classifications. Along with the 16 percent raise that all CPS staff will receive over the five-year life of the contract, these nurses will see additional significant pay raises.

The new contract will also financially reward those who become a Nationally Certified School Nurse, which a bachelor-trained nurse with a year of experience in schools can obtain by passing an exam. The approximately 110 certified school nurses (CSNs), along with occupational and physical therapists, will directly benefit from an expansion of a monthly stipend. This previously was only given to psychologists, school social workers, and speech pathologists.

To staunch the hemorrhaging of school nurses, CPS started paying tuition for HSNs who wanted to become CSNs a couple years ago. This would cost a nurse about $10,000 to do on their own. In some cases, a veteran HSN becoming a CSN would involve an involuntary pay cut — which this contract will stop from happening.

This proposed contract will set aside $2 million over the life of the contract — not just for the education of HSNs, but for LPNs who want to work their way toward becoming HSNs and then CSNs. Additionally, CPS has committed to spending half a million dollars on recruitment over the next five years, which, with the added financial incentives and educational benefits, should become an easier task.

These wins did not come easily. Nurses started meeting at CTU two years ago, when conditions markedly worsened. Last year, we expanded those discussions to include parent and health advocacy organizations. The January 2019 United Teachers Los Angeles (UTLA) strike, which won more nurses in their schools, was a major shot in the arm to CTU in our own quest to deliver better care to our students.

On the heels of their victory, CTU nurses and UTLA leaders held meetings to specifically discuss how that was accomplished. In early March, UTLA president Alex Caputo-Pearl spent the day with hundreds of CTU activists at a training centered on our contract campaign. Later that month, a virtual meeting was organized specifically for CTU nurses with a rank-and-file UTLA school nurse leader, as well as Arlene Inouye, UTLA secretary and cochair of the union’s contract bargaining team. Dozens participated in a discussion about how UTLA developed their contract demand for more nurses, worked with parents on raising that issue, organized the entire membership around it, and the exact contract language they had won. These member-to-member conversations were key elements in the overall strategy.

A nurse in every school every day was a simple demand for our unions and school communities to get behind. But it took a collective effort and an eleven-day strike to win it. We should take pride in that work — our students will be the beneficiaries of it. The lessons of determined organizing, bargaining for the common good, using the strike weapon, and inter-union solidarity need to be spread to other cities — so others can also reap the rewards.