State of School Health in Virginia Janet B. Wright, BSN, RN, NCSN School & Adolescent Health Specialist Virginia Association of School Nurses Fall Conference November 5, 2016 Virginia Beach, Virginia

Disclose Statement Planner, Presenter and Author Disclosures Janet B. Wright I disclose the absence of personal financial relationships with commercial interests relevant to this educational activity within the past 12 months.

School Health Statistics National School Nurse Data Set National Uniform School Nurse Data Set initiative Step Up and Be Counted! Joint effort by National Association of School Nurses (NASN) and the National Association of State School Nurse Consultants (NASSNC) started in 2014 Create uniform data points 2020 Goal- National systematic & robust data collection method Use data for school nurse specific research & advocacy (Bergen et al, 2015) 3 major data points are- Workforce (number of RNs, LPNs, UAPs) Health office disposition (students sent back to class, home, or EMS call) Chronic conditions: asthma, DM I & II, life-threatening allergies and seizures

NASN/NASSNC Step Up and Be Counted! Department of Education School Health Specialist position- Virginia Designated State Data Champion Virginia participation 2014/15SY, 2015/16SY Virginia survey includes- *private/parochial school nurses * medical and dental home (2015/16) data points

Step Up! Virginia Data Not mandated Non-scientific Various levels of participation Many errors (Virginia Department of Education, 2016) Uniform data set provided definitions for the data requested. Difficulty collecting the number of RN FTE’s. Attempted collection 3 times to get accurate data. This highlights the need to read all definitions. Please choose “not to report” vs. reporting differently from the definitions.

Step Up! Virginia Data Demographics Data collected at two intervals Fall 2015- Chronic condition School health staffing/workforce Spring 2016- Health office dispositions 1,814/ 1,848 schools in reporting divisions 1,276,619 enrolled students/ 1,187,108 students represented in survey (DOE, 2016) (VDOE, 2016)

School Nurse/School Health Workforce Step Up! Virginia Data School Nurse/School Health Workforce 1,284.9-FTE RN Positions providing direct care 246.3- FTE LPN Positions providing direct care 446- UAPs 26.9- RNs with special assignments 115- RN FTE’s providing administrative services (DOE, 2016) Note: FTE=Full time equivalent

Virginia Data Ratios Ratio of 1:923.8 RN only Ratio of 1:775.4 RN & LPN State School Nurse Consultant Positions (1 DOE, 1 VDH) (DOE, 2016) DOE concern for RN FTE accuracy in the reporting process.

Chronic Health Conditions Step Up! Virginia Data Chronic Health Conditions Asthma: 104,665 (101,804 ‘15) Diabetes Type 1: 3,512 (3,399 ‘15) Diabetes Type 2: 614 (578 ‘15) Seizures: 8,046 (7,561 ‘15) Allergies: 47,789 (43,717 ‘15) Note: LFA=Life-Threatening Allergies (DOE, 2016)

Step Up! Virginia Data Medical and Dental Home 200,620 students reported to have a medical home Note:(65 divisions did not collect data) 48,280 students reported to have a dental home Note:(78 divisions did not collect data) (DOE, 2016) Virginia added these data points to assist the VDH 1305 Grant that focuses on PA, nutrition, and chronic health conditions; and to assist Virginia Oral Health initiatives.

Health Office Disposition Data Step Up! Virginia Data Health Office Disposition Data 89 School Divisions reported Not able to determine the total number of students represented (DOE, 2016) So important to fully read the directions for completing & submitting the survey.

Step Up! Virginia Data Health Office Student Disposition Data Students Seen and RN LPN UAP Back to Class 1,629,323 (10 did not report) 265,592 (16 did not report) 76,720 (19 did not report) Sent Home 136,052 30,403 (15 did not report) 9,005 Referred for emergency care 49,940 (6 did not report) 158 (13 did not report) 1,181 (18 did not report) Note: 89 school divisions reported (DOE, 2016)

