1. Janice Selekman DNSc, RN, NCSN, FNASN Professor University of Delaware
Helping West Virginia Support the Need for a School Nurse in Every School
Janice Selekman DNSc, RN, NCSN, FNASN
Professor
University of Delaware

2. Data: Teen Pregnancy and Births
National
West Virginia
1991: Pregnant
116/1000 females 15-19
2011: Pregnant
52/1000
1991: Teen births
61.8/1000 females 15-19
2016: Teen births
26.4/1000 females 15-19
1991: 57 births/1000
2011: Pregnant
63/1000 females 15-19
2016: Teen births
39.6/1000 females 15-19
17% = repeat births

3. WV decreased the # of births to teen mothers by 9.9% from 2012-2013
Starting in 2001 West Virginia has been higher than the national average in teen births (having been below the average until that time)
WV decreased the # of births to teen mothers by 9.9% from
BUT pregnancy rate is still 50% higher is WV compared to year old women in US
In the WV 2016 report, the youngest father was 14; the youngest mother was 13
[oldest mother = 47; oldest father = 74]
Your 2014 state data said you had improved significantly in
Decreasing child and teen deaths
Enrolling 4-year olds in pre K
Decreasing the number of high school dropouts

4. Data: Overweight and Obesity
1980 vs US
West Virginia
1980: obese
7% 6-11 years
5% years
2012: obese
18% 6-11 years
21% years
2015
17.9% teens obese
12.2% females and 23.4% males
17% teens overweight

5. Youth Risk Behavior Survey 2014
National (% 15-18)
West Virginia (% 15-18)
Did not go to school because felt unsafe
5.6
8.9
Carried a weapon on school property
4.1
6.5
Ever smoked
32.3 #1
Smoked before age 13
6.6 #2
Drank alcohol before age 13
17.2
18.4
Currently use marijuana
21.7
16.5
Ever had intercourse
41.2 #3
Had intercourse before age 13
3.9
5.1
Currently sexually active
30.1
35.5
No pregnancy prevention used
13.8 12

6. Areas for improvement National West Virginia
Were electronically bullied
15.5 #2
Were bullied on school property
20.2
24.4

7. Where is the data on school nurses?
How many of you have saved a life?
How many of you have identified a child/staff who needed immediate attention/diagnosis

8. Characteristics of a Profession
1. Provides essential services
2. Possesses a body of specialized knowledge and skills needed to practice the profession, NORMALLY NOT POSSESSED BY THE NONPROFESSIONAL

9. Characteristics of a Profession
3. Requires a specified period of specialized education 4. Has a professional association that regulates the work of the profession and has an ethical code of conduct 5. Members are involved in decision making in the service of clients

10. Characteristics of a Profession
6. Strong service motivation and commitment to competence 7. Committed to quality comprehensive care, safety and interdisciplinary collaboration

11. Characteristics of a Profession
8. Serves as role models and mentors
Presenting/ teaching
Publishing
“What the staff nurse and APN can learn from the school nurse and what we need from you”
9. High level of public trust, based on profession’s demonstrated capacity to provide service markedly beyond that which would otherwise be available

12. Characteristics of a Profession
10. Accepts responsibility and is accountable to society
Demonstrate efficacy
CONTINUOUS EVALUATION OF THE EFFECTIVENESS OF YOUR PRACTICE
This is different from competence
OUTCOMES!!!!!!

13. Data collection by State School Nurse Consultants: 2014
32 states collect information on 855 data points
Range = 3 (Michigan) to 297 (Pennsylvania) data points (WV = 171)
Info on number of RNs
Children with chronic health conditions
Health screenings

14. West Virginia 2 questions on school demographics
66 questions about staff (education, certification, non-RN staff, supervision, health care to staff, health care to visitors, and all the community teams on which you participate)
103 questions on students (numbers screened and actions taken, first aid and acute problems, nursing procedures done, medications given and the routes of administration, mental health and other chronic conditions addressed, and healthcare plans)

15. You have a tremendous amount of data in this state
WHO SEES IT?
WHO ANALYZES IT?
WHAT ACTIONS ARE TAKEN BECAUSE OF IT?
WHAT OUTCOME MEASURES DO YOU HAVE?
HOW CAN YOU DEMONSTRATE THE DIFFERENCE THAT YOU MADE?

16. We must be able to show that WE made a difference
We MUST go beyond the number of children we see
And the number of tasks that we do
We must be able to show that WE made a difference

17. Where are the outcomes?
For weight, vision, hearing, posture, BP and dental
Number screened and referred
Number receiving treatment
AND THEN WHAT?????
WHAT IS IMPACT ON ACADEMIC PERFORMANCE?

18. Outcomes Component of the end result of the nursing process
Demonstrates effectiveness of the nursing interventions
Measureable
Reflect the nursing goals
A form of accountability
Reflects the quality of care

19. Definition of School Nursing (NASN, 2010)
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. (NASN, 2016)

20. North Carolina Outcomes
For life-threatening allergies, Type 1 Diabetes, obesity, seizure disorder, and asthma
Student can verbalize accurate knowledge of condition
Student has improved grades
Student has decreased absences
Recognize and avoid allergic, asthma, or seizure triggers
Identify appropriate portion sizes; improve food choices
Demonstrate skill in administering epinephrine, using inhalers/spacers, counting carbs, testing blood sugars, and calculating and delivering insulin
Increasing physical activity
Reducing episodes of allergy or seizures
Remaining within peak flow goals; improving HgA1c or BMI
Reducing side effect of medications and avoiding complications of seizure activity

21. Possible outcomes Children who got glasses and their grades improved
# teens who return to school after delivery
# pregnant teens who stay in school
Increasing attendance rates of children with chronic conditions
$ brought into the school (or in-kind services)
Letters of satisfaction from parents and staff
# hours/week you are paid to be in your car driving from 1 school to another

22. Unique questions
“What is #1 health issue that consumed a large amount of time and resources?”
“List the 3 most common reasons individual health counseling is provided”

23. How can West Virginia school nurses USE these data?
Let me tell you the difference I make in the lives of children!

24. Does the HIPAA Privacy Rule allow a healthcare provider to disclose protected health information (PHI) about a student to a school nurse?
Answer:
Yes.  The HIPAA Privacy Rule allows covered health care providers to disclose PHI about students to school nurses, physicians, or other health care providers for treatment purposes, without the authorization of the student or student’s parent.  For example, a student’s primary care physician may discuss the student’s medication and other health care needs with a school nurse who will administer the student’s medication and provide care to the student while the student is at school. In addition, a covered health care provider may disclose proof of a student's immunizations directly to a school nurse or other person designated by the school to receive immunization records if the school is required by State or other law to have such proof prior to admitting the student, and a parent, guardian, or other person acting in loco parentis has agreed to the disclosure.  See 45 CFR (b)(1)(vi). Updated 09/19/13

26. The most important component of your job…is the child

27. So, are you done? NO! Your challenge - Where are the data?
Show the nation why they need highly educated school nurses
Get outcomes
Put them on your website
Publish them in journals, but especially in local newspapers
Brag to your principal and school board
Let’s show them the differences that school nurses can make in the lives of children

28. Ask questions, get a team, make a plan Act
Identify the problem
Decide what data needs to be collected to document that you have a problem
Ask questions, get a team, make a plan
Act
And then measure your results (outcomes)
AND THEN SPREAD THE WORD