2020 School Health Conference Q/A February 19, 2020
Staffing and Nurse Roles in the Schools • Telehealth is great but let’s think bigger. Let’s utilize our Advanced Practice Nurses in our school districts. Any thoughts on that? How would that look? Can Children’s Hospital help make that a reality in Virginia? • I will not be able to attend this meeting however my burning issue is that even with all of this information, without a bonafide nurse, a real nurse, an RN preferably, the students would not have the care that they would need in the event of any of the above mentioned conditions or occurrences. We need to get RNs in the schools to make this work. Let’s get that done before we ask someone who is labeled as a "school nurse" and is not, to do any kind of assessment. I appreciate your training but first things first. Let’s get trained nurses in the schools and make it a requirement.
School physician and School nurse • Recommendations from the AAP Council on School Health is for every school system have a school physician and that each school have registered professional school nurse. “Promoting the presence of a qualified school nurse in every school and a school physician in every district fosters the close interdependent relationship between health and education. Academic achievement, improved attendance, and better graduation rates can be a direct result of a coordinated team effort among the medical, family, and educational homes all recognizing that good health and strong education cannot be separated.” From School Health: Policy and Practice, 7 th edition
School School Nur Nurse ‐ Ke Key Ro Roles • Clinicians/care coordination • Leaders • Advocates • Health Promoters • Educators • Policy Makers • Community Liaisons From School Health: Policy and Practice, 7 th edition
Role of the School Nurse • Facilitate normal development and positive student response to interventions • Providing leadership in promoting student health and safety, including healthy environment https://www.nasn.org/nasn/advocacy/professional ‐ practice ‐ documents/position ‐ statements/ps ‐ role • Provide quality health care and with actual and potential health problems • Use clinical judgement in providing case management, self ‐ advocacy, and learning • Actively collaborate with others to build student and family capacity for adaption, self ‐ services https://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNpositionstatementsFullView/tabid/462/ArticleID/87/Role ‐ of ‐ the ‐ School ‐ Nurse ‐ Revised ‐ 2011
Role of the School Nurse • School nurses lead in the development of policies, programs, and procedures for the provision of school health services at an individual or district level, relying on student ‐ centered, evidence ‐ based practice and performance data to inform care • the school nurse leads in delivery of care that preserves and protects student and family autonomy, dignity, privacy, and other rights sensitive to diversity in the school setting • As an advocate for the individual student, the school nurse provides skills and education that encourage self ‐ empowerment, problem solving, effective communication, and collaboration with others • At the policy development and implementation level, school nurses provide system ‐ level leadership and act as change agents, promoting education and healthcare reform. • School nurses employ cultural competency in delivering effective care in culturally diverse communities • The school nurse strives to promote health equity, assisting students and families in connecting with healthcare services, financial resources, shelter, food, and health promotion. • School nurses are members of two divergent communities (educational and medical/nursing), and as such are able to communicate fluently and actively collaborate with practitioners from both fields (Wolfe, 2013). As a case manager, the school nurse coordinates student health care between the medical home, family, and school. • School nurses deliver quality health care and nursing intervention for actual and potential health problems. • Continuous quality improvement is the nursing process in action: assessment, identification of the issue, development of a plan of action, implementation of the plan, and evaluation of the outcome. https://www.nasn.org/nasn/advocacy/professional ‐ practice ‐ documents/position ‐ statements/ps ‐ role
Critical Knowledge Base for School Physicians ADA, Americans With Disabilities Act; FERPA, Family Education Rights and Privacy Act; HIPAA, Health Insurance Portability and Accountability Act; IDEA, Individuals With Disabilities Act. ↵ a Unless there is a separate team physician Infectious diseases (eg, outbreak control) Sports medicine Emergency preparedness (eg, children with special health care needs) Public health (eg, risk assessment and The value of physical management, resources) education and physical Environmental and occupational health (eg, indoor activity at school air quality) Immunizations (eg, school requirements and medical contraindications) Injury prevention Health and learning (eg, medical, emotional, attentional, and learning problems that affect Medical ‐ legal issues Conditioning learning) State and district school and public Disqualifying conditions Social services resources (eg, access to health health laws, regulations, and policies Hydration insurance and assistance programs) IDEA, Section 504, and ADA The effects of climate A coordinated school health model (eg, health extremes on athletes FERPA and HIPAA and how they intersect services, health education, healthy and safe in the school setting environment, physical education and activity, Concussion management nutrition services, counseling/psychology/social Adolescent health (eg, brain development Adaptive physical services, staff health promotion and and reproductive health) education family/community involvement)
Roles for School Physicians Anaphylaxis management Asthma education and management Mandated Services Assist in the management of specific medical emergencies or immediacies Physical exams (grade mandated, special education, work permits, sports participation) Participate at the building level in comprehensive, multidisciplinary teams and wellness councils Oversight of return to sports (eg, concussion management programs) Programmatic leadership Health program evaluation and quality improvement Active member on teams/committees (eg, special education, wellness, health education) Health education Consultation Mental health promotion programs Write standing nursing orders/protocols Nutrition and food services Athletic advisor/team physician Physical activity and education Staff wellness Oversee health aspects of athletic programs and best practice standards Family and community education Infectious diseases esp. for close contact sports Liaison with primary care physicians regarding specific concerns Participation of athletes with serious medical conditions Professional performance development Evaluation and collaborative oversight of nursing staff and other health service Adaptive physical education for acutely injured or chronically disabled youngsters providers, including one ‐ on ‐ one nurses and door ‐ to ‐ door transportation Mixed gender competition Develop policies Reviews of emergency care plans for children with life ‐ threatening conditions. Contagious diseases/pandemics Classroom observations of children with special needs Restraint, suspension, expulsion Health education curriculum development Bullying Direct consultation with principals or the superintendent Reproductive health Medical ‐ legal issues Chronic school absenteeism Parent attorneys or advocates in accommodation disputes and hearings Develop protocols Building and playground health and safety Delivery of medications Bloodborne pathogen incidents Seizure management School closure related to illness or weather extremes, or infections that affect public Diabetes care health
Advanced Practice Nurses in Schools • Yes it is possible and is happening in some dedicated School ‐ Based Health Clinics • Similar issues to physicians in schools • Cost/Economics • Liability • Legal arrangements
Asthma Questions • If a student comes to the clinic requesting his inhaler, and my assessment shows everything normal/good, I still give the student a dose of his inhaler. Is this correct? Yes immediately but if this is happening recurrently may need to check in with his clinician, consider use of peak flow meter to document • Asthma inhalers ‐ Some kids parents want the child to take the inhaler every day. I notice with some kids they have less visits to the ER when given every day. Is this safe for the kids body. Use of daily controller inhaler is safe and assists with keeping child in school, out of hospital, and out of ER ‐ better quality of life
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