General Assembly 2016 HB 475- return to learn protocol for students returning to school after treatment for pediatric cancer. SB 665- middle school student athletes required to have a pre-participation physical prior to try-outs or participation. Requires each local school board to establish a Return to Learn Protocol for the gradual return to academic activities by students who have been treated for pediatric cancer that shall include provisions for accommodations, modifications, and monitoring. 1. § 1. The Department of Education (Department) shall review regulations established pursuant to the federal Individuals with Disabilities Education Act (IDEA), 20 U.S.C. § 1400 et seq., and § 504 of the federal Rehabilitation Act of 1973, 29 U.S.C. § 794, and suggest revisions to Department guidance documents on such federal regulations relating to a return to learn protocol for students who have been treated for pediatric cancer. § 22.1-271.7. Public middle school student-athletes; pre-participation physical examination. No public middle school student shall be a participant on or try out for any school athletic team or squad with a predetermined roster, regular practices, and scheduled competitions with other middle schools unless such student has submitted to the school principal a signed report from a licensed physician, a licensed nurse practitioner practicing in accordance with his practice agreement, or a licensed physician assistant acting under the supervision of a licensed physician attesting that such student has been examined, within the preceding 12 months, and found to be physically fit for athletic competition.

School Health Resources Manual Revisions Manual for Training Public School Employees in the Administration of Insulin & Glucagon-July 2015 (DOE) First Aid Flip Chart- August 2016 (VDH)  Manual for the Training of Public School Employees in the Administration of Medication-final editing in progress (DOE) Guidelines for Specialized Health Care Procedures- final editing in progress (VDH) Virginia School Health Guidelines-editing pending (VDH)

DOE Funded Opportunities 2016 CEU’s Provided to All DOE SISN Conference Participants DOE SISN Conference Longwood University DOE School Nurse Grantees to NASN2016 Conference Indianapolis, Indiana National Board for Certification of School Nurses Examination- 27 Nurse Applicants Participated 255 10 20 passed!! Congratulations!! (DOE,2016)

Recognition VDOE & VASN received the National Board for Certification of School Nurses (NBCSN) President’s Award at NASN 2016 conference for funding 56 nurses to take the NBCSN exam over the past 13 months! (DOE,2016)

VDH Funded Opportunities 2014-16 CDC 1305 Chronic Health Conditions Grant CDC 1305 Grant Year School Nurse Grant Awardees Attending NASN Annual Conference Chronic Health Condition Session Sponsored at DOE SISN Conference GY2 2014 9 NASN H.A.N.D.S. (Diabetes) Training (48 participants) GY3 2015 7 NASN SCOT (Obesity) Training (36 participants) GY4 2016 15 Asthma Training (70 participants) VDH received grant award for the CDC 1305 grant that includes 3 components: PA, nutrition and school health chronic health conditions. The school health components/performance measures focus on professional development and data collection (NASN/NASSNC SUBC survey).

NASN Updates http://www.nasn.org/RoleCareer Definition of School Nursing- School nursing, a specialized practice of public health nursing, protects and promotes student health, facilitates normal development, and advances academic success. School nurses, grounded in ethical and evidence-based practice, are the leaders that bridge health care and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that allow individuals and communities to develop their full potentials. Approved by the NASN Board of Directors June 2016. http://www.nasn.org/RoleCareer

NASN Updates NASN’s Framework for 21st Century School Nursing Practice TM Creates an overarching structure that includes concepts integral to the complex clinical specialty practice of school nursing. http://www.nasn.org/Framework

Contact Information Janet Wright, BSN, RN, NCSN School & Adolescent Health Specialist Virginia Department of Health Janet.wright@vdh.virginia.gov 804-864-7689 http://166.67.66.226/livewell/programs/schoolage/ School Health Specialist (vacancy) Virginia Department of Education http://www.doe.virginia.gov/support/health_medical/index.shtml

Thank You! “Accept my sincere thanks for your continued commitment to the school nursing profession. It is my privilege to serve alongside you.” Janet Inspiration for all school nurses- “What does it mean to be a school nurse?” https://www.youtube.com/watch?v=OF54NbWYtfQ (NASN 2015 Conference)

References Bergren, M.D., Maughan, E.D., Wolfe, L.C., Patrick, K., Watts, H.E.S., Pontius, D.J., et al (2015). What’s up with “Step up”? Step up and be counted. NASN School Nurse, 29-32. Campbell, T. (2016). 2016 School health update: Summer institute for school nursing July 10, 2016 [Power point slides]. Richmond, VA.