SCHOOL NURSING Healthy students learn better! By: Karen Buchert R.N.,P.H.N., M.S. Licensed School Nurse Greenway Health Services

Objectives: To inform administrators, school board members and the community of current health issues and needs in the school setting To review the history of school nursing To explain the role of the Licensed School Nurse and Health Services. Review Health Office services activities

History of School Nursing Practice of school nursing began in the United States in 1902 Initial role of the School Nurse was to reduce absenteeism. The primary need involved intervening with students and families regarding health care needs related to communicable diseases. Public Health Nurses were key players- home visits, prevention efforts, direct care.

School Nurse The role has expanded from it’s original focus but the essence of school nursing remains the same. Healthy children are more successful learners. The school nurse has a multi-faceted role within the school setting, one that supports the physical, mental, emotional and social health of students and their success in the learning process. NASN 2003

National Association of School Nurses: Who is the School Nurse? Health Services Provider Health Educator Mental Health Assessor Nutrition Advocate Physical Activity Promoter Promoter of a Safe Environment Staff Health Educator

7 roles of the School Nurse Provides: 1. direct health care to students and staff 2. leadership for the provision of health services, supervises health staff New: revenue- through supervision of 3 rd party billing 3. health screenings and referrals for health conditions

School Nurse roles Promotes: 4. a healthy and safe environment for school children 5. health and wellness (through prevention, early intervention, cooperation and collaboration with school and community resources)

School Nurse roles Serves: 6. in a leadership role for health policies and programs 7. as a liaison between school personnel, family, community and health care providers

Health Services To attempt to meet student needs and manage paperwork… Most districts have:  at least one Licensed School Nurse/RN/PHN,  Health Assistants/Licensed Practical Nurses or Registered Nurses  Clerical assistance

Minnesota School Nurse License A school nurse provides pre kindergarten through grade 12 students nursing services in a school setting MN Board of Teaching (MN Dept. of Children, Families and Learning) issues school nurse licenses Requires a 4 year baccalaureate Registered Nurse License and Public Health certification

Roles: Licensed School Nurse/RN & Health Assistant/LPN RN: assessment, referrals, nursing diagonoses, set goals, plan care, implement care, delegate care to qualified others, supervise, evaluate teach, manage care, Maintain client safety, collaborate with other professionals. LPN: implement aspects of care as directed, maintain client safety, participate in the development of a plan of care and evaluating care, contribute to an assessment.

Legal Issues Individuals with Disabilities Education Act ( IDEA) -free, appropriate public education regardless of the level or severity of their disability (funds) Nursing services are a vital “related service” Section 504 of the Rehabilitation Act of requires accommodations be made for a person with a disability Nurse Practice Act- protects public health, safety and welfare

Health Issues in Schools Diabetes Asthma Seizures Bee sting or severe food allergies Students with special needs Medications administration, gastrostomy tube feedings, nebulizer treatments.

Diabetes GHS- 3 CJMS-1 VE-3 ME-0 Individual Health Plan MD orders, parent permission Monitor blood sugars, administer insulin, monitor food intake, calculate carbohydrates, respond to emergencies (administer glucagon, call 911) Informing staff

Asthma GHS-40 CJMS-45 VE&ME-34 Individual Health Plan MD orders, parent permission Monitor inhaler use, teaching Parent contacts Informing staff

Seizures GHS-4 CJMS-9 VE & ME-7 Yearly updates from parents Medications if prescribed, documentation Inform staff, in service on seizure care

Severe Allergies: Bee sting / Food Allergies /Peanut Allergy Epi-Pens – 5 currently prescribed in the district 1 ME, 3 CJMS, 1 GHS Collaborate with parent and student Individual Health Plans Inform staff Train staff Prevention of incidents- especially with peanut allergy

Students with Special Health Care Needs Work with parent/student to plan for care/needs during the school day Individual Health Plan Often 1:1 Para Includes Early Childhood Special Education students (often high need children with significant health concerns)

