School Nurse Bill

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

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.

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.

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.

PRO

• American Lung Association:Severe asthma is one of the greatest threats to

student healthAffects 1 in 10 studentsAbout 2 students in every classroomAccording 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.

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!

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.

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).

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.

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.

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.

National Law Mandates• IDEA (Individuals with Disabilities Education Act) of

1975.• Americans with Disabilities Act of 1990.• Rehabilitation Act of 1973Although 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.

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…

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.

Ethical Framework

The Utilitarian Approach

Ethical Framework• Conceived in the 19th 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 numberLimitations Assumes that one can measure harm and benefit Conflict with traditional nursing goals of individual patient

advocacy

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).

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.

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

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

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 32nd with 1:1,328

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.

• http://www.youtube.com/watch?v=_Mf0tVnGfqY&feature=fvwrel