1. School Nurse Bill

2. Organized Groups Pro National Association of School Nurses (NASN) CDC Healthy People 2020 American Nurses Association American Academy of Pediatrics American Dental Association American Lung Association Food Allergy and Anaphylaxis Network

3. PRO NASN believes  every child deserves a school nurse, every school day.  NASN recommends ratio based on student health needs. Healthy People 2020 objective  student-to-school nurse ratio of 1:750 well students  Baseline in 2006 was 40.6%  Target improvement 44.7% with 10% improvement.

4. PRO CDC: Reported  8.9% of children in 2008 without health insurance  1,300,000 homeless children in U.S.  Schools have become the only source of health care for many children and adolescents.  Communicable and infections diseases account for millions of school days lost each year  Students with health problem attended by school nurse were able to return to class 95% of time.  School nurses have a positive impact on immunization rates.  Using a formula based approach offers a reasonable means for achieving better student outcome.

5. PRO American Academy of Pediatrics: Students today face increase social issues as well as the need for preventative services and interventions for acute and chronic health issues. American Nurses Association: When there is no nurse on the school premises, the responsibility to administer the necessary medication and treatments falls on administrators, educators and staff that are ill-prepared to perform these tasks. Statistics from the National Center for Educational Statistics indicate that of the 52,000,000 children who currently spend their day in schools, 16% have chronic physical, emotional, or other health problems.

6. PRO American Lung Association:  Severe asthma is one of the greatest threats to student health  Affects 1 in 10 students  About 2 students in every classroom  According to CDC, students in the US lost approx. 14.7 million school days to asthma.  More school nurses might help keep those students in the class room.

7. Organized Group Con School districts facing economic constraints Many states do not follow the Federally recommended nurse-to student ratio which is 1:750 students in the general school population 1:225 students in the mainstreamed population School Administrators do not want to lose one of their teachers. Losing the school nurses verses losing a teacher. Difficult choice!

8. Problem School nurses lack of documentation of the benefits or outcomes of school nursing services. Leads to efforts going unrecognized & undervalued. School nurses must educate school administrators, teachers, and parents about the services they provide and the positive impact they have on children. Need evidence that full-time school nurses are needed in schools so that health needs of students can be met.

9. Evidence For example a study done in 2004, investigating difference between student access to full-time and part-time school nurses found that, a full time nurse might attend to 74 visits related to asthma compared to a part-time nurse who might attend to only 6.4 visits per 100 students enrolled in the school. (Telljohann, 2004).

10. Economic Impact http://www.youtube.com/watch?v=tUH9Cjos6wM School nurses make approximately $ 40,000 to $ 60,000 nationwide. May be different depending on the geographic location. According to the Health Resources and Service Administration (HRSA), there were 73,697 RNs working as school nurses in 2010. There is no shortage of school nurses. There is a shortage of funded school nurse positions!!! If every state follows the federal guideline for student- to-school nurse ratio, more local school district and state budget will be spent on salaries.

11. Economic Impact If more budget is utilized to fund school nurse positions then probably some other area suffers- may be one less teacher or a physical education personnel, arts, music…. School districts reduce funding for school nurses to help close a state deficit While the funding for school nurses decline the need stays the same or grows.

12. Related Policies S 2047: Student-to-school nurse ratio improvement act of 2012 introduced on 1-30- 2012. HR 2730 HR 2750 Similar bill in 2009 Senator Charles Schumer proposed a companion bill in the Senate. Neither bills came out of committee.

13. National Law Mandates IDEA (Individuals with Disabilities Education Act) of 1975. Americans with Disabilities Act of 1990. Rehabilitation Act of 1973  Although these laws require school districts to provide services to students with special needs, they do not mandate that such services be provided by school nurses.  School districts therefore are not obliged to hire school nurses. Instead they may hire unlicensed assistive personnel.

14. Legal and Ethical Concerns Compromising child safety- life threatening situations and even death in some instances. According to ANA- mistakes are more than three times as likely to occur Growing number of chronic illnesses Nurses cover multiple schools and may not be available when a child is in distress May develop into something more serious while waiting for the school nurse to arrive. Depending on secretaries, non-medical personnel, teachers or principal to administer medications and treatments. Non-medical personnel not qualified to handle emergencies, food allergies, medication allergies etc. U.S supreme court ruling requires public school district to provide medical care for students with disabilities including handling devices such as tracheostomy tubes, ventilators, and feeding pumps- requires trained personnel to handle…

15. Ethical Concerns Every day 3.5 million school children take medication at school. The includes 200 types of prescription drugs about 3 times the number taken in the late 1980’s The number of children allergic to peanuts and tree nuts has doubled since 1997. HIPPA regulations. STDs, TEEN pregnancies, Sexual behavior Reporting specific communicable diseases as required by state laws Student demands not to share information, protect privacy & confidentiality DNR orders for children attending schools with chronic condition such as kidney failure, cardiac issues etc. IDEA and ADA mandates to include ill students in regular schools More school nurses might help keep those students in the classroom. If we cannot afford school nurses we’ve got our priorities skewed! It is like not putting in a traffic light until there is a serious accident. Girl in Tacoma died in school because of peanut allergy and acute asthma attack – school nurse wasn’t there school staff failed to deliver a shot of epinephrine. Result – Death of a child in school.

16. Ethical Framework The Utilitarian Approach

17. Ethical Framework Conceived in the 19 th century By Jeremy Bentham and John S. Mill Help legislators determine which laws were morally best Ethical actions are those that provide the greatest good for the greatest number  Limitations  Assumes that one can measure harm and benefit  Conflict with traditional nursing goals of individual patient advocacy

18. Impact on Healthcare and Nursing Decreasing the student-to-school nurse ratio will help  Effective/efficient management of chronic illnesses  Effective/timely management of emergencies  Increasing attendance  Improved attendance = academic success  Keeps students at school and parents at work  Allows teachers to teach instead of providing healthcare to children  Reducing the number of 911 calls  School nurses may be the only health provider a child sees (ANA, 2005).

19. Impact on Healthcare Currently, more than 50% of public schools in the US do not have a full time RN. Wide ration disparities exist from state to state, within states and school districts, and between urban and rural schools. Students today have increasingly complex needs for nursing care. School nurses facilitate learning for all students, especially those with asthma, food allergies, obesity, vision and hearing difficulties, dental problems, mental and behavioral problems, and those who need prescribed medicine for either acute or chronic conditions. With 98% of school-age children in the US spending their days at school, the role of the school nurse is critical to the implementation of quality school health services. For many children, contact with a school nurse is often the only consistent access to a health care professional.

20. Nursing School nurses will be able to provide better care to their student patients Be available in the school building when needed Administer medications and vaccines Reduce medication errors Assess health status and make referrals Prepare for disaster Provide health counseling and wellness programs Foster healthy habits among school children School nurse is seen as less of a threat that educators and other school personnel

21. How many school nurses are needed NASN recommends  1:750 for well students  1: 225 for students who require daily professional school nursing services  1: 125 for student population with complex health needs  1:1 for students with multiple disabilities

22. Where do we stand As of August 2011  34 states failed to meet a minimum standards  16 states and District of Columbia met the recommendations  Vermont topped the list with 1:396 students  Michigan bottom of the list 1:4411 students  Ohio ranked 32 nd with 1:1,328

23. How to achieve the target States require funding Bill HR 2229 (2011) introduced by Carolyn McCarthy to make demonstration grants to eligible local educational agencies for the purpose of reducing the student-to-school nurse ratio in public elementary and secondary schools Student-to-Student Nurse Ratio Improvement Act of 2011 is currently in committee.

24. http://www.youtube.com/watch?v=_Mf0tVnG fqY&feature=fvwrel http://www.youtube.com/watch?v=_Mf0tVnG fqY&feature=fvwrel