Health Services Activities: Health concerns lists Immunization compliance- K and 7 th Annual health updates K-12, requires lots of tracking and follow up Record keeping- information is entered into the computer, filing Communicating with teachers, school staff regarding student health needs

Day to Day Health Office Activities Student needs- emergency first aid, injury care, illness care, psychosocial issues care Medication administration and monitoring, managing students with special daily health needs- Medical procedures Parent contacts Relaying new information to teachers/staff

What do we do in Health Services… Health Screenings: Height, weight, vision and hearing screening – volunteer recruitment Scoliosis Screening Lice screening Rechecks then referrals (tracking and follow up on all screening referrals) Connect with community resources Lion’s Club, Headstart, Public Health, regional school audiologist

What do we do in Health Services… More than handing out bandaids Individual health plans written or updated- sent then the tracking and follow up begins Education-Growing up for Gr 5 Education 1:1 with students, teacher requests for classroom Third party billing

Miscellaneous Health Office Activities Sports physicals-computer entry, updating Athletic Office, coordinating Blood borne pathogen kits/training, record keeping Ordering and maintaining supplies for each school Health Office Receiving new students, sending out records on student withdrawing

LSN additional duties Child Study Meetings at each school Health assessments Open houses, conferences, kindergarten round up Student staff meetings as appropriate Supervision of health office staff Staff health promotion- flu shots

LSN additional duties Promoting Health and wellness Newsletter articles Web page for Health Services Referrals to and collaboration with outside community resources Submit Immunization Report Coordinate the Early Childhood Screening Program

Early Childhood Screening Intended for 3 and 4 year olds Purpose is to identify children with risk factors or developmental concerns. Goal is to connect and inform families of resources that are available and to promote early intervention if problems are identified. (provide interventions prior to Kindergarten entry.

Early Childhood Screening Includes: Ht, Wt, vision and hearing Developmental screening (fine and gross motor skills, cognitive, social, language and speech development) Review of health history and immunizations and other risk factors Exit interview to review all results and make recommendations

Early Childhood Screening Outreach, coordinate and collaborate Headstart, ECFE, ECSE, Public Health, Medical community, School Health Children First- (help with outreach) Referrals, tracking and follow up-TIME! 7 screenings per year, screen Year end report - district is paid $40.00 per child screened

Concerns Increasing health / mental health needs of students Many students don’t have health insurance- school health is their primary health provider Increasing number of diabetics Safety/Student needs- availability of health staff on site Funding issues-always. New equipment? ……how to be creative in seeking funding

Concerns Most 50 + years olds assume all schools have a school nurse. Licensed School Nurses are spread very thin nationally. Early Childhood Special Education population –many health issues, nursing services not readily available. Some school sites visited once per week/and on call. Emergency care training yearly for bus drivers before school start- procedures

Concerns Need hours prior to the first workshop day to complete: 1. Immunization review, tracking and follow up 2. Incorporate a bus staff in- service 3. Blood borne pathogen duties 4. Health concerns lists and Individual Health plans (Take care of safety issues related to student health needs)

Goals Continue to work on Bloodborne pathogen training, State requirements Have more staff trained in First Aid and CPR, especially special education staff. Set up yearly plan for updates and have a budget designated to support this. AED’s in buildings- Police Dept. patrol cars have AEDs

Goals: To educate or inform the community, school board members and administrators of Greenway School Health Services and student health needs. Health Services Web page (Blandin Educational Leadership personal goals)

Health is basic to the basics- A point recognized by current and past US Surgeons General: Educators need students to be: 1. Ready to learn 2. In school, in class 3. Safe 4. Socialized 5. Able to care for themselves Looking at the acquisition of learning in this manner, school nurses emerge as major contributors.

Sources National Association of School Nurses (NASN) School Nurses Of Minnesota (SNOM) Nurses Practice Act Carol Costante. Healthy Learners: The Link Between Health and student Achievement, American School Board Journal, 1/02

The End