FOUR YEARS AGO, a Philadelphia school nurse literally breathed life into the lungs of a child in respiratory and cardiac distress. She compressed her chest until medics arrived to take over. The child recovered at CHOP and went on to have a successful heart transplant. The front page story on Christmas Day told of the greatest gift her parents would ever receive - their little girl discharged with a brand new heart.

That same week, 50 school nurses were laid off. By year's end the district was operating 100 nurses short. A model school health program, emulated nationally, has been limping along since then with nurses trying to serve as many as seven schools and 1,500 students each. Schools already trying to function with skeleton staffs under the district's "Doomsday Budget" saw nurses only one or two days a week.

Parents and students have been left wondering what it will take for the district's administration to make this issue a priority and return to the standards we successfully maintained up until a few years ago?

The services of Philadelphia certified school nurses to the school community are once again in danger, but this time the cuts may be permanent. In a move that is disturbingly familiar, the district is planning to outsource the positions of certified school nurses.

At a January SRC meeting, Superintendent William Hite invited a number of health-service companies to present "other models" in order to explain how they could provide services without costing the district more money.

Karen Lynch, Hite's director of student services, said that the current school health services could be phased out, and the "proposal request clearly lays it out as a possibility." She added that the incentive for providers was to make money by billing Medicaid for services provided to children while in school. Nurses, including me, who attended that meeting and listened to what seemed like infomercials for these companies, came away with an awareness that these providers lack an understanding of the essential mission of the school nurse.

I can safely say, on behalf of my colleagues, that we beg to differ with the idea that there could be any opportunity for "enhancement" of medical services to students with any outsourced model. We know, after years of experience, that having a full-time certified school nurse in each public school is the standard our children deserve. Hawking this proposal for a drastic and disruptive overhaul as a win for children neglects the fact that it would eliminate 183 nurses who have an average of 20 years with the district. Those experienced nurses know that without the knowledge of families and the relationships built over the years with students, parents and the faculties, the administration's model is doomed to fail.

Certified school nurses are vitally important to supporting a child's education in the least restrictive environment. Our duties are less clinical in nature than those potential providers appear to believe. Very few student visits to the nurse's office result in billable services, and students should not be removed from class so that providers can find new and unnecessary ways to provide a billable service. A school nurse's job, as part of the educational team of the school, is to assess and to return the child to class whenever possible. Surely Hite understands that we need highly qualified nurses just as much as highly qualified teachers.

The district's nurses are willing to continue our fight to advocate for the kind of schools our children deserve. We will continue to breathe life into our students and our schools.

Eileen Duffey has been a certified school nurse for 20 years.