School Nursing

The Relentless School Nurse: How Are We Treating Our Children?

“The true character of society is revealed in how it treats its children?” – Nelson Mandela

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School nursing is filled with challenging moments, some are more emergent than others. Imagine this scenario:  A preschool student whose family is displaced, enters school with no physical exam or immunizations has a seizure at school. The student is admitted to the hospital, and upon discharge, is released with multiple referrals to specialists and diagnostic studies. The family, undocumented and homeless, has no insurance. The mother’s employer will not provide proof of income because she is paid in cash. Helping a family navigate the healthcare system with insurance is complicated enough, but without insurance or documentation, the barriers seem insurmountable.

Children are at the mercy of their family’s circumstances. No matter where you stand on the issue of immigration, caring for all of our children must be a shared value. Come with me to school, visit with my students.  Meet the little girl who was hoarding food for her family by stuffing her pants pockets with whatever was being served for lunch.  Let me introduce you to the 3-year-old boy who just books for the first time.  And these students are the lucky ones, they are not separated from their parents living in tents on our borders.

Between now and December 10th, public comments are being accepted regarding the new “public charge” rule introduced under the Trump administration.  This would profoundly change what officials consider when making determinations during immigration proceedings.  The rule proposes that applicants seeking to live in the U.S. from other countries or immigrants seeking to stay permanently should be denied rights if they rely too heavily on government subsidies and services during the period of time they are waiting for their hearings. These categories include government housing, subsidized healthcare, and Supplemental Nutrition Assistance Program (SNAP), previously known as food stamps.

Inadmissibility on Public Charge Grounds

The U.S. Department of Homeland Security (DHS) proposes to prescribe how it determines whether an alien is inadmissible to the United States under section 212(a)(4) of the Immigration and Nationality Act (INA) because he or she is likely at any time to become a public charge. Aliens who seek adjustment of status or a visa, or who are applicants for admission, must establish that they are not likely at any time to become a public charge, unless Congress has expressly exempted them from this ground of inadmissibility or has otherwise permitted them to seek a waiver of inadmissibility. Moreover, DHS proposes to require all aliens seeking an extension of stay or change of status to demonstrate that they have not received, are not currently receiving, nor are likely to receive, public benefits as defined in the proposed rule. – This Proposed Rule document was issued by the U.S. Citizenship and Immigration Services (USCIS)

Because of the proposed rules, there has been a steady downward trend in parents seeking health insurance for their children. Marginalized immigrant families, who already living in the shadows are seeking to become even less visible. Hiding in plain sight, are families that are struggling to survive in a country that has become increasingly hostile and unwelcoming.

  • The uninsurance rate for citizen children with noncitizen parents declined more than the uninsurance rate for citizen children with only US-citizen parents. 
  • The uninsurance rate fell 10 percentage points among citizen children with noncitizen parents and 3.5 percentage points among those with only citizen parents.
  • One-fifth, or 6.8 million, of the children on Medicaid or CHIP are citizens but have noncitizen parents, according to a report released on Tuesday by the Urban Institute
  • The Trump administration’s proposed “public charge” rule could discourage their parents from enrolling them in health insurance.
  • The public comment period for the new rule ends Dec. 10. – (Kenney et al. 2018)

To date, more than 132,000 public comments have been posted. You can add your voice, by clicking here: Public Comment.

We cannot remain silent when it comes to the health, welfare, and future of children. As Nelson Mandela said, “The true character of society is revealed in how it treats its children?” Our true character is being tested, let’s not fail to act on behalf of our most vulnerable population, our children.


Kenney, Genevieve M., et al. “Proposed Public Charge Rule Could Erode Health Insurance Coverage Gains among Citizen Children with Noncitizen Parents.” Urban Institute, The Urban Institute, 4 Dec. 2018,